過敏性鼻炎的緩解

過敏性鼻炎的緩解

楊惟婷

 

據台北市衛生局統計,1985 年孩童過敏性鼻炎的比例為 7.84%,2007年竟增加至 50%,20年之間人數飆漲7倍。奇美醫學中心統計也發現,在 PM2.5濃度達到紫爆的期間,因鼻子過敏而就診的人數會增加 3∼4 成。

 

有過敏性鼻炎時,如何透過食療、改變生活習慣來改善?

 

一、過敏性鼻炎症狀

 

簡單的說,過敏(allergy)乃是我們體內免疫系統將一些原本是無害的物質,誤認為對我們有潛在威脅而產生不正確的過度反應。能導致過敏反應的物質通稱為過敏原(allergens),常見的過敏原包括了塵蹣、黴菌、花粉、貓狗等動物皮屑、帶殼海鮮、大豆、花生等高致敏食物、蟑螂、空氣污染、化學品及其衍生物等。

 

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。所以,過敏性鼻炎是免疫系統受到刺激引發的發炎反應。

 

如何診斷過敏性鼻炎?

過敏性鼻炎有四大典型症狀。
1、鼻子癢
2、打噴嚏
3、流鼻水
4、鼻塞

診斷主要根據臨床症狀。
◎開始先鼻子癢、打噴嚏,嚴重時眼睛也會癢。鼻子過敏的打噴嚏很劇烈,連續十幾聲,和一般感冒的一兩聲不同,另外感冒也不容易鼻子癢、眼睛癢。
◎接著會流大量清澈的鼻水,有時一早醒來就要用掉半包衛生紙,到後來還會出現鼻塞。

◎若病患本身有其他過敏疾病,或父母、兄弟姐妹有過敏病史,或理學檢查發現有黑眼圈及鼻黏膜蒼白腫脹,就可以更加確定診斷。
◎另外可檢驗過敏抗體.IgE、過敏原皮膚試驗、鼻黏膜抹片檢查等來輔助診斷。

 

二、過敏性鼻炎的食療

 

避免菸酒與少攝取帶殼海鮮、堅果、人工添加物、油炸與辛辣食物。
中醫認為冰品冷飲與西瓜、竹筍等寒性食物會刺激副交感神經,增加發作頻率,也應盡量避免食用。
過敏性鼻炎的食療可多用以下食物﹕

1、薑
薑的辛味成分薑辣素和薑烯酚能提高身體免疫力與新陳代謝、治鼻塞,可以期待緩和過敏性鼻炎症狀的效果。

 

2、蓮藕

蓮藕含有豐富的黏液素,能避免鼻黏膜太過乾燥,1 天吃 30∼40 公克的蓮藕粉,連續 2 周就可期待改善過敏性鼻炎的效果。

 

3、洋蔥

洋蔥含有豐富的槲皮素,槲皮素是一種類似抗組織胺特性的物質,具有抑制過敏、抗發炎的作用。

 

4、黑豆

黑豆含有能強化鼻黏膜的維生素 B12、鋅、鐵、大豆皂苷,能提高免疫力的卵磷脂、木酚素等成分,有助於預防過敏。

 

5、益生菌

益生菌可以調節免疫系統,降低過敏反應。從優格、優酪乳、味噌、泡菜等食物中也能攝取到益生菌。

 

6、魚油

沙丁魚、鰹魚、鯖魚、秋刀魚等青背魚含有豐富的 EPA 和 DHA,可以讓免疫系統正常運作,有抗發炎、抗過敏的效果。

 

7、紫蘇

紫蘇有很高的殺菌效果,富含維生素K、木犀草素、α-亞麻酸等,可以恢復免疫機能、減少發炎反應,緩和過敏性鼻炎的症狀。

 

8、薄荷

薄荷的類黃酮能抑制肥大細胞釋放出過敏物質,對一般的過敏性鼻炎也有效。

 

三、過敏性鼻炎的環境改善

 

