{"id":109678,"date":"2025-02-12T16:20:22","date_gmt":"2025-02-12T09:20:22","guid":{"rendered":"https:\/\/vnras.com\/drug\/?p=109678"},"modified":"2025-02-12T16:27:11","modified_gmt":"2025-02-12T09:27:11","slug":"viem-mui-di-ung-ar-chan-doan-va-mot-so-cac-lieu-phap-dieu-tri-benh","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/viem-mui-di-ung-ar-chan-doan-va-mot-so-cac-lieu-phap-dieu-tri-benh\/","title":{"rendered":"Vi\u00eam m\u0169i d\u1ecb \u1ee9ng (AR): ch\u1ea9n \u0111o\u00e1n v\u00e0 m\u1ed9t s\u1ed1 c\u00e1c li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ec7nh"},"content":{"rendered":"<p style=\"text-align: right;\">L\u01b0\u1ee3t d\u1ecbch: NT H\u039d<\/p>\n<h2>T\u1ed5ng quan<\/h2>\n<p><strong>Vi\u00eam m\u0169i d\u1ecb \u1ee9ng<\/strong> (AR) l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p c\u00f3 m\u1ed1i li\u00ean h\u1ec7 ch\u1eb7t ch\u1ebd v\u1edbi hen v\u00e0 vi\u00eam k\u1ebft m\u1ea1c. C\u00e1c tri\u1ec7u ch\u1ee9ng \u0111i\u1ec3n h\u00ecnh bao g\u1ed3m ng\u1ea1t m\u0169i, ng\u1ee9a m\u0169i, ch\u1ea3y n\u01b0\u1edbc m\u0169i v\u00e0 h\u1eaft h\u01a1i. Vi\u1ec7c h\u1ecfi b\u1ec7nh s\u1eed chi ti\u1ebft, kh\u00e1m l\u00e2m s\u00e0ng v\u00e0 test d\u1ecb nguy\u00ean l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n AR. Corticosteroid x\u1ecbt m\u0169i v\u00e0 thu\u1ed1c kh\u00e1ng histamine th\u1ebf h\u1ec7 th\u1ee9 hai l\u00e0 c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb ch\u00ednh. Li\u1ec7u ph\u00e1p mi\u1ec5n d\u1ecbch v\u1edbi d\u1ecb nguy\u00ean l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u ch\u1ec9nh mi\u1ec5n d\u1ecbch hi\u1ec7u qu\u1ea3, \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng b\u1ed5 tr\u1ee3 ho\u1eb7c thay th\u1ebf cho li\u1ec7u ph\u00e1p d\u01b0\u1ee3c l\u00fd.<\/p>\n<h2>Gi\u1edbi thi\u1ec7u<\/h2>\n<p>Vi\u00eam m\u0169i \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 t\u00ecnh tr\u1ea1ng vi\u00eam ni\u00eam m\u1ea1c m\u0169i. \u0110\u00e2y l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p, \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn kho\u1ea3ng 40% d\u00e2n s\u1ed1. Vi\u00eam m\u0169i d\u1ecb \u1ee9ng (AR) l\u00e0 d\u1ea1ng vi\u00eam m\u0169i m\u1ea1n t\u00ednh th\u01b0\u1eddng g\u1eb7p nh\u1ea5t, \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn 20% d\u00e2n s\u1ed1 \u1edf Canada, v\u00e0 c\u00e1c b\u1eb1ng ch\u1ee9ng cho th\u1ea5y t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh \u0111ang ng\u00e0y c\u00e0ng gia t\u0103ng. Vi\u00eam m\u0169i d\u1ecb \u1ee9ng n\u1eb7ng c\u00f3 li\u00ean quan \u0111\u1ebfn nh\u1eefng suy gi\u1ea3m \u0111\u00e1ng k\u1ec3 v\u1ec1 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng, gi\u1ea5c ng\u1ee7 v\u00e0 hi\u1ec7u su\u1ea5t l\u00e0m vi\u1ec7c.<\/p>\n<p>Tr\u01b0\u1edbc \u0111\u00e2y, vi\u00eam m\u0169i d\u1ecb \u1ee9ng \u0111\u01b0\u1ee3c coi l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd khu tr\u00fa t\u1ea1i m\u0169i, nh\u01b0ng c\u00e1c b\u1eb1ng ch\u1ee9ng g\u1ea7n \u0111\u00e2y cho th\u1ea5y n\u00f3 c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t ph\u1ea7n c\u1ee7a b\u1ec7nh l\u00fd \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p. C\u00f3 nhi\u1ec1u m\u1ed1i li\u00ean h\u1ec7 v\u1ec1 m\u1eb7t sinh l\u00fd, ch\u1ee9c n\u0103ng v\u00e0 mi\u1ec5n d\u1ecbch gi\u1eefa \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean (m\u0169i, khoang m\u0169i, xoang c\u1ea1nh m\u0169i, v\u00f2i Eustach, h\u1ea7u v\u00e0 thanh qu\u1ea3n) v\u00e0 \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p d\u01b0\u1edbi (kh\u00ed qu\u1ea3n, nh\u00e1nh ph\u1ebf qu\u1ea3n, ti\u1ec1u ph\u1ebf qu\u1ea3n v\u00e0 ph\u1ed5i). V\u00ed d\u1ee5, c\u1ea3 hai \u0111\u1ec1u ch\u1ee9a bi\u1ec3u m\u00f4 c\u00f3 l\u00f4ng chuy\u1ec3n, bao g\u1ed3m c\u00e1c t\u1ebf b\u00e0o goblet ti\u1ebft ch\u1ea5t nh\u1ea7y, gi\u00fap l\u1ecdc kh\u00f4ng kh\u00ed \u0111i v\u00e0o v\u00e0 b\u1ea3o v\u1ec7 c\u1ea5u tr\u00fac b\u00ean trong \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p.<\/p>\n<p>H\u01a1n n\u1eefa, l\u1edbp d\u01b0\u1edbi ni\u00eam m\u1ea1c c\u1ee7a \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean v\u00e0 \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p d\u01b0\u1edbi g\u1ed3m m\u1ed9t l\u1edbp m\u1ea1ch m\u00e1u, tuy\u1ebfn nh\u1ea7y, t\u1ebf b\u00e0o \u0111\u1ec7m, d\u00e2y th\u1ea7n kinh v\u00e0 t\u1ebf b\u00e0o ph\u1ea3n \u1ee9ng vi\u00eam. C\u00e1c b\u1eb1ng ch\u1ee9ng \u0111\u00e3 cho th\u1ea5y r\u1eb1ng vi\u1ec7c k\u00edch th\u00edch d\u1ecb nguy\u00ean \u1edf \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean kh\u00f4ng ch\u1ec9 g\u00e2y ph\u1ea3n \u1ee9ng vi\u00eam c\u1ee5c b\u1ed9, m\u00e0 c\u00f2n g\u00e2y ra c\u00e1c ph\u1ea3n \u1ee9ng vi\u00eam \u1edf \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p d\u01b0\u1edbi, \u0111i\u1ec1u n\u00e0y \u0111\u01b0\u1ee3c c\u1ee7ng c\u1ed1 b\u1edfi th\u1ef1c t\u1ebf r\u1eb1ng vi\u00eam m\u0169i v\u00e0 hen th\u01b0\u1eddng c\u00f9ng t\u1ed3n t\u1ea1i. Do \u0111\u00f3, vi\u00eam m\u0169i d\u1ecb \u1ee9ng v\u00e0 hen d\u01b0\u1eddng nh\u01b0 \u0111\u1ea1i di\u1ec7n cho m\u1ed9t b\u1ec7nh l\u00fd vi\u00eam \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p k\u1ebft h\u1ee3p, v\u00e0 c\u1ea7n \u0111\u01b0\u1ee3c xem x\u00e9t \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o vi\u1ec7c \u0111\u00e1nh gi\u00e1 v\u00e0 qu\u1ea3n l\u00fd t\u1ed1i \u01b0u cho b\u1ec7nh nh\u00e2n vi\u00eam m\u0169i d\u1ecb \u1ee9ng.