鼻内用辣椒素
目前已发现,鼻内辣椒素、TRPV1 受体(瞬时受体电位香草醛亚家族,成员 1)激动剂对治疗 NAR 患者或 NAR 占重要组成部分的患者是有效的。[45]Gevorgyan A, Segboer C, Gorissen R, et al. Capsaicin for non-allergic rhinitis. Cochrane Database Syst Rev. 2015 Jul 14;(7):CD010591.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010591.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/26171907?tool=bestpractice.com 这表明瞬时受体电位 (TRP) 受体在本病中的作用。[11]Bernstein JA, Davis BP, Picard JK, et al. A randomized, double-blind, parallel trial comparing capsaicin nasal spray with placebo in subjects with a significant component of nonallergic rhinitis. Ann Allergy Asthma Immunol. 2011 Aug;107(2):171-8.http://www.ncbi.nlm.nih.gov/pubmed/21802026?tool=bestpractice.com[46]Van Gerven L, Alpizar YA, Wouters MM, et al. Capsaicin treatment reduces nasal hyperreactivity and transient receptor potential cation channel subfamily V, receptor 1 (TRPV1) overexpression in patients with idiopathic rhinitis. J Allergy Clin Immunol. 2014 May;133(5):1332-9, 1339.http://www.ncbi.nlm.nih.gov/pubmed/24139494?tool=bestpractice.com Cochrane 评价得出结论,辣椒素是在医生监督下可以尝试的合理选择,特别是因为非变应性鼻炎的治疗选择很少。[45]Gevorgyan A, Segboer C, Gorissen R, et al. Capsaicin for non-allergic rhinitis. Cochrane Database Syst Rev. 2015 Jul 14;(7):CD010591.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010591.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/26171907?tool=bestpractice.com在医生监督下给予辣椒素时,应进行局部麻醉,因为所用辣椒素的浓度会引起很大的刺激。[11]Bernstein JA, Davis BP, Picard JK, et al. A randomized, double-blind, parallel trial comparing capsaicin nasal spray with placebo in subjects with a significant component of nonallergic rhinitis. Ann Allergy Asthma Immunol. 2011 Aug;107(2):171-8.http://www.ncbi.nlm.nih.gov/pubmed/21802026?tool=bestpractice.com也可以使用顺势疗法制剂,其中包括辣椒素和其他成分,例如桉树和薄荷醇,两者也可以激活 TRP 受体。由于它们有鼻腔喷雾剂剂型,因此患者可以在没有直接监督的情况下使用,但由于添加了额外的成分,因此它们不被认为是真正的辣椒素。
TRPV1 拮抗剂
SB-705498 是一种选择性 TRPV1 拮抗剂,已有研究表明将该药用于治疗 NAR 患者是安全和有效的。[47]Holland C, van Drunen C, Denyer J, et al. Inhibition of capsaicin-driven nasal hyper-reactivity by SB-705498, a TRPV1 antagonist. Br J Clin Pharmacol. 2014 May;77(5):777-88.http://www.ncbi.nlm.nih.gov/pubmed/23909699?tool=bestpractice.com然而,一项小型、随机交叉研究显示,SB-705498 不能预防寒冷诱发的 NAR 症状。[48]Murdoch RD, Bareille P, Denyer J, et al. TRPV1 inhibition does not prevent cold dry air-elicited symptoms in non-allergic rhinitis. Int J Clin Pharmacol Ther. 2014 Apr;52(4):267-76.http://www.ncbi.nlm.nih.gov/pubmed/24472402?tool=bestpractice.com
奥洛他定
奥洛他定是一种鼻内抗组胺药,在血管运动性鼻炎患者中与氮卓斯汀疗效相似。[49]Lieberman P, Meltzer EO, LaForce CF, et al. Two-week comparison study of olopatadine hydrochloride nasal spray 0.6% versus azelastine hydrochloride nasal spray 0.1% in patients with vasomotor rhinitis. Allergy Asthma Proc. 2011 Mar-Apr;32(2):151-8.https://www.ingentaconnect.com/content/ocean/aap/2011/00000032/00000002/art00012#http://www.ncbi.nlm.nih.gov/pubmed/21352639?tool=bestpractice.com然而,奥洛他定是一种选择性 H1 抗组胺药,与已知下调 TRPV1 的氮卓斯汀相比,其伴随的机械效应不太清楚。[13]Singh U, Bernstein JA, Haar L, et al. Azelastine desensitization of transient receptor potential vanilloid 1: a potential mechanism explaining its therapeutic effect in nonallergic rhinitis. Am J Rhinol Allergy. 2014 May-Jun;28(3):215-24.http://www.ncbi.nlm.nih.gov/pubmed/24980233?tool=bestpractice.com
肉毒素
A 型肉毒毒素是对其他治疗耐药的慢性鼻炎患者的潜在治疗选择。[50]Ozcan C, Ismi O. Botulinum toxin for rhinitis. Curr Allergy Asthma Rep. 2016 Aug;16(8):58.http://www.ncbi.nlm.nih.gov/pubmed/27461136?tool=bestpractice.com
有争议的疗法
目前未经证实的非变应性鼻炎的治疗方式包括射频刺激和动力学振动刺激。[51]Juto JE, Axelsson M. Kinetic oscillation stimulation as treatment of non-allergic rhinitis: an RCT study. Acta Otolaryngol. 2014 May;134(5):506-12.http://www.tandfonline.com/doi/full/10.3109/00016489.2013.861927http://www.ncbi.nlm.nih.gov/pubmed/24580125?tool=bestpractice.com[52]Deenadayal DS, Kumar MN, Sudhakshin P, et al. Radiofrequency reduction of inferior turbinates in allergic and non allergic rhinitis. Indian J Otolaryngol Head Neck Surg. 2014 Jan;66(Suppl 1):231-6.http://www.ncbi.nlm.nih.gov/pubmed/24533389?tool=bestpractice.com