RU1777910C - Vasomotor rhinitis treatment method - Google Patents

Abstract

Usage: in medicine, namely in otorhinolaryngology. The purpose of the invention is to increase the effectiveness of treatment by activating the function of neutrophils and macrophages. SUMMARY OF THE INVENTION: One dose of human immunoglobulin (1.5 ml) is diluted in saline in a ratio of 1: 2. After thoroughly cleaning the nose, the gauze turunda moistened with the prepared solution was introduced into both halves of the nose, to the posterior ends of the nasal concha, along the general nasal passage. An electrode (cathode) is applied to the outer ends of the gauze turundas. A plate of another electrode (anode) is placed on the back of the patient. The current strength is 0.3-0.5 mA. The duration of the procedure is 10-15 minutes. The course of treatment is 6-8 sessions. 1 tab.

Description

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The invention relates to medicine, namely to otorhinolaryngology and can be used to treat vasomotor rhinitis, a neuro-vegetative form with a relapsing course

A method is known for the treatment of vasomotor rhinitis, a neuro-vegetative form by introducing a 5% solution of calcium chloride on the mucous membrane of the nasal cavity by electrophoresis. The action of calcium chloride is based on a decrease in the permeability of capillaries. However, the use of calcium preparations can contribute to the development of hypercoagulation and thrombosis, which impairs the function of the microvasculature. In addition, the permeability of vascular-tissue barriers at this stage of the disease is a manifestation of adaptation, and therefore, the use of drugs that reduce it is not rational.

A prototype of the claimed invention is a method for the treatment of vasomotor rhinitis with diphenhydramine endonasal electrophoresis. The mechanism of action of diphenhydramine is based on the blockade of H-cholinergic systems, which prevents the development of mucosal sensitization and the transition of the pathological process to a new quality - the allergic form of vasomotor rhinitis, the N-1 blocking effect of antihistamines effectively reduces itching and sneezing, but weakly affects nasal obstruction . They do not reduce nasal congestion and do not affect the increase in resistance to nasal breathing exhibited by rhinomanometry.

In addition, the use of diphenhydramine as an antiallergic agent requires long-term or often repeated course treatment. As a result, a quick addiction to the drug develops or, more dangerous, allergic reactions occur and, moreover, with prolonged

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forms of rhinitis, diphenhydramine is not very effective, since it does not belong to drugs with an immunomodulating effect.

The aim of the invention is to increase the effectiveness of treatment by activating the function of neutrophils and macrophages by immunoglobulin.

This goal is achieved in that the patient is injected into the nasal mucosa by electrophoresis with a solution of human immunoglobulin diluted in saline in a ratio of 1: 2.

A treatment method is as follows.

One dose of human immunoglobulin (1.5 ml) is diluted with saline in a ratio of 1: 2. After thoroughly cleaning the nose with the help of aspiration, vacuum, or rinsing with warm saline, the narrow gauze turunda is moistened in the common nasal passage, moistened with the mixture prepared (immunoglobulin with physiological saline), and placed on the outer ends of the gauze turund electrode (cathode). A plate of another electrode (anode) is laid on the back. The current strength is 0.3-0.5 mA. The duration of the procedure is 10-15 minutes. The course of treatment is 6-8 sessions. A feature of the treatment method is the optimal 1: 2 dilution of immunoglobulin. A higher concentration (1: 1) causes exacerbation of rhinitis, a lower concentration (1: 3) is ineffective.

Methods for using human immunoglobulin to prevent and treat various bacterial and viral infections by intramuscular administration are known. Other routes of administration of immunoglobulin are practically not used or even developed. The reason for this is the dominant idea of the substitution mechanism of action of the drug as an antibody concentrate.

Studies have shown that commercial preparations of immunoglobulin, along with specific, antibody activity, have a pronounced effect, immunomodulating effect due to ligand-receptor interactions and activation of various immunocompetent cells. With direct contact of immunoglobulin, the functional activity of macrophages and neutrophils changes, phagocytosis, oxygen-dependent metabolism (HCT test) are stimulated, and their adhesive properties increase similarly to the action of the factor

inhibitory migration of macrophages. In addition, we conducted studies on the detection in commercial preparations of immunoglobulin and chemokinetic

lymphokines that regulate the migration of phagocytes. A new methodological approach was used to detect these lymphokines - fractionation of drugs by gel filtration and testing of a large number of fractions in a screening test of in vitro cell migration.

Studies have shown the presence of both inhibition and stimulation of macrophage migration in all

5 investigated series of immunoglobulin preparations.

Thus, the detection in commercial preparations of immunoglobulin from abortion-placental blood of a person

0 chemokinetic lymphokines, allows one to consider the possibilities of fundamentally new, previously unknown manifestations of functional cooperation in the neutrophil-lymphocyte system in the process of immune response.

The results of the influence of the proposed method for the treatment of vasomotor rhinitis on the state of local immunity in comparison with the prototype are shown in the table.

