過敏性鼻炎
楊惟婷
台灣地區6歲至12歲的學齡兒童，高達3成有過敏性鼻炎。由於接觸到塵蟎、二手菸等過敏源，就開始流鼻水或打噴嚏。加上近年來空氣中PM2.5（空氣懸浮微粒）濃度時常破表，更讓鼻子過敏與眼睛癢的症狀加重，雖不至於馬上造成生命危險，卻讓很多人鼻塞更嚴重，必須成天張口呼吸、上課上班注意力不集中、若未妥善治療，恐會造成睡眠品質低落，甚至產生慢性鼻竇炎、中耳炎、腺樣體肥大，嗅覺受損和氣喘等後遺症。
尤其在冷暖交替變化快速的春季，對於有過敏性鼻炎的人來說，真的是很難熬的，典型的症狀包括打噴嚏、鼻塞、流鼻水，也常有眼睛癢、揉眼睛的不適情形。
一、什麼是過敏性鼻炎？
「鼻炎」是鼻腔內黏膜因發炎反應形成的紅腫現象，患者常會有鼻塞、鼻子癢、流鼻水、喉嚨癢，甚至引起咳嗽等不適的症狀。
正常人的鼻子有呼吸、暖化空氣及過濾空氣的功能，會分泌一種薄薄、無色透明的液體，稱為「黏液」，它的功能有潤濕鼻腔「黏膜」，使鼻腔能阻擋吸氣時由環境空氣中進入鼻腔的微小顆粒，如塵埃、黴菌、細菌或病毒，花粉等，避免這些異物進入到肺臟中造成感染或傷害。
通常黏液會帶著這些異物隨黏膜纖毛的運動往下流到咽喉處，而隨者吞嚥動作吞入胃中，這就是一般所謂的「鼻涕倒流」，是一種正常的生理現象，而不是病態的症狀。而這些外來物量並不多，不會對身體產生傷害，一般也不會有所感覺。
而鼻內黏膜一旦過敏發炎時，鼻子會分泌更多的黏液，此時黏液會因如病毒或細菌的感染，會變成黃膿而混濁，當這種感染發炎的黏液會流入喉嚨產生咳嗽，也會由前鼻口流出體外。
二、過敏性鼻炎的成因
鼻子是人體呼吸道的入口，具備呼吸、感覺及免疫器官的功能。當我們吸入的過敏原與體內的特異性 IgE（免疫球蛋白 E）抗體結合，就可能會引發身體的免疫反應，屬於身體免疫細胞之一的肥大細胞釋放出組織胺等炎症物質，導致鼻黏膜發炎的狀態，就稱為過敏性鼻炎。
而過敏性鼻炎２大成因如下：
1、遺傳體質
林口長庚醫院耳鼻喉部部長李達人醫師曾撰文表示，根據統計，父母其中之一有過敏性鼻炎，其子女罹患的機率約 30%；如果父母都有過敏性鼻炎，子女罹患的機率更高達 50∼75%。
2、接觸過敏原
通常，許許多多塵蟎、空氣中PM2.5（空氣懸浮微粒）、二手菸…等過敏源，隨著呼吸進入了鼻腔，會刺激鼻腔內黏膜，身體會釋放一些物質來反應，使鼻腔黏膜產生一連串複雜的發炎反應，其中最主要是「組織胺」的釋放及發炎的症狀，如眼睛癢，打噴涕，流鼻水等。
而引起過敏性鼻炎過敏反應的「過敏原」，可簡單分為：
（1）環境過敏原：
塵蟎、蟑螂、黴菌、家中灰塵、動物皮毛、PM2.5空氣污染物質、異常的氣味（如香水或或化學物質）、香菸、花粉等，其中塵蟎幾乎占 90%。尤其台灣屬於海島型國家，濕度較高，容易使環境孳生黴菌、塵蟎等，加重發作情形。
（2）季節性過敏原：有些人只會在特定的某些時段發病，如百花盛開花粉飛揚的春季，每年 12 月至隔年 5 月的沙塵暴來襲期間，春秋兩季溫度劇烈變化的時期。