<\/p>\n<p>Trong vi\u00eam m\u0169i d\u1ecb \u1ee9ng, nhi\u1ec1u t\u1ebf b\u00e0o vi\u00eam bao g\u1ed3m t\u1ebf b\u00e0o mast, t\u1ebf b\u00e0o TCD4+, t\u1ebf b\u00e0o B, \u0111\u1ea1i th\u1ef1c b\u00e0o v\u00e0 b\u1ea1ch c\u1ea7u \u00e1i toan th\u00e2m nh\u1eadp v\u00e0o ni\u00eam m\u1ea1c m\u0169i khi ti\u1ebfp x\u00fac v\u1edbi d\u1ecb nguy\u00ean k\u00edch th\u00edch. \u1ede nh\u1eefng ng\u01b0\u1eddi b\u1ecb d\u1ecb \u1ee9ng, c\u00e1c t\u1ebf b\u00e0o T th\u00e2m nh\u1eadp v\u00e0o ni\u00eam m\u1ea1c m\u0169i ch\u1ee7 y\u1ebfu l\u00e0 Th2 v\u00e0 ti\u1ebft ra c\u00e1c cytokine (v\u00ed d\u1ee5: IL-3, IL-4, IL-5 v\u00e0 IL-13), nh\u1eefng ch\u1ea5t n\u00e0y th\u00fac \u0111\u1ea9y qu\u00e1 tr\u00ecnh s\u1ea3n xu\u1ea5t IgE t\u1eeb t\u01b0\u01a1ng b\u00e0o. S\u1ef1 li\u00ean k\u1ebft ch\u00e9o c\u1ee7a IgE g\u1eafn tr\u00ean b\u1ec1 m\u1eb7t t\u1ebf b\u00e0o mast v\u1edbi d\u1ecb nguy\u00ean s\u1ebd k\u00edch ho\u1ea1t gi\u1ea3i ph\u00f3ng c\u00e1c ch\u1ea5t trung gian, nh\u01b0 histamine v\u00e0 leukotriene, g\u00e2y ra hi\u1ec7n t\u01b0\u1ee3ng gi\u00e3n ti\u1ec1u \u0111\u1ed9ng m\u1ea1ch, t\u0103ng t\u00ednh th\u1ea5m th\u00e0nh m\u1ea1ch, ng\u1ee9a, ch\u1ea3y m\u0169i, ti\u1ebft d\u1ecbch nh\u1ea7y v\u00e0 co th\u1eaft c\u01a1 tr\u01a1n \u1edf ph\u1ed5i. C\u00e1c ch\u1ea5t trung gian v\u00e0 cytokine \u0111\u01b0\u1ee3c gi\u1ea3i ph\u00f3ng trong giai \u0111o\u1ea1n s\u1edbm c\u1ee7a ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch v\u1edbi d\u1ecb nguy\u00ean k\u00edch th\u00edch s\u1ebd kh\u1edfi ph\u00e1t ph\u1ea3n \u1ee9ng vi\u00eam ti\u1ebfp theo trong 4 \u0111\u1ebfn 8 gi\u1edd sau \u0111\u00f3 (ph\u1ea3n \u1ee9ng vi\u00eam giai \u0111o\u1ea1n mu\u1ed9n), g\u00e2y ra c\u00e1c tri\u1ec7u ch\u1ee9ng t\u00e1i ph\u00e1t (th\u01b0\u1eddng l\u00e0 ng\u1ea1t m\u0169i), th\u01b0\u1eddng dai d\u1eb3ng.<\/p>\n<h1>Ph\u00e2n lo\u1ea1i<\/h1>\n<p>Vi\u00eam m\u0169i \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i th\u00e0nh c\u00e1c nh\u00f3m sau \u0111\u00e2y d\u1ef1a theo nguy\u00ean nh\u00e2n: trung gian IgE (d\u1ecb \u1ee9ng), autonomic, nhi\u1ec5m tr\u00f9ng v\u00e0 v\u00f4 c\u0103n (kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n).<\/p>\n<p>B\u1ea3ng 1. Ph\u00e2n lo\u1ea1i vi\u00eam m\u0169i theo nguy\u00ean nh\u00e2n<\/p>\n<table>\n<tbody>\n<tr>\n<td><\/td>\n<td>M\u00f4 t\u1ea3<\/td>\n<\/tr>\n<tr>\n<td>Trung gian IgE (d\u1ecb \u1ee9ng)<\/td>\n<td>Vi\u00eam ni\u00eam m\u1ea1c m\u0169i trung gian IgE, g\u00e2y th\u00e2m nh\u1eadp b\u1ea1ch c\u1ea7u \u00e1i toan v\u00e0 t\u1ebf b\u00e0o Th2 v\u00e0o ni\u00eam m\u1ea1c m\u0169i.<\/p>\n<p>\u0110\u01b0\u1ee3c ph\u00e2n lo\u1ea1i th\u00e0nh t\u1eebng \u0111\u1ee3t ho\u1eb7c dai d\u1eb3ng.<\/td>\n<\/tr>\n<tr>\n<td>Autonomic<\/td>\n<td>Vasomotor<\/p>\n<p>Do thu\u1ed1c<\/p>\n<p>Suy gi\u00e1p<\/p>\n<p>N\u1ed9i ti\u1ebft t\u1ed1<\/p>\n<p>Vi\u00eam m\u0169i kh\u00f4ng do d\u1ecb \u1ee9ng k\u00e8m h\u1ed9i ch\u1ee9ng t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan (NARES)<\/td>\n<\/tr>\n<tr>\n<td>Nhi\u1ec5m tr\u00f9ng<\/td>\n<td>Do nhi\u1ec5m virus (th\u01b0\u1eddng g\u1eb7p nh\u1ea5t), vi khu\u1ea9n ho\u1eb7c n\u1ea5m<\/td>\n<\/tr>\n<tr>\n<td>V\u00f4 c\u0103n<\/td>\n<td>Kh\u00f4ng th\u1ec3 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c nguy\u00ean nh\u00e2n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>Tr\u01b0\u1edbc \u0111\u00e2y, vi\u00eam m\u0169i d\u1ecb \u1ee9ng \u0111\u01b0\u1ee3c chia th\u00e0nh 2 d\u1ea1ng: theo m\u00f9a (x\u1ea3y ra trong m\u00f9a c\u1ee5 th\u1ec3) ho\u1eb7c quanh n\u0103m. Tuy nhi\u00ean, kh\u00f4ng ph\u1ea3i t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n \u0111\u1ec1u ph\u00f9 h\u1ee3p v\u1edbi c\u00e1c ph\u00e2n lo\u1ea1i n\u00e0y. V\u00ed d\u1ee5, m\u1ed9t s\u1ed1 t\u00e1c nh\u00e2n g\u00e2y d\u1ecb \u1ee9ng nh\u01b0 ph\u1ea5n hoa c\u00f3 th\u1ec3 theo m\u00f9a \u1edf nh\u1eefng v\u00f9ng kh\u00ed h\u1eadu l\u1ea1nh, nh\u01b0ng l\u1ea1i xu\u1ea5t hi\u1ec7n quanh n\u0103m \u1edf v\u00f9ng kh\u00ed h\u1eadu \u1ea9m h\u01a1n. Do \u0111\u00f3, AR hi\u1ec7n nay \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i d\u1ef1a v\u00e0o th\u1eddi gian xu\u1ea5t hi\u1ec7n tri\u1ec7u ch\u1ee9ng (t\u1eebng \u0111\u1ee3t ho\u1eb7c dai d\u1eb3ng) v\u00e0 m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng (nh\u1eb9, trung b\u00ecnh ho\u1eb7c n\u1eb7ng) (H\u00ecnh 1). H\u01b0\u1edbng d\u1eabn c\u1ee7a ARIA (Allergic Rhinitis and its Impact on Asthma) \u0111\u1ecbnh ngh\u0129a vi\u00eam m\u0169i d\u1ecb \u1ee9ng \u201ct\u1eebng \u0111\u1ee3t\u201d (intermittent) l\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng xu\u1ea5t hi\u1ec7n \u00edt h\u01a1n 4 ng\u00e0y trong tu\u1ea7n ho\u1eb7c k\u00e9o d\u00e0i d\u01b0\u1edbi 4 tu\u1ea7n li\u00ean ti\u1ebfp, v\u00e0 AR &#8220;dai d\u1eb3ng&#8221; (persistent) l\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng xu\u1ea5t hi\u1ec7n h\u01a1n 4 ng\u00e0y trong tu\u1ea7n v\u00e0 k\u00e9o d\u00e0i h\u01a1n 4 tu\u1ea7n li\u00ean ti\u1ebfp. C\u00e1c tri\u1ec7u ch\u1ee9ng \u0111\u01b0\u1ee3c coi l\u00e0 nh\u1eb9 khi b\u1ec7nh nh\u00e2n kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn gi\u1ea5c ng\u1ee7 v\u00e0 c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n c\u00e1c ho\u1ea1t \u0111\u1ed9ng b\u00ecnh th\u01b0\u1eddng (bao g\u1ed3m c\u00f4ng vi\u1ec7c h\u1ecdc t\u1eadp). C\u00e1c tri\u1ec7u ch\u1ee9ng \u0111\u01b0\u1ee3c coi l\u00e0 trung b\u00ecnh\/n\u1eb7ng n\u1ebfu ch\u00fang \u1ea3nh h\u01b0\u1edfng \u0111\u00e1ng k\u1ec3 \u0111\u1ebfn gi\u1ea5c ng\u1ee7 ho\u1eb7c c\u00e1c ho\u1ea1t \u0111\u1ed9ng sinh ho\u1ea1t h\u00e0ng ng\u00e0y, v\u00e0\/ho\u1eb7c n\u1ebfu b\u1ec7nh nh\u00e2n c\u1ea3m th\u1ea5y kh\u00f3 ch\u1ecbu. Vi\u1ec7c \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng v\u00e0 th\u1eddi gian c\u1ee7a tri\u1ec7u ch\u1ee9ng l\u00e0 r\u1ea5t quan tr\u1ecdng v\u00ec n\u00f3 s\u1ebd \u0111\u1ecbnh h\u01b0\u1edbng c\u00e1ch ti\u1ebfp c\u1eadn qu\u1ea3n l\u00fd ph\u00f9 h\u1ee3p cho t\u1eebng b\u1ec7nh nh\u00e2n.