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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