（3）易致敏食物：花生、蛋、牛奶、螃蟹、小麥等，中醫觀點則認為寒涼、生冷食物、冰品冷飲、刺激性食物會直接傷害鼻黏膜。
引起過敏性鼻炎的根本原因是由於「監控環境的自律神經太過敏感、失調，而導致對過敏原反應過度」。
由於鼻子和氣管的神經會監控外界環境變化，正常人碰到過低的溫度、病毒及毒氣等有害物質，會透過鼻塞減少吸入肺部，還會透過流鼻涕和打噴嚏去除有害物質。但是有過敏的人，他的神經監控異常，對沒有很低的溫度和無毒的塵蹣花粉等產生太激烈的反應。
最近國外醫學研究證實，過敏性鼻炎的兒童確實也有自律神經失調的情形，其特徵是副交感神經過度興奮，造成鼻黏膜腫脹而造成鼻塞、流鼻水、打噴嚏等過度反應的症狀。
久而久之，靜脈鬱積而血液回堵在眼睛周圍，造成眼袋血液循環不良，甚至黑色素沉澱，因此形成明顯的貓熊眼。而交感神經反應過低，更容易誘發鼻腔發炎反應。加上鼻淚管上下相通，過敏性鼻炎患者通常也有過敏性結膜炎，眼睛會癢。
羅馬大學研究也發現，過敏性鼻炎患者血液中淋巴球的副交感神經接受器的表現也比健康者高出許多。因此，自律神經在保護鼻腔功能上扮演重要的角色，它影響黏膜分泌、血管張力、微血管通透性，和活化上呼吸道黏膜的發炎細胞。鼻腔和鼻竇的完善功能就是依靠「自律神經」的神經傳導物質：腎上腺素，乙醯膽鹼和感覺神經三者之間的微妙平衡。
因此，過敏性鼻炎是「鼻子的自律神經失調」的一種表現，所以，只要透過調節體表自律神經反射的途徑，來恢復自律神經活性的平衡，就能改善上呼吸道的血液循環與免疫功能，同時採用整合性的輔助療法將已被過度活化的免疫系統一併做改善。這種治療不需要吃藥打針，也沒有藥物可以從過敏的源頭發揮根本治療的效果。
尤其，吃藥治療只能控制過敏性鼻炎症狀，無法治療造成症狀的源頭—-「鼻子的自律神經失調」。所以，如果不治療有問題的神經反應，只治療過敏的症狀，是無法斷根。
三、過敏性鼻炎的解迷
Q：為何會得到過敏性鼻炎？
A：過敏與遺傳、經濟水平及環境都有關。
1、父母中只要一位有過敏，約有三分之一的機會，會生出過敏兒；若父母都有過敏，則會提高到三分之二，且若第一胎生出過敏兒，第二胎還是過敏兒的機率，高達百分之百。
若是有過敏家族史，早上起床時，特別容易打噴嚏、鼻塞、流鼻水，常合併有眼睛結膜炎的症狀，加上過敏性鼻炎的小朋友，因鼻黏膜腫脹，會造成下眼瞼的靜脈迴流不正常，因此下眼瞼常會看起來黑黑、腫腫的，像是黑眼圈，有經驗的醫師，很容易對過敏性鼻炎，作出正確的診斷。
2、過敏與經濟水平也有關係，當經濟水平越高，患有過敏症的比例也越高，推測與家庭經濟環境好，家中裝潢多，致過敏原變多有正相關。
3、而家庭的衛生環境好，也會讓過敏的機率增加，這是因為人體的免疫系統，分為對抗病毒侵襲的第一型T細胞，跟造成過敏病的第二型T細胞，兩者的強弱有如陰陽，當第一型T細胞強時，第二型T細胞就會弱，當第一型T細胞弱時，第二型的T細胞就會強。