0 As can be seen from the table, before treatment in patients with vasomotor rhinitis, there was a decrease in the indices of local immunity as compared with the control (decrease in the amount of secretory im5 munoglobulin A, phagocytic activity of neutrophils). Against the background of a deficiency of humoral and cellular immunity, seeding of the nasal mucosa by microbes and the presence of a large number of neutrophils were revealed. After treatment with diphenhydramine, no convincing changes in the immune status on the nasal mucosa were observed. While treatment with immunoglobulin revealed an increase in the phagocytic activity of neutrophils. a decrease in microbial contamination of the nasal mucosa and its sensitization, Example 1. Patient R., 53 years old, complained of a lack of nasal breathing, mucous discharge from the nose and sneeze. From the anamnesis it was found that 13 years ago she underwent surgery tonsillectomy. Removal of the tonsils contributed to the development of immune deficiency in the mucus of the upper respiratory tract. Subsequently, she often became ill with runny nose. Despite treatment, the disease was usually difficult to terminate and tended to be protracted. Last A months after a respiratory infection more continuously. I received treatment: antibiotics, antihistamines, vasoconstrictor mouth guards, physiotherapeutic procedures. Due to the absence of a positive effect, it was hospitalized in the otolaryngological department, where intensive drug therapy was carried out for 15 days, blockade of the lower nasal concha with novocaine solution. The positive dynamics is insignificant. A course of acupuncture was carried out, the improvement was short-lived. After a month, the state returned to its original state. When examining the nasal cavity of the mucosa, the membrane is stagnant, cyanotic, the nasal concha are swollen, the nasal cavity is filled, the mucus is in the nasal passages. A study of microcirculation and blood flow velocity by the radioisotope method with albumin J 131 revealed stagnant events in the nasal mucosa, a sign of microvasculature involvement. The half-life was 30 minutes.

In the rhinocytogram: the average epithelial destruction index (SPD) is 0.25, the phagocytic activity of neutrophils (FAN) is 0.15, neutrophils are more than 100 cells in a smear, eosinophils in clusters of up to 20, a large number of bacteria. The amount of secretory immunoglobulin A was 0.54 g / l.

Treatment with immunoglobulin electrophoresis in the nose has begun (1: 2 dilution). By the third session, there was a slight increase in rhinorrhea and nasal obstruction, on the sixth day of treatment, breathing through the nose improved, and by the end of the treatment course (8 days), breathing through the nose was restored, and sneezing and rhinorrhea stopped. The mucous membrane of the nose acquired a pink appearance; the nasal concha were contracted. The normalization of capillary function was evidenced by the half-life of J 131 albumin from the mucous membrane (Ti / 2 8 min). The dynamics of laboratory research was also positive: SPD 0.32. FAN 0.28, neutrophils and single bacteria. Eosinophils 1-2-3 in a smear. Slg A 0.25 g / l. Good results were maintained with a follow-up of 15 months.

Example 2. Patient K., 26 years old, complains of a lack of nasal breathing, moderate nasal discharge and sneezing. Over the course of 8 years, he suffers from continuously recurring rhinitis up to 2-3 times a year. Constantly uses vasoconstrictor drops, at least 3 times during the day. The cause of the disease recurrence cannot be indicated. Allergic history is negative. When rhinoscopy of the mucous membrane is red, the nasal concha are enlarged and mucus is in the nasal passages. Treatment with immunoglobulin endonasal electrophoresis was started (1: 1 dilution). By the third session, signs of an aggravation of the process appeared: there was no breathing through the nose, the discharge was plentiful, transparent, a headache appeared, sleep worsened, and it became irritable. Due to the pronounced activity of the process, treatment is discontinued.

Example 3. Patient S., aged 30, complains of shortness of breath through the nose, mucous discharge, sneezing in the morning. Runny nose often suffers 2 times a year. As a rule, the course of rhinitis is protracted, recovering slowly. The last exacerbation lasts 6 months. A history of 11 years ago underwent surgery for removal of the tonsils, an allergic history is negative. With rhinoscopy, a pale, swollen mucous membrane of the nose is determined. The nasal concha are swollen, mucus is transparent in the nasal passages. The treatment with immunoglobulin endonasal electrophoresis has begun, diluting it 1: 3. Conducted 8 sessions. At the end of the course of treatment, the patient noted improvement, breathing through the nose during the daytime was restored, exudation decreased. However, at night, breathing through the nose was limited, which caused concern to the patient, disturbed sleep.

Electrophoresis of immunoglobulin in the nose was carried out by 38 patients with vasomotor rhinitis, a neurovegetative form, with frequent relapses. The use of this method allowed to increase the effectiveness of treatment by activating local immunity, restoring the natural elimination of pathogenic agents from the nasal mucosa, preventing sensitization and developing autoimmune processes in the nasal mucosa. Immunoglobulin also exerted an angioprotective effect on blood vessels, improved microcirculation, and restored respiratory function of the nose.

Compared with the prototype, human immunoglobulin had pronounced immunomodulating properties, the phagocytic activity of neutrophils, the completeness of phagocytosis, the identification and lysis of microorganisms, the elimination of affected epithelial cells clearly increased, the drug did not become addicted during treatment, which allowed, if necessary, repeat treatment courses. Immunoglobulin has been shown to be effective in the treatment of severe rhinitis. After treatment there was a prolonged remission.

Claims (1)

SUMMARY OF THE INVENTION A method for treating vasomotor rhinitis, comprising endonezal electrophoresis, characterized in that that, in order to accelerate the restoration of nasal breathing and lengthen the period of remission by restoring the anti-infection protection of the mucous membrane of the upper respiratory tract, immunoglobulin diluted in saline in a ratio of 1: 2 is administered.