Allergic rhinitis and comorbid diseases. Otorhinolaryngologist’s view. Case report

Comorbid diseases aggravate allergic rhinitis (AR), require additional examination and correction of treatment. The article presents a review of publications on the relationship of AR with adenoid and exudative otitis media (EOM). The analysis confirmed the fact of more significant hypertrophy of the nasopharynx tonsil and more pronounced nasal obstruction in children with AR compared to children without atopy, more severe course of AR in children with adenoid. Early control of allergy reduces the need for adenoidectomy, but surgery cannot be the first step because it does not cure AR. After adenoidectomy, patients should be closely monitored to control allergy symptoms. The analysis of publications did not allow to establish a reliable relationship between AR and EOM. However, comorbidity is supported by a significant prevalence of EOM in children with AR (25%), a high level of eosinophilic cationic protein and immunoglobulin E in the exudate of the middle ear, which requires an attempt at conservative treatment of AR before tympanostomy. Despite the variety of drugs to control AR, oral non-sedating antihistamines are still the first line of therapy. A special place is occupied by the Quinuclidine derivative Hifenadin (Fenkarol®), which combines the advantages of I and II generations of antihistamines. Along with cholinolytic, ganglioblocking and antiserotonin effects, due to its low lipophilicity, Fenkarol® does not penetrate the blood-brain barrier, does not potentiate the sedative effect, which makes it in demand not only in dermatoses, but also in AR, which was demonstrated by clinical observation.