<\/p>\n<p>Ph\u00e2n lo\u1ea1i vi\u00eam m\u0169i d\u1ecb \u1ee9ng theo th\u1eddi gian v\u00e0 m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a tri\u1ec7u ch\u1ee9ng<\/p>\n<ul>\n<li>T\u1eebng \u0111\u1ee3t<\/li>\n<\/ul>\n<p>Tri\u1ec7u ch\u1ee9ng &lt; 4 ng\u00e0y\/tu\u1ea7n ho\u1eb7c &lt; 4 tu\u1ea7n li\u00ean ti\u1ebfp<\/p>\n<ul>\n<li>Dai d\u1eb3ng<\/li>\n<\/ul>\n<p>Tri\u1ec7u ch\u1ee9ng &gt; 4 ng\u00e0y\/tu\u1ea7n ho\u1eb7c &gt; 4 tu\u1ea7n li\u00ean ti\u1ebfp<\/p>\n<ul>\n<li>Nh\u1eb9<\/li>\n<\/ul>\n<p>Ng\u1ee7 b\u00ecnh th\u01b0\u1eddng<\/p>\n<p>Kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn sinh ho\u1ea1t h\u00e0ng ng\u00e0y, th\u1ec3 thao, gi\u1ea3i tr\u00ed<\/p>\n<p>L\u00e0m vi\u1ec7c h\u1ecdc t\u1eadp b\u00ecnh th\u01b0\u1eddng<\/p>\n<p>Kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng g\u00e2y kh\u00f3 ch\u1ecbu<\/p>\n<ul>\n<li>Trung b\u00ecnh-n\u1eb7ng<\/li>\n<\/ul>\n<p>Kh\u00f3 ng\u1ee7, ho\u1eb7c<\/p>\n<p>\u1ea2nh h\u01b0\u1edfng \u0111\u1ebfn sinh ho\u1ea1t h\u00e0ng ng\u00e0y, th\u1ec3 thao, gi\u1ea3i tr\u00ed, ho\u1eb7c<\/p>\n<p>\u1ea2nh h\u01b0\u1edfng \u0111\u1ec3 c\u00f4ng vi\u1ec7c h\u1ecdc t\u1eadp, ho\u1eb7c<\/p>\n<p>C\u00f3 tri\u1ec7u ch\u1ee9ng g\u00e2y kh\u00f3 ch\u1ecbu<\/p>\n<p>Hai lo\u1ea1i vi\u00eam m\u0169i \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i th\u00eam v\u00e0 \u0111\u1ec1 c\u1eadp \u0111\u1ebfn l\u00e0: vi\u00eam m\u0169i ngh\u1ec1 nghi\u1ec7p (occupational rhinitis) v\u00e0 vi\u00eam m\u0169i d\u1ecb \u1ee9ng c\u1ee5c b\u1ed9 (local allergic rhinitis).<\/p>\n<h3>Vi\u00eam m\u0169i ngh\u1ec1 nghi\u1ec7p<\/h3>\n<p>Vi\u00eam m\u0169i ngh\u1ec1 nghi\u1ec7p l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng vi\u00eam c\u1ee7a m\u0169i do ti\u1ebfp x\u00fac v\u1edbi m\u00f4i tr\u01b0\u1eddng l\u00e0m vi\u1ec7c c\u1ee5 th\u1ec3. C\u00e1c tri\u1ec7u ch\u1ee9ng bao g\u1ed3m h\u1ea1n ch\u1ebf th\u00f4ng kh\u00ed, t\u0103ng xu\u1ea5t ti\u1ebft, h\u1eaft h\u01a1i v\u00e0 ng\u1ee9a m\u0169i, kh\u00f4ng do c\u00e1c k\u00edch th\u00edch b\u1edfi c\u00e1c y\u1ebfu t\u1ed1 ngo\u00e0i n\u01a1i l\u00e0m vi\u1ec7c. C\u00e1c ng\u00e0nh ngh\u1ec1 c\u00f3 nguy c\u01a1 cao bao g\u1ed3m nh\u00e2n vi\u00ean ph\u00f2ng th\u00ed nghi\u1ec7m, ch\u1ebf bi\u1ebfn th\u1ef1c ph\u1ea9m, b\u00e1c s\u0129 th\u00fa y, n\u00f4ng d\u00e2n v\u00e0 c\u00f4ng nh\u00e2n trong c\u00e1c ng\u00e0nh s\u1ea3n xu\u1ea5t. Th\u01b0\u1eddng kh\u1edfi ph\u00e1t trong hai n\u0103m \u0111\u1ea7u l\u00e0m vi\u1ec7c, c\u00f3 th\u1ec3 qua trung gian IgE do nh\u1ea1y c\u1ea3m v\u1edbi d\u1ecb nguy\u00ean ho\u1eb7c do k\u00edch \u1ee9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p. Tri\u1ec7u ch\u1ee9ng xu\u1ea5t hi\u1ec7n ngay l\u1eadp t\u1ee9c ho\u1eb7c v\u00e0i gi\u1edd sau khi ti\u1ebfp x\u00fac, th\u01b0\u1eddng k\u00e8m theo c\u00e1c tri\u1ec7u ch\u1ee9ng \u1edf m\u1eaft v\u00e0 \u1edf ph\u1ed5i. Ch\u1ea9n \u0111o\u00e1n d\u1ef1a v\u00e0o b\u1ec7nh s\u1eed, ti\u1ec1n s\u1eed, kh\u00e1m l\u00e2m s\u00e0ng v\u00e0 kh\u1ea3o s\u00e1t t\u1ea1i n\u01a1i l\u00e0m vi\u1ec7c c\u0169ng nh\u01b0 x\u00e9t nghi\u1ec7m d\u1ecb nguy\u00ean. \u0110i\u1ec1u tr\u1ecb t\u1eadp trung v\u00e0o vi\u1ec7c tr\u00e1nh ti\u1ebfp x\u00fac v\u1edbi t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh v\u00e0 s\u1eed d\u1ee5ng thu\u1ed1c \u0111i\u1ec1u tr\u1ecb khi c\u1ea7n. C\u00f3 r\u1ea5t \u00edt b\u1eb1ng ch\u1ee9ng cho th\u1ea5y vi\u00eam m\u0169i ngh\u1ec1 nghi\u1ec7p ti\u1ebfn tri\u1ec3n th\u00e0nh hen, m\u1eb7c d\u00f9 \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 x\u1ea3y ra. V\u00ec v\u1eady, b\u1ec7nh nh\u00e2n th\u01b0\u1eddng kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o b\u1ecf vi\u1ec7c n\u1ebfu tri\u1ec7u ch\u1ee9ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t hi\u1ec7u qu\u1ea3.<\/p>\n<h3>Vi\u00eam m\u0169i d\u1ecb \u1ee9ng c\u1ee5c b\u1ed9 (LAR)<\/h3>\n<p>Vi\u00eam m\u0169i d\u1ecb \u1ee9ng c\u1ee5c b\u1ed9 l\u00e0 m\u1ed9t th\u1ec3 l\u00e2m s\u00e0ng \u0111\u1eb7c tr\u01b0ng v\u1edbi ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng khu tr\u00fa t\u1ea1i ni\u00eam m\u1ea1c m\u0169i, kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 hi\u1ec7n t\u01b0\u1ee3ng atropy to\u00e0n th\u00e2n. Theo \u0111\u1ecbnh ngh\u0129a, b\u1ec7nh nh\u00e2n LAR c\u00f3:<\/p>\n<ul>\n<li>Ti\u1ec1n s\u1eed tri\u1ec7u ch\u1ee9ng xu\u1ea5t hi\u1ec7n khi ti\u1ebfp x\u00fac v\u1edbi d\u1ecb nguy\u00ean theo m\u00f9a v\u00e0\/ho\u1eb7c quanh n\u0103m<\/li>\n<li>Kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c d\u1ecb nguy\u00ean qua test l\u1ea5y da ho\u1eb7c IgE \u0111\u1eb7c hi\u1ec7u<\/li>\n<li>K\u1ebft qu\u1ea3 d\u01b0\u01a1ng t\u00ednh v\u1edbi x\u00e9t nghi\u1ec7m k\u00edch th\u00edch d\u1ecb nguy\u00ean trong m\u0169i<\/li>\n<\/ul>\n<p>L\u01b0u \u00fd l\u00e0 x\u00e9t nghi\u1ec7m k\u00edch th\u00edch d\u1ecb nguy\u00ean trong m\u0169i kh\u00f4ng ph\u1ea3i l\u00fac n\u00e0o c\u0169ng c\u00f3 s\u1eb5n trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng th\u01b0\u1eddng quy.