現代人的家庭衛生環境好，存在環境中的病毒等感染病源變少，對抗病毒侵襲的第一型T細胞自然會比較弱，使得造成過敏病的第二型T細胞變強，過敏性疾病，如過敏性鼻炎，也就會增加了。
Q：如何避免過敏性鼻炎發作？
A：在這個季節冷熱交替，容易發生「過敏」的關鍵時刻，建議早上一醒來，離開棉被前，至少先戴上厚的棉布口罩保暖五分鐘，避免鼻腔直接吸入冷空氣，喝一杯溫開水再起床。
也得隨時注意氣象預報，若預知冷鋒過境、空氣品質差，就盡量避免出外活動；出門上班上學，則建議要戴上口罩，以降低吸入冷空氣或髒空氣的機會，可降低呼吸道的不適症狀。
Q：過敏性鼻炎如何治療？
A：過敏性鼻炎多會作抽血檢查，主要目的是為知道有哪些「過敏原」會導致鼻黏膜發炎。
在台灣最常見的呼吸道「過敏原」，就是塵蟎，要想改善，建議盡量避免鋪地毯、勿使用窗簾，控制家中相對溼度在50％到60％，可有效降低塵蟎量，減少過敏性鼻炎的發作。
在藥物治療上，分兩大類：
一是抗組織胺，可減少流鼻水、流鼻涕、鼻子癢與眼睛癢症狀；
二是類固醇噴劑，具抗發炎、降低鼻塞等效果。
若鼻塞很嚴重，才能在醫囑下，暫時使用血管收縮劑，但不宜長期使用，以免血管越來越難收縮，鼻塞越來越嚴重。
局部使用的類固醇噴劑，劑量低、安全高，雖偶有流鼻血的副作用，但對於降低鼻黏膜發炎、鼻塞，甚至可能引發的鼻竇炎、中耳炎、中耳積水與腺樣體肥大等，都有相當幫助。
Q：父母親要如何知道過敏兒是否引發鼻竇炎、中耳炎、中耳積水或腺樣體肥大？
A：
1、鼻竇炎，可能有黃鼻涕，也可能只是鼻塞、鼻涕倒流，或臉頰痛、前額痛；
2、中耳炎會很痛，不難判斷；
3、中耳積水，則會影響到聽力，小朋友可能會覺得耳朵悶悶的、聽不見大人叫他、或看電視會越來越大聲。
4、腺樣體是鼻咽部中的淋巴組織，受過敏性鼻炎影響，常會因此腫大並壓迫到耳咽管，症狀除會導致鼻塞、鼻涕倒流外，常見的還有睡覺時張口呼吸、打鼾與夜咳等症狀；若是腺樣體太肥大，還可能導致阻塞性的呼吸中止症，讓孩子在睡夢中，暫時停止呼吸、血氧下滑。
當孩子出現以上症狀的時候，建議要盡速就醫，以作進一步的診斷及治療。
Q：當孩子有過敏問題時，父母常會問要不要吃益生菌、喝羊奶抗過敏？
A：事實上，益生菌、羊奶，在治療過敏性鼻炎等呼吸道的過敏上，還未有足夠研究或證據顯示有療效。
如果有過敏家族史，建議可哺育母奶至少六個月到一歲，可將寶寶得過敏疾病的機率從40％，降低到16％。
台灣最常見的過敏原塵蟎，最愛躲在寢具、厚窗簾裡及地毯、床底下，建議家裡盡量不要使用厚窗簾及地毯。
在季節交替，寢具換季前，一定要先洗棉被、曬棉被，以免累積在棉被上的塵蟎，一蓋到身上，就造成過敏性鼻炎的發作，也由於躲在床底下的塵蟎，很難打掃乾淨，建議可使用除溼機，將家中的相對溼度降低到60％以下，創造不利塵蟎生存的環境，會比買高貴的空氣濾清器或吸塵器更實際效益。
此外，香菸易誘發呼吸道的過敏反應，家有過敏兒的家長，不應在家抽菸，以免讓孩子吸到二手菸。
四、認識過敏三兄弟
一般的過敏疾病，最常見的主要分為過敏性鼻炎、氣喘和異位性皮膚炎。
◎過敏性鼻炎