1、徹底清潔室內及寢具

勤於打掃,冷氣機、除濕機、空氣清淨機等要定期清洗與更換濾網。
枕頭套每周洗一次,寢具2周洗一次,以 55∼65 度的熱水清洗後日曬,用吸塵器吸除塵蟎與蟑螂屍骸、糞便,也可選用防蟎寢具。

 

2、少放地毯與絨毛玩具

布製品容易堆積灰塵、孳生黴菌、藏匿塵蟎,應盡量少用,或是選擇短毛地毯,絨毛玩具不放床邊,不用太厚重的窗簾布,時常清潔。

 

3、保持環境通風

現代住宅密閉性高,濕氣容易留在室內,利於塵蟎、黴菌繁殖。多通風換氣,使用除濕機讓室內濕度不超過 65%,使用空氣清淨機也能減少空氣中的過敏原。

另避免使用家中的冷氣機,尤其過敏兒最好少吹冷氣。因為,濕冷的環境也會讓支氣管變得更敏感,大部分的氣喘或鼻子過敏症狀,會在接觸冷風和冰水後變得更嚴重。

 

4、室內避免豢養寵物

寵物容易掉落毛髮,產生灰塵等過敏原,毛髮與皮屑都是塵蟎喜愛的食物,應該盡量讓寵物待在室外,常幫牠洗澡。

 

5、生活作息規律

過勞、壓力大、熬夜、情緒起伏大都會影響免疫系統,保持睡眠充足、紓解壓力,可以調節自律神經,降低鼻過敏發作。

 

6、適度運動能增強免疫力

多多運動,尤其是游泳,多曬太陽,增加抵抗力,也比較容易改善過敏體質。

日本耳鼻喉科學會表示,游泳能減少鼻子對過敏原的敏感度,但泳池的餘氯量要在 0.3∼0.7ppm之間,以免刺激鼻黏膜。

 

7、避免出現在溫差變化大的場所,如夏季在大太陽下突然喝冰水或吹冷氣。

很多人以為注意保暖只能預防感冒,但對於長期受呼吸系統過敏困擾的民眾而言,保持身體暖和更是一項不可忽視的工作。

身體最容易著涼的部位,分別是頭頂、後腦、喉嚨、前胸、上背、腰、腳踝,以及大腿前側與手指、腳趾。無論什麼季節,都要注意這幾個地方的溫度,尤其到了炎熱夏天,只想躲進冷氣房裡,更要小心別讓自己的頭部、肩頸直接吹到風。女生穿短褲短裙,坐下來時也建議在腿上蓋一件薄外套,避免腿部受寒。

《哈佛醫師養生法》一書指出,不論是哪一種過敏,切忌冰冷,因為人是恆溫的動物,只要冰品一下肚,人體便需要耗費能量來平衡下降的體溫。

所以,除了從外部加強保暖,日常生活中也可以用食物提升體內的溫度。容易受寒的人可以在食物中添加熱性佐料,例如老薑、大蒜,胡椒粉、肉桂這些吃了會讓身體暖呼呼,微微冒汗的食物,都能活化血液循環、促進代謝。

 

8、多喝熱水,因為口腔的熱度會提升鼻腔的溫度,減少鼻黏膜腫大的機會。

 

9、騎乘機車或可能吸入不舒服的冷空氣時,戴上口罩或用圍巾掩口鼻。

 

四、過敏性鼻炎的緩解過敏症狀

 

由於引起過敏性鼻炎的根本原因是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,所以也沒有藥物可以從過敏的源頭發揮根本治療的效果。

吃藥治療只能緩解過敏性鼻炎症狀,無法治療造成症狀的源頭—-「鼻子的自律神經失調」。所以,只能緩解過敏的症狀,是無法斷根。

 