<\/p>\n<p>Cho \u0111\u1ebfn nay, kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng n\u00e0o cho th\u1ea5y vi\u00eam m\u0169i d\u1ecb \u1ee9ng c\u1ee5c b\u1ed9 l\u00e0 ti\u1ec1n \u0111\u1ec1 d\u1eabn \u0111\u1ebfn vi\u00eam m\u0169i d\u1ecb \u1ee9ng to\u00e0n th\u00e2n, v\u00ec v\u1eady c\u00e1c nghi\u00ean c\u1ee9u theo d\u00f5i kh\u00f4ng ghi nh\u1eadn s\u1ef1 ti\u1ebfn tri\u1ec3n th\u00e0nh AR \u0111i\u1ec3n h\u00ecnh \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y. Tuy nhi\u00ean, th\u1eddi gian theo d\u00f5i c\u00f3 th\u1ec3 ch\u01b0a \u0111\u1ee7 d\u00e0i \u0111\u1ec3 ph\u00e1t hi\u1ec7n s\u1ef1 ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh.<\/p>\n<h2>Ch\u1ea9n \u0111o\u00e1n v\u00e0 x\u00e9t nghi\u1ec7m<\/h2>\n<p>Vi\u00eam m\u0169i d\u1ecb \u1ee9ng th\u01b0\u1eddng l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng k\u00e9o d\u00e0i. B\u1ec7nh nh\u00e2n m\u1eafc AR th\u01b0\u1eddng kh\u00f4ng nh\u1eadn th\u1ee9c \u0111\u01b0\u1ee3c \u1ea3nh h\u01b0\u1edfng c\u1ee7a b\u1ec7nh \u0111\u1ebfn ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng v\u00e0 c\u00e1c ho\u1ea1t \u0111\u1ed9ng kh\u00e1c, do \u0111\u00f3 h\u1ecd kh\u00f4ng th\u01b0\u1eddng xuy\u00ean \u0111i kh\u00e1m t\u1ea1i c\u00e1c c\u01a1 s\u1edf y t\u1ebf. \u0110i\u1ec1u n\u00e0y \u0111\u01b0\u1ee3c cho l\u00e0 nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng k\u00e9o d\u00e0i quanh n\u0103m c\u00f3 th\u1ec3 d\u1ea7n th\u00edch nghi v\u00e0 kh\u00f4ng coi tri\u1ec7u ch\u1ee9ng c\u1ee7a m\u00ecnh l\u00e0 quan tr\u1ecdng. Th\u00eam v\u00e0o \u0111\u00f3, c\u00e1c b\u00e1c s\u0129 c\u0169ng c\u00f3 th\u1ec3 b\u1ecf s\u00f3t vi\u1ec7c h\u1ecfi b\u1ec7nh nh\u00e2n v\u1ec1 t\u00ecnh tr\u1ea1ng n\u00e0y trong c\u00e1c l\u1ea7n ki\u1ec3m tra s\u1ee9c kh\u1ecfe \u0111\u1ecbnh k\u1ef3. Vi\u1ec7c s\u00e0ng l\u1ecdc vi\u00eam m\u0169i \u0111\u1eb7c bi\u1ec7t quan tr\u1ecdng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb hen, v\u00ec c\u00e1c nghi\u00ean c\u1ee9u ch\u1ec9 ra r\u1eb1ng vi\u00eam m\u0169i xu\u1ea5t hi\u1ec7n \u1edf 95% b\u1ec7nh nh\u00e2n hen.<\/p>\n<p>Khai th\u00e1c ti\u1ec1n s\u1eed, b\u1ec7nh s\u1eed v\u00e0 kh\u00e1m l\u00e2m s\u00e0ng k\u1ef9 l\u01b0\u1ee1ng l\u00e0 n\u1ec1n t\u1ea3ng quan tr\u1ecdng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n vi\u00eam m\u0169i d\u1ecb \u1ee9ng. X\u00e9t nghi\u1ec7m d\u1ecb nguy\u00ean c\u0169ng r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 x\u00e1c nh\u1eadn r\u1eb1ng d\u1ecb \u1ee9ng l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y vi\u00eam m\u0169i. Chuy\u1ec3n b\u1ec7nh nh\u00e2n \u0111\u1ebfn chuy\u00ean gia d\u1ecb \u1ee9ng n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t n\u1ebfu ch\u1ea9n \u0111o\u00e1n vi\u00eam m\u0169i d\u1ecb \u1ee9ng ch\u01b0a \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh r\u00f5.<\/p>\n<h3>Ti\u1ec1n s\u1eed b\u1ec7nh s\u1eed<\/h3>\n<p>Trong qu\u00e1 tr\u00ecnh khai th\u00e1c ti\u1ec1n s\u1eed b\u1ec7nh, b\u1ec7nh nh\u00e2n th\u01b0\u1eddng m\u00f4 t\u1ea3 c\u00e1c tri\u1ec7u ch\u1ee9ng kinh \u0111i\u1ec3n c\u1ee7a vi\u00eam m\u0169i d\u1ecb \u1ee9ng bao g\u1ed3m: ng\u1ea1t m\u0169i, ng\u1ee9a m\u0169i, ch\u1ea3y m\u0169i v\u00e0 h\u1eaft h\u01a1i. Vi\u00eam k\u1ebft m\u1ea1c d\u1ecb \u1ee9ng c\u0169ng th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn vi\u00eam m\u0169i d\u1ecb \u1ee9ng v\u00e0 tri\u1ec7u ch\u1ee9ng \u0111i\u1ec3n h\u00ecnh bao g\u1ed3m \u0111\u1ecf m\u1eaft, ch\u1ea3y n\u01b0\u1edbc m\u1eaft v\u00e0 ng\u1ee9a m\u1eaft. Ch\u1ea3y d\u1ecbch th\u00e0nh sau h\u1ecdng do vi\u00eam m\u0169i c\u00f3 th\u1ec3 g\u00e2y ho ho\u1eb7c c\u1ea3m gi\u00e1c c\u00f3 \u0111\u1eddm trong h\u1ecdng.<\/p>\n<p>Khuy\u1ebfn c\u00e1o khai th\u00e1c k\u1ef9 v\u1ec1 m\u00f4i tr\u01b0\u1eddng gia \u0111\u00ecnh v\u00e0 n\u01a1i l\u00e0m vi\u1ec7c\/tr\u01b0\u1eddng h\u1ecdc c\u1ee7a b\u1ec7nh nh\u00e2n \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh c\u00e1c t\u00e1c nh\u00e2n g\u00e2y vi\u00eam m\u0169i d\u1ecb \u1ee9ng. M\u00f4i tr\u01b0\u1eddng n\u00ean t\u1eadp trung v\u00e0o c\u00e1c d\u1ecb nguy\u00ean th\u01b0\u1eddng g\u1eb7p v\u00e0 c\u00f3 th\u1ec3 li\u00ean quan AR, bao g\u1ed3m: ph\u1ea5n hoa, l\u00f4ng \u0111\u1ed9ng v\u1eadt, kh\u00f3i thu\u1ed1c l\u00e1 ho\u1eb7c \u0111\u1ed9 \u1ea9m trong nh\u00e0, c\u0169ng nh\u01b0 c\u00e1c ch\u1ea5t \u0111\u1ed9c h\u1ea1i kh\u00e1c m\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 ti\u1ebfp x\u00fac t\u1ea1i n\u01a1i l\u00e0m vi\u1ec7c ho\u1eb7c \u1edf nh\u00e0. Vi\u1ec7c s\u1eed d\u1ee5ng m\u1ed9t s\u1ed1 lo\u1ea1i thu\u1ed1c (v\u00ed d\u1ee5: ch\u1eb9n beta, acid acetylsalicylic, NSAIDs, \u1ee9c ch\u1ebf men chuy\u1ec3n v\u00e0 hormone thay th\u1ebf) c\u0169ng nh\u01b0 vi\u1ec7c s\u1eed d\u1ee5ng cocaine \u0111\u1ec3 gi\u1ea3i tr\u00ed c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c tri\u1ec7u ch\u1ee9ng vi\u00eam m\u0169i. Do \u0111\u00f3, c\u1ea7n h\u1ecfi b\u1ec7nh nh\u00e2n v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c ho\u1eb7c ch\u1ea5t k\u00edch th\u00edch hi\u1ec7n t\u1ea1i ho\u1eb7c g\u1ea7n \u0111\u00e2y.<\/p>\n<p>Ti\u1ec1n s\u1eed b\u1ec7nh c\u0169ng c\u1ea7n bao g\u1ed3m vi\u1ec7c h\u1ecfi b\u1ec7nh nh\u00e2n v\u1ec1 ti\u1ec1n s\u1eed gia \u0111\u00ecnh c\u00f3 m\u1eafc c\u00e1c b\u1ec7nh l\u00fd atopy, \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng v\u00e0 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c b\u1ec7nh \u0111\u1ed3ng m\u1eafc nh\u01b0 hen, ng\u1ee7 ng\u00e1y, ng\u01b0ng th\u1edf khi ng\u1ee7, vi\u00eam xoang, vi\u00eam tai gi\u1eefa ho\u1eb7c polyp m\u0169i. B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 cho r\u1eb1ng c\u00e1c tri\u1ec7u ch\u1ee9ng m\u0169i k\u00e9o d\u00e0i l\u00e0 do \u201cc\u1ea3m l\u1ea1nh\u201d, v\u00ec v\u1eady c\u0169ng c\u1ea7n ghi nh\u1eadn t\u1ea7n su\u1ea5t v\u00e0 th\u1eddi gian xu\u1ea5t hi\u1ec7n c\u1ee7a c\u00e1c \u0111\u1ee3t nhi\u1ec5m virus \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean.<\/p>\n<p>Tr\u01b0\u1edbc khi t\u00ecm \u0111\u1ebfn c\u01a1 s\u1edf y t\u1ebf, b\u1ec7nh nh\u00e2n th\u01b0\u1eddng t\u1ef1 d\u00f9ng c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00f4ng k\u00ea \u0111\u01a1n ho\u1eb7c c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1c \u0111\u1ec3 ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng c\u1ee7a m\u00ecnh. \u0110\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n v\u1edbi c\u00e1c \u0111i\u1ec1u tr\u1ecb n\u00e0y c\u00f3 th\u1ec3 cung c\u1ea5p th\u00eam th\u00f4ng tin trong ch\u1ea9n \u0111o\u00e1n v\u00e0 h\u01b0\u1edbng qu\u1ea3n l\u00fd ti\u1ebfp theo trong vi\u00eam m\u0169i d\u1ecb \u1ee9ng. V\u00ed d\u1ee5, tri\u1ec7u ch\u1ee9ng c\u1ea3i thi\u1ec7n sau d\u00f9ng thu\u1ed1c kh\u00e1ng histamine th\u1ebf h\u1ec7 th\u1ee9 hai l\u00e0 m\u1ed9t ch\u1ec9 \u0111i\u1ec3m m\u1ea1nh m\u1ebd g\u1ee3i \u00fd nguy\u00ean nh\u00e2n d\u1ecb \u1ee9ng. Tuy nhi\u00ean, c\u1ea7n l\u01b0u \u00fd nh\u1eefng \u0111\u00e1p \u1ee9ng v\u1edbi thu\u1ed1c kh\u00e1ng histamine th\u1ebf h\u1ec7 th\u1ee9 nh\u1ea5t (vd, diphehydramine, brompheniramine maleate, chlorpheniramine maleate, clesmatine) kh\u00f4ng ch\u1ec9 \u0111i\u1ec3m nh\u00f3m nguy\u00ean nh\u00e2n d\u1ecb \u1ee9ng, v\u00ec c\u00e1c \u0111\u1eb7c t\u00ednh kh\u00e1ng cholinergic v\u00e0 an th\u1ea7n c\u1ee7a nh\u1eefng lo\u1ea1i thu\u1ed1c n\u00e0y c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m ch\u1ea3y m\u0169i v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng gi\u1ea5c ng\u1ee7 m\u00e0 kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u00e0o vi\u1ec7c vi\u00eam c\u00f3 ph\u1ea3i do d\u1ecb \u1ee9ng hay kh\u00f4ng. \u0110\u00e1p \u1ee9ng v\u1edbi corticosteroid d\u1ea1ng x\u1ecbt c\u0169ng g\u1ee3i \u00fd nguy\u00ean nh\u00e2n d\u1ecb \u1ee9ng v\u00e0 th\u01b0\u1eddng cho th\u1ea5y r\u1eb1ng vi\u1ec7c \u0111i\u1ec1u tr\u1ecb n\u00e0y s\u1ebd ti\u1ebfp t\u1ee5c mang l\u1ea1i l\u1ee3i \u00edch trong t\u01b0\u01a1ng lai. N\u1ebfu corticosteroid d\u1ea1ng x\u1ecbt m\u0169i \u0111\u00e3 t\u1eebng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng, vi\u1ec7c x\u00e1c \u0111\u1ecbnh th\u1eddi gian \u0111i\u1ec1u tr\u1ecb, m\u1ee9c \u0111\u1ed9 tu\u00e2n th\u1ee7 v\u00e0 k\u1ef9 thu\u1eadt s\u1eed d\u1ee5ng l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 li\u1ec7u l\u00e0 th\u1eed nghi\u1ec7m \u0111i\u1ec1u tr\u1ecb c\u00f3 ph\u00f9 h\u1ee3p kh\u00f4ng, v\u00ec corticosteroid d\u1ea1ng x\u1ecbt m\u0169i c\u00f3 th\u1ec3 m\u1ea5t 2-4 tu\u1ea7n \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3.<\/p>\n<h3>Kh\u00e1m l\u00e2m s\u00e0ng<\/h3>\n<p>Vi\u1ec7c kh\u00e1m l\u00e2m s\u00e0ng \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n nghi ng\u1edd vi\u00eam m\u0169i d\u1ecb \u1ee9ng n\u00ean bao g\u1ed3m \u0111\u00e1nh gi\u00e1 c\u00e1c d\u1ea5u hi\u1ec7u b\u00ean ngo\u00e0i, m\u0169i, tai, xoang, th\u00e0nh sau h\u1ecdng, ph\u1ed5i v\u00e0 da. C\u00e1c d\u1ea5u hi\u1ec7u b\u00ean ngo\u00e0i c\u00f3 th\u1ec3 g\u1ee3i \u00fd vi\u00eam m\u0169i d\u1ecb \u1ee9ng bao g\u1ed3m: th\u1edf b\u1eb1ng mi\u1ec7ng k\u00e9o d\u00e0i, hay c\u1ecd m\u0169i ho\u1eb7c c\u00f3 n\u1ebfp nh\u0103n ngang r\u00f5 r\u1ec7t tr\u00ean m\u0169i, hay h\u00edt m\u0169i ho\u1eb7c \u0111\u1eb1ng h\u1eafng, v\u00e0 qu\u1ea7ng th\u00e2m d\u1ecb \u1ee9ng. Kh\u00e1m m\u0169i th\u01b0\u1eddng cho th\u1ea5y t\u00ecnh tr\u1ea1ng s\u01b0ng ni\u00eam m\u1ea1c m\u0169i v\u00e0 ti\u1ebft d\u1ecbch nh\u1ea7y nh\u1ea1t m\u00e0u, lo\u00e3ng. C\u1ea7n c\u00e2n nh\u1eafc th\u1ef1c hi\u1ec7n n\u1ed9i soi m\u0169i \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 c\u00e1c b\u1ea5t th\u01b0\u1eddng v\u1ec1 c\u1ea5u tr\u00fac, bao g\u1ed3m l\u1ec7ch v\u00e1ch ng\u0103n m\u0169i, lo\u00e9t v\u00e0 polyp m\u0169i.<\/p>\n<p>Tai th\u01b0\u1eddng c\u00f3 v\u1ebb b\u00ecnh th\u01b0\u1eddng \u1edf b\u1ec7nh nh\u00e2n vi\u00eam m\u0169i d\u1ecb \u1ee9ng; tuy nhi\u00ean, \u0111\u00e1nh gi\u00e1 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng v\u00f2i Eustach b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng k\u00ednh soi tai kh\u00ed n\u00e9n n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t. Nghi\u1ec7m ph\u00e1p Valsalva (t\u0103ng \u00e1p l\u1ef1c trong khoang m\u0169i b\u1eb1ng c\u00e1ch c\u1ed1 g\u1eafng th\u00f4i ra qua m\u0169i trong khi b\u1ecbt k\u00edn m\u0169i) c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 xem c\u00f3 d\u1ecbch sau m\u00e0ng nh\u0129 hay kh\u00f4ng.<\/p>\n<p>Vi\u1ec7c kh\u00e1m xoang n\u00ean bao g\u1ed3m vi\u1ec7c s\u1edd n\u1eafn c\u00e1c xoang \u0111\u1ec3 ki\u1ec3m tra d\u1ea5u hi\u1ec7u \u0111au ho\u1eb7c g\u00f5 nh\u1eb9 v\u00e0o r\u0103ng h\u00e0m tr\u00ean b\u1eb1ng que \u0111\u00e8 l\u01b0\u1ee1i \u0111\u1ec3 ph\u00e1t hi\u1ec7n s\u1ef1 nh\u1ea1y c\u1ea3m. Th\u00e0nh sau h\u1ecdng c\u0169ng c\u1ea7n \u0111\u01b0\u1ee3c ki\u1ec3m tra \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c d\u1ea5u hi\u1ec7u ch\u1ea3y d\u1ecbch th\u00e0nh sau h\u1ecdng. Ngo\u00e0i ra, c\u1ea7n kh\u00e1m k\u1ef9 ph\u1ed5i v\u00e0 da \u0111\u1ec3 t\u00ecm c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a hen \u0111i k\u00e8m (v\u00ed d\u1ee5: kh\u00f2 kh\u00e8) ho\u1eb7c vi\u00eam da.