原因：
過敏性鼻炎屬於第一型過敏反應，上呼吸道的鼻腔黏膜吸入過敏原造成發炎，也是慢性病的一種，症狀會反覆發作，過敏性鼻炎症狀的發生是因為當接觸到過敏原時，體內會釋放出肥大細胞，細胞會跟IgE（免疫球蛋白 E）抗體結合，隨後肥大細胞就會釋放出組織胺，組織胺會使鼻管腫脹、鼻內黏膜分泌物增加、微血管增生，甚至息肉生成，所以也可能會導致鼻竇炎；夜晚接觸寢具時就會加重發作，甚至會有睡眠窒息症的危險。
學童盛行率：約5成
症狀：
早上起床或接觸過敏原時，會流鼻水、打噴嚏、鼻塞與眼睛紅癢與溢淚、眼睛周圍腫脹。從鼻腔流出的液體通常是清澈的。
症狀通常會在接觸過敏原後的幾分鐘後產生，而且會影響睡眠、工作能力以及在學學生的注意力，因為花粉而有病徵的患者，大概都集中在一年的特定時間發病。
併發症：鼻竇炎、中耳炎、中耳積水與腺樣體肥大
許多過敏性鼻炎的病患也會為氣喘、過敏性結膜炎或異位性皮膚炎所苦。
過敏性鼻炎孩子中，有40％同時患有氣喘；氣喘的小孩，則有70％～80％有過敏性鼻炎；當過敏性鼻炎孩子，咳嗽達一到二週，且天氣變化、運動與半夜時咳得特別厲害，就得小心是不是也有氣喘體質。
◎氣喘(支氣管炎)
原因：
下呼吸道的支氣管吸入過敏原造成發炎，導致支氣管變狹窄、易喘
學童盛行率：約2成
症狀：
胸悶、呼吸困難、呼吸有喘鳴聲；夜咳及運動後咳嗽不止
併發症：支氣管纖維化，影響到肺功能、急性大發作時可能會猝死
氣喘為國人最常見的呼吸道過敏疾病，與遺傳有關，是屬於慢性疾病的一種，是因為呼吸道發炎所致，容易發生在晚上或半夜，因過敏病患支氣管更為敏感，若長期呼吸時，將飄揚的塵蹣、或其排泄物吸入支氣管內，呼吸道受到刺激，支氣管便會收縮，氣管內積滿黏液，呼吸道腫脹，導致空氣無法順利進出到肺泡，呼吸就會產生哮鳴聲（似水笛聲），以致感覺呼吸困難、胸悶，有50%的氣喘病患是幼童的時候就發作，但也有到成人才發現有氣喘，氣喘的症狀有時會讓人誤以為是感冒而以，忽略了是否為罹患了氣喘，其實若及早在良好的控制下，就能免於症狀的發生。
◎異位性皮膚炎(過敏性濕疹)
原因：
皮膚接觸到過敏原，產生發炎、搔癢
異位性皮膚炎是一種過敏性的皮膚炎，主要會有皮膚「搔癢」與「皮膚敏感」等症狀，屬於慢性疾病，通常在幼兒時期或新生兒的時候，就容易發現皮膚有溼疹，這些皮膚的症狀也會因年齡而有所不同，好發部位為肘部、膝部、膕（膝後窩）部、四肢或全身，患者的皮膚會有丘疹、水泡、或發膿產生分泌物，皮膚脫屑（乾癬），有的甚至會有蕁麻疹、紅斑疹等症狀產生，此過敏患者與遺傳有密切的關係，通常2~3個月大的嬰兒開始陸續出現症狀，大約有百分之五十的患者，是在幼兒時期一歲以前出現皮膚過敏症狀。
學童盛行率：約1成
症狀：
手、腳、頸與嘴角有反覆的皮膚搔癢
併發症：金黃色葡萄球菌或疱疹感染，而患者裡有百分之八十也合併有鼻炎、氣喘…等過敏性疾病。
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