很多家屬在門診常問:鼻子過敏能不能斷根?答案是不能。
但治療後可以減緩症狀,改善生活品質。

◎治療方法有下列幾種:目前緩解過敏的症狀,仍是以藥物、鼻劑為主。

1、藥物包括四類,抗組織胺、抗鼻充血劑、類固醇及敏鼻速樂(cromoglycate)。

抗組織胺Anti-histamine是治療鼻過敏的首選藥物,可以緩解打噴嚏、流鼻水、鼻子搔癢症狀及減少因鼻水倒流引起的咳嗽,但對鼻塞效果有限。

以往第一代抗組織胺為短效,常用於孕婦及兒童(因為藥物比較老,上市時間長,可確定沒有畸形兒或其他影響兒童發育的後遺症),缺點是常有嗜睡的壞處,影響日常作息。

不過,現在已經有長效的第二、三代抗組織胺,服藥改為每天1∼2次,而且不會嗜睡,不會影響白天工作,非常方便。

 

2、抗鼻充血劑常和抗組織胺並用,可加速解決流鼻水的惱人症狀。

解鼻充血劑Nasal decongestant

  • 促進鼻腔內血管收縮,可以緩解鼻塞症狀
  • 缺點是可能造成興奮或心悸,奧運選手常因服用感冒藥被查出含有麻黃素等興奮劑,就是此類藥物惹的事。
  • 不適合長期使用,可能會有鼻黏膜萎縮的副作用

 

3、手術治療的選擇。當內科療法無法改善時,可考慮用手術治療,主要有各式雷射手術、冷凍治療、電燒、下鼻甲手術等等,可供選擇來改善過敏所導致的鼻塞、流鼻涕、打噴嚏症狀。但要注意的是,手術治療的確會改善鼻塞症狀,但長時間後過敏症狀可能會再復發,因為過敏是屬於全身發炎反應,不易因手術而完全治癒。

 

◎藥物治療主要使用方式﹕
1、若症狀輕微,不影響活動、上學、情緒,且間歇性發作,以口服抗組織胺為主。

2、若症狀較嚴重或持續性發作,可直接使用類固醇鼻噴劑,初期併用口服抗組織胺。
3、新一代的鼻噴劑中類固醇含量不到口服類固醇的百分之一,而且絕大部分只作用於鼻黏膜,被身體吸收的很少,是目前治療過敏性鼻炎中最有效且沒有全身性類固醇之副作用。

4、目前最新的類固醇鼻噴劑也製造成每天一噴的長效簡單型,可以說是越來越方便了。敏鼻速樂是一種作用在黏膜內肥大細胞的外用藥,常見於鼻噴劑及眼藥水,少有副作用,也可以嘗試一下。

 

五、對抗花粉症的食療

 

對抗花粉症(hay fever)不見得完全要靠吃藥,以下五種食物就能助你對抗花粉症。

 

1、優格:

田納西州的泛德堡大學(Vanderbilt University)醫學院發現,吃優格可影響白血球,提升你的免疫系統,進而緩解一些花粉症的症狀。研究員針對涉及1900人的23項研究進行分析,其中17項顯示,優格所含的益生菌(probiotics)可緩解花粉症。益生菌可能改變患者過敏的嚴重度、症狀和生活品質。.

 

2、蜂蜜:

地方出產的蜂蜜因為含有造成花粉症的當地花粉,可減少花粉症的症狀,而你的花粉症是對所住地區的花粉產生的反應,所以吃了所住地產的蜂蜜,有助你的免疫系統對抗過敏原。不過這不會馬上見效,必須吃一整年才能受益。

 

3、檸檬:

花粉症患者體內往往缺乏生物黃酮(bioflavonoids),這種抗氧化劑保持你的眼睛健康。生物黃酮通常在含有大量維他命C的食物可找到,例如檸檬和覆盆子(raspberries)。

 

4、薑黃(turmeric):

薑黃含有薑黃素(curcumin),這種化學合成物具有強大的抗發炎效用,也有抗過敏的功用,能制止組織胺在身體釋出。咖哩內富含薑黃素,不妨多吃。

 

5、鳳梨:

鳳梨不但含有生物黃酮,也有豐富的鳳梨酵素(bromelain),有助分解積聚的黏液,使鼻子暢通。

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