<\/p>\n<h3>X\u00e9t nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n<\/h3>\n<p>M\u1eb7c d\u00f9 khai th\u00e1c chi ti\u1ebft b\u1ec7nh s\u1eed, ti\u1ec1n s\u1eed v\u00e0 kh\u00e1m l\u00e2m s\u00e0ng k\u0129 l\u01b0\u1ee1ng \u0111\u1ec3 \u0111\u01b0a ra ch\u1ea9n \u0111o\u00e1n vi\u00eam s\u00e0ng vi\u00eam m\u0169i, nh\u01b0ng c\u1ea7n th\u1ef1c hi\u1ec7n c\u00e1c x\u00e9t nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n b\u1ed5 sung \u0111\u1ec3 x\u00e1c nh\u1eadn vi\u00eam m\u0169i c\u00f3 ph\u1ea3i do nguy\u00ean nh\u00e2n d\u1ecb \u1ee9ng g\u00e2y ra. Test l\u1ea5y da \u0111\u01b0\u1ee3c coi l\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u00ednh \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh c\u00e1c t\u00e1c nh\u00e2n d\u1ecb \u1ee9ng c\u1ee5 th\u1ec3 g\u00e2y vi\u00eam m\u0169i. Thu\u1ed1c kh\u00e1ng histamine c\u00f3 th\u1ec3 g\u00e2y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn vi\u1ec7c di\u1ec5n gi\u1ea3i k\u1ebft qu\u1ea3 test l\u1ea9y da, do \u0111\u00f3 c\u1ea7n ng\u1eebng s\u1eed d\u1ee5ng thu\u1ed1c 5-7 ng\u00e0y tr\u01b0\u1edbc khi l\u00e0m test. M\u1ed9t gi\u1ea3i ph\u00e1p thay th\u1ebf h\u1ee3p l\u00fd cho test l\u1ea5y da l\u00e0 x\u00e9t nghi\u1ec7m IgE \u0111\u1eb7c hi\u1ec7u v\u1edbi d\u1ecb nguy\u00ean. C\u00e1c x\u00e9t nghi\u1ec7m n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng ng\u1eebng d\u00f9ng thu\u1ed1c kh\u00e1ng histamine \u0111\u1ec3 l\u00e0m test l\u1ea9y da, nh\u1eefng ng\u01b0\u1eddi kh\u00f4ng th\u1ec3 \u0111\u1ebfn tr\u1ef1c ti\u1ebfp \u0111\u1ec3 l\u00e0m x\u00e9t nghi\u1ec7m ho\u1eb7c nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb ch\u00e0m lan r\u1ed9ng khi\u1ebfn h\u1ecd kh\u00f4ng th\u1ec3 l\u00e0m \u0111\u01b0\u1ee3c test l\u1ea5y da. Test l\u1ea9y da \u0111\u01b0\u1ee3c coi l\u00e0 nh\u1ea1y h\u01a1n v\u00e0 hi\u1ec7u qu\u1ea3 h\u01a1n v\u1ec1 m\u1eb7t chi ph\u00ed so v\u1edbi x\u00e9t nghi\u1ec7m IgE \u0111\u1eb7c hi\u1ec7u trong huy\u1ebft thanh, \u0111\u1ed3ng th\u1eddi c\u00f3 \u01b0u \u0111i\u1ec3m l\u00e0 cho k\u1ebft qu\u1ea3 ngay l\u1eadp t\u1ee9c. Tuy nhi\u00ean, x\u00e9t nghi\u1ec7m IgE \u0111\u1eb7c hi\u1ec7u trong huy\u1ebft thanh l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn thay th\u1ebf ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c trong h\u1ed7 tr\u1ee3 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>Vi\u1ec7c x\u00e9t nghi\u1ec7m d\u1ecb nguy\u00ean th\u1ee9c \u0103n ch\u1ec9 d\u1ef1a v\u00e0o tri\u1ec7u ch\u1ee9ng c\u1ee7a vi\u00eam m\u0169i d\u1ecb \u1ee9ng kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o. Ngo\u00e0i ra, ch\u1ee5p xoang m\u0169i c\u0169ng kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o tr\u00ean b\u1ec7nh nh\u00e2n ch\u1ec9 c\u00f3 tri\u1ec7u ch\u1ee9ng g\u1ee3i \u00fd vi\u00eam m\u0169i d\u1ecb \u1ee9ng.<\/p>\n<h2>\u0110i\u1ec1u tr\u1ecb<\/h2>\n<p>M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb vi\u00eam m\u0169i d\u1ecb \u1ee9ng l\u00e0 gi\u1ea3m b\u1edbt tri\u1ec7u ch\u1ee9ng. C\u00e1c l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee5c ti\u00eau n\u00e0y bao g\u1ed3m c\u00e1c bi\u1ec7n ph\u00e1p tr\u00e1nh ti\u1ebfp x\u00fac d\u1ecb nguy\u00ean, r\u1eeda m\u0169i b\u1eb1ng n\u01b0\u1edbc mu\u1ed1i sinh l\u00fd, thu\u1ed1c kh\u00e1ng histamine \u0111\u01b0\u1eddng u\u1ed1ng, corticosteroid d\u1ea1ng x\u1ecbt m\u0169i, thu\u1ed1c x\u1ecbt k\u1ebft h\u1ee3p corticosteroid\/kh\u00e1ng histamine, thu\u1ed1c \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 leukotriene (LTRAs) v\u00e0 li\u1ec7u ph\u00e1p mi\u1ec5n d\u1ecbch d\u1ecb nguy\u00ean (allergen immunotherapy).<\/p>\n<p>C\u00e1c li\u1ec7u ph\u00e1p kh\u00e1c c\u00f3 th\u1ec3 h\u1eefu \u00edch \u0111\u1ed1i v\u1edbi m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n bao g\u1ed3m thu\u1ed1c corticosteroid \u0111\u01b0\u1eddng u\u1ed1ng v\u00e0 thu\u1ed1c tr\u1ecb ng\u1ea1t m\u0169i (decongestants). Vi\u00eam m\u0169i d\u1ecb \u1ee9ng v\u00e0 hen d\u01b0\u1eddng nh\u01b0 l\u00e0 m\u1ed9t b\u1ec7nh vi\u00eam \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p k\u1ebft h\u1ee3p, do \u0111\u00f3 vi\u1ec7c \u0111i\u1ec1u tr\u1ecb hen l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 quan tr\u1ecdng c\u1ea7n xem x\u00e9t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb vi\u00eam m\u0169i d\u1ecb \u1ee9ng. Trong b\u1ea5t k\u1ef3 giai \u0111o\u1ea1n n\u00e0o, n\u00ean c\u00e2n nh\u1eafc chuy\u1ec3n b\u1ec7nh nh\u00e2n \u0111\u1ebfn b\u00e1c s\u0129 chuy\u00ean khoa d\u1ecb \u1ee9ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh v\u00e0 th\u1ea3o lu\u1eadn v\u1ec1 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb\/qu\u1ea3n l\u00fd.<\/p>\n<figure id=\"attachment_109681\" aria-describedby=\"caption-attachment-109681\" style=\"width: 685px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-109681\" src=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/02\/viem-mui-di-ung.jpg\" alt=\"\u0110i\u1ec1u tr\u1ecb b\u1ec7nh vi\u00eam m\u0169i d\u1ecb \u1ee9ng\" width=\"685\" height=\"591\" title=\"\" srcset=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/02\/viem-mui-di-ung.jpg 685w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/02\/viem-mui-di-ung-464x400.jpg 464w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/02\/viem-mui-di-ung-350x302.jpg 350w\" sizes=\"auto, (max-width: 685px) 100vw, 685px\" \/><figcaption id=\"caption-attachment-109681\" class=\"wp-caption-text\">\u0110i\u1ec1u tr\u1ecb b\u1ec7nh vi\u00eam m\u0169i d\u1ecb \u1ee9ng<\/figcaption><\/figure>\n<h3>Tr\u00e1nh ti\u1ebfp x\u00fac d\u1ecb nguy\u00ean<\/h3>\n<p>\u0110i\u1ec1u tr\u1ecb \u0111\u1ea7u ti\u00ean \u0111\u1ed1i v\u1edbi vi\u00eam m\u0169i d\u1ecb \u1ee9ng l\u00e0 tr\u00e1nh ti\u1ebfp x\u00fac v\u1edbi c\u00e1c d\u1ecb nguy\u00ean li\u00ean quan (v\u00ed d\u1ee5: m\u1ea1t b\u1ee5i nh\u00e0, n\u1ea5m m\u1ed1c, th\u00fa c\u01b0ng, ph\u1ea5n hoa) v\u00e0 c\u00e1c ch\u1ea5t k\u00edch th\u00edch (v\u00ed d\u1ee5: kh\u00f3i thu\u1ed1c l\u00e1) trong kh\u1ea3 n\u0103ng c\u00f3 th\u1ec3.<\/p>\n<h3>N\u01b0\u1edbc mu\u1ed1i sinh l\u00fd v\u00f4 tr\u00f9ng<\/h3>\n<p>R\u1eeda m\u0169i b\u1eb1ng n\u01b0\u1edbc mu\u1ed1i sinh l\u00fd v\u00f4 tr\u00f9ng \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 gi\u00fap c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng \u0111\u1ed3ng th\u1eddi l\u00e0m gi\u1ea3m nhu c\u1ea7u s\u1eed d\u1ee5ng thu\u1ed1c \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n vi\u00eam m\u0169i d\u1ecb \u1ee9ng. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y c\u0169ng gi\u00fap duy tr\u00ec \u0111\u1ed9 \u1ea9m \u1edf m\u0169i v\u00e0 l\u00e0m s\u1ea1ch ch\u1ea5t nh\u1ea7y. N\u01b0\u1edbc mu\u1ed1i sinh l\u00fd v\u00f4 tr\u00f9ng l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn d\u1ec5 s\u1eed d\u1ee5ng, chi ph\u00ed th\u1ea5p, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 t\u1ef1 trang b\u1ecb, kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng ph\u1ee5 ti\u1ec1m \u1ea9n nh\u01b0 trong c\u00e1c li\u1ec7u ph\u00e1p d\u00f9ng thu\u1ed1c.<\/p>\n<h3>Thu\u1ed1c kh\u00e1ng histamine<\/h3>\n<p>Thu\u1ed1c kh\u00e1ng histamine th\u1ebf h\u1ec7 th\u1ee9 2 \u0111\u01b0\u1eddng u\u1ed1ng, nh\u01b0 desloratadine (Aerius), fexofenadine (Allegra), loratadine (Claritin), cetirizine (Reactine), bilastine (Blexten) v\u00e0 rupatadine (Rupall) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c d\u00f9ng nh\u01b0 li\u1ec7u ph\u00e1p \u0111\u1ea7u tay cho b\u1ec7nh nh\u00e2n vi\u00eam m\u0169i d\u1ecb \u1ee9ng. Thu\u1ed1c kh\u00e1ng histamine th\u1ebf h\u1ec7 2 \u0111\u01b0\u1eddng u\u1ed1ng \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 hi\u1ec7u qu\u1ea3 trong gi\u1ea3m h\u1eaft h\u01a1i, ng\u1ee9a m\u0169i v\u00e0 ch\u1ea3y m\u0169i khi \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec1u \u0111\u1eb7n v\u00e0o th\u1eddi \u0111i\u1ec3m tri\u1ec7u ch\u1ee9ng \u0111\u1ea1t m\u1ee9c t\u1ed1i \u0111a ho\u1eb7c tr\u01b0\u1edbc khi ti\u1ebfp x\u00fac v\u1edbi d\u1ecb nguy\u00ean. M\u1eb7c d\u00f9 hi\u1ec7u qu\u1ea3 c\u1ee7a ch\u00fang th\u1ea5p h\u01a1n so v\u1edbi corticosteroid d\u1ea1ng x\u1ecbt m\u0169i, nh\u01b0ng ch\u00fang c\u00f3 th\u1ec3 l\u00e0 l\u1ef1a ch\u1ecdn \u01b0u ti\u00ean cho b\u1ec7nh nh\u00e2n d\u1ef1a tr\u00ean mong mu\u1ed1n c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n<p>M\u1eb7c d\u00f9 c\u00e1c thu\u1ed1c kh\u00e1ng histamine th\u1ebf h\u1ec7 1 (v\u00ed d\u1ee5: diphehydramine, chlorpheniramine) c\u0169ng c\u00f3 hi\u1ec7u qu\u1ea3 trong vi\u1ec7c gi\u1ea3m tri\u1ec7u ch\u1ee9ng, nh\u01b0ng ch\u00fang \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u00f3 t\u00e1c \u0111\u1ed9ng ti\u00eau c\u1ef1c \u0111\u1ebfn nh\u1eadn th\u1ee9c v\u00e0 kh\u1ea3 n\u0103ng ho\u1ea1t \u0111\u1ed9ng. V\u00ec th\u1ebf, ch\u00fang kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o trong \u0111i\u1ec1u tr\u1ecb vi\u00eam m\u0169i d\u1ecb \u1ee9ng.<\/p>\n<h3>Corticosteroid x\u1ecbt m\u0169i<\/h3>\n<p>Corticosteroid d\u1ea1ng x\u1ecbt m\u0169i l\u00e0 li\u1ec7u ph\u00e1p \u0111\u1ea7u tay cho b\u1ec7nh nh\u00e2n vi\u00eam m\u0169i d\u1ecb \u1ee9ng (AR) v\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u01a1n \u0111\u1ed9c ho\u1eb7c k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c kh\u00e1ng histamine \u0111\u01b0\u1eddng u\u1ed1ng. Khi \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u00fang c\u00e1ch v\u00e0 \u0111\u1ec1u \u0111\u1eb7n, corticosteroid d\u1ea1ng x\u1ecbt m\u0169i c\u00f3 hi\u1ec7u qu\u1ea3 trong vi\u1ec7c gi\u1ea3m vi\u00eam ni\u00eam m\u1ea1c m\u0169i v\u00e0 c\u1ea3i thi\u1ec7n b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn ni\u00eam m\u1ea1c. C\u00e1c nghi\u00ean c\u1ee9u v\u00e0 ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p cho th\u1ea5y corticosteroid d\u1ea1ng x\u1ecbt m\u0169i v\u01b0\u1ee3t tr\u1ed9i h\u01a1n so v\u1edbi thu\u1ed1c kh\u00e1ng histamine v\u00e0 thu\u1ed1c \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 leukotriene (LTRAs) trong vi\u1ec7c ki\u1ec3m so\u00e1t c\u00e1c tri\u1ec7u ch\u1ee9ng AR, bao g\u1ed3m ng\u1ea1t m\u0169i v\u00e0 ch\u1ea3y m\u0169i. Ch\u00fang c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u1ea3i thi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng \u1edf m\u1eaft v\u00e0 gi\u1ea3m c\u00e1c tri\u1ec7u ch\u1ee9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p d\u01b0\u1edbi \u1edf b\u1ec7nh nh\u00e2n c\u00f3 hen \u0111\u1ed3ng m\u1eafc.<\/p>\n<p>C\u00e1c corticosteroid d\u1ea1ng x\u1ecbt m\u0169i \u0111\u01b0\u1ee3c ph\u00ea duy\u1ec7t t\u1ea1i Canada bao g\u1ed3m fluticasone furoate (Avamys), beclomethasone (Beconase), fluticasone propionate (Flonase), triamcinolone acetonide (Nasacort), mometasone furoate (Nasonex), ciclesonide (Omnaris) v\u00e0 budesonide (Rhinocort). L\u00fd t\u01b0\u1edfng nh\u1ea5t l\u00e0 n\u00ean b\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng corticosteroid d\u1ea1ng x\u1ecbt m\u0169i ngay tr\u01b0\u1edbc khi ti\u1ebfp x\u00fac v\u1edbi c\u00e1c d\u1ecb nguy\u00ean li\u00ean quan. Do hi\u1ec7u qu\u1ea3 t\u1ed1i \u0111a c\u00f3 th\u1ec3 c\u1ea7n \u0111\u1ebfn v\u00e0i ng\u00e0y \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c, n\u00ean s\u1eed d\u1ee5ng ch\u00fang m\u1ed9t c\u00e1ch \u0111\u1ec1u \u0111\u1eb7n.<\/p>\n<p>T\u00e1c d\u1ee5ng ph\u1ee5 th\u01b0\u1eddng g\u1eb7p nh\u1ea5t c\u1ee7a corticosteroid d\u1ea1ng x\u1ecbt m\u0169i l\u00e0 k\u00edch \u1ee9ng v\u00e0 r\u00e1t m\u0169i. C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 n\u00e0y th\u01b0\u1eddng c\u00f3 th\u1ec3 ng\u0103n ng\u1eeba b\u1eb1ng c\u00e1ch h\u01b0\u1edbng tia x\u1ecbt h\u01a1i l\u1ec7ch kh\u1ecfi v\u00e1ch ng\u0103n m\u0169i. B\u1eb1ng ch\u1ee9ng cho th\u1ea5y beclomethasone v\u00e0 triamcinolone c\u00f3 th\u1ec3 l\u00e0m ch\u1eadm s\u1ef1 ph\u00e1t tri\u1ec3n \u1edf tr\u1ebb em so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c, tuy nhi\u00ean c\u00f2n thi\u1ebfu c\u00e1c nghi\u00ean c\u1ee9u d\u00e0i h\u1ea1n v\u1ec1 \u1ea3nh h\u01b0\u1edfng c\u1ee7a li\u1ec1u th\u00f4ng th\u01b0\u1eddng beclomethasone d\u1ea1ng x\u1ecbt m\u0169i \u0111\u1ed1i v\u1edbi s\u1ef1 ph\u00e1t tri\u1ec3n.<\/p>\n<p>\u0110i\u1ec1u quan tr\u1ecdng c\u1ea7n l\u01b0u \u00fd l\u00e0 h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n b\u1ecb vi\u00eam m\u0169i d\u1ecb \u1ee9ng khi \u0111\u1ebfn kh\u00e1m \u0111\u1ec1u c\u00f3 tri\u1ec7u ch\u1ee9ng m\u1ee9c \u0111\u1ed9 trung b\u00ecnh-n\u1eb7ng v\u00e0 c\u1ea7n s\u1eed d\u1ee5ng corticosteroid d\u1ea1ng x\u1ecbt m\u0169i. Bousquet v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 ghi nh\u1eadn k\u1ebft qu\u1ea3 c\u1ea3i thi\u1ec7n \u1edf c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng khi \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1ch k\u1ebft h\u1ee3p c\u00e1c thu\u1ed1c n\u00e0y.<\/p>\n<h3>K\u1ebft h\u1ee3p corticosteroid v\u00e0 kh\u00e1ng histamine d\u1ea1ng x\u1ecbt m\u0169i<\/h3>\n<p>N\u1ebfu corticosteroid d\u1ea1ng x\u1ecbt m\u0169i kh\u00f4ng hi\u1ec7u qu\u1ea3, c\u00f3 th\u1ec3 th\u1eed s\u1eed d\u1ee5ng thu\u1ed1c x\u1ecbt k\u1ebft h\u1ee3p corticosteroid\/kh\u00e1ng histamine, ch\u1eb3ng h\u1ea1n nh\u01b0 fluticasone propionate\/azelastine hydrochloride (Dymista) ho\u1eb7c olopatadine hydrochloride\/mometasone furoate monohydrate (Ryaltris). C\u00e1c thu\u1ed1c x\u1ecbt k\u1ebft h\u1ee3p n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u00f3 hi\u1ec7u qu\u1ea3 trong v\u00e0i ph\u00fat, v\u00e0 hi\u1ec7u qu\u1ea3 h\u01a1n so v\u1edbi t\u1eebng th\u00e0nh ph\u1ea7n ri\u00eang l\u1ebb, v\u1edbi \u0111\u1ed9 an to\u00e0n t\u01b0\u01a1ng t\u1ef1 nh\u01b0 corticosteroid d\u1ea1ng x\u1ecbt m\u0169i. Thu\u1ed1c x\u1ecbt k\u1ebft h\u1ee3p corticosteroid\/kh\u00e1ng histamine c\u0169ng v\u01b0\u1ee3t tr\u1ed9i h\u01a1n so v\u1edbi vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c kh\u00e1ng histamine \u0111\u01b0\u1eddng u\u1ed1ng k\u1ebft h\u1ee3p v\u1edbi corticosteroid d\u1ea1ng x\u1ecbt m\u0169i. Tuy nhi\u00ean, ch\u01b0a c\u00f3 d\u1eef li\u1ec7u c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t n\u00e0o v\u1ec1 hi\u1ec7u qu\u1ea3 gi\u1eefa hai ph\u01b0\u01a1ng ph\u00e1p n\u00e0y sau khi s\u1eed d\u1ee5ng l\u00e2u d\u00e0i hay kh\u00f4ng.<\/p>\n<h3>Thu\u1ed1c \u0111\u1ed1i v\u1eadn th\u1ee5 th\u1ec3 leukotriene (LTRAS)<\/h3>\n<p>C\u00e1c thu\u1ed1c \u0111\u1ed1i v\u1eadn th\u1ee5 th\u1ec3 leukotriene nh\u01b0 montelukast v\u00e0 zafirlukast c\u0169ng hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb vi\u00eam m\u0169i d\u1ecb \u1ee9ng; tuy nhi\u00ean, ch\u00fang kh\u00f4ng c\u00f3 v\u1ebb hi\u1ec7u qu\u1ea3 b\u1eb1ng corticosteroid d\u1ea1ng x\u1ecbt m\u0169i. M\u1eb7c d\u00f9 trong m\u1ed9t nghi\u00ean c\u1ee9u ng\u1eafn h\u1ea1n cho th\u1ea5y s\u1ef1 k\u1ebft h\u1ee3p gi\u1eefa LTRAS v\u00e0 thu\u1ed1c kh\u00e1ng histamine c\u00f3 hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi corticosteroid d\u1ea1ng x\u1ecbt m\u0169i, nh\u01b0ng c\u00e1c nghi\u00ean c\u1ee9u d\u00e0i h\u1ea1n \u0111\u00e3 ch\u1ee9ng minh r\u1eb1ng corticosteroid d\u1ea1ng x\u1ecbt m\u0169i hi\u1ec7u qu\u1ea3 h\u01a1n trong vi\u1ec7c l\u00e0m gi\u1ea3m c\u00e1c tri\u1ec7u ch\u1ee9ng v\u1ec1 \u0111\u00eam v\u00e0 tri\u1ec7u ch\u1ee9ng \u1edf m\u0169i. Hi\u1ec7n t\u1ea1i, montelukast l\u00e0 LTRA duy nh\u1ea5t \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb vi\u00eam m\u0169i d\u1ecb \u1ee9ng \u1edf ng\u01b0\u1eddi l\u1edbn t\u1ea1i Canada.<\/p>\n<p>LTRAS n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng khi c\u00e1c \u0111i\u1ec1u tr\u1ecb kh\u00e1c nh\u01b0 thu\u1ed1c kh\u00e1ng histamine \u0111\u01b0\u1eddng u\u1ed1ng, corticosteroid d\u1ea1ng x\u1ecbt m\u0169i v\u00e0\/ho\u1eb7c thu\u1ed1c x\u1ecbt k\u1ebft h\u1ee3p corticosteroid\/kh\u00e1ng histamine kh\u00f4ng \u0111\u01b0\u1ee3c dung n\u1ea1p t\u1ed1t ho\u1eb7c kh\u00f4ng \u0111\u1ee7 hi\u1ec7u qu\u1ea3 trong vi\u1ec7c ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng. LTRAs \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng vi\u00eam m\u0169i v\u00e0o ban \u0111\u00eam. N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 c\u1ea3 b\u1ec7nh hen \u0111\u1ed3ng m\u1eafc, LTRA c\u00f3 th\u1ec3 mang l\u1ea1i l\u1ee3i \u00edch cho c\u1ea3 hai t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd. Tuy nhi\u00ean, LTRAs c\u00f3 th\u1ec3 \u0111i k\u00e8m v\u1edbi nguy c\u01a1 g\u00e2y ra c\u00e1c bi\u1ebfn c\u1ed1 t\u00e2m th\u1ea7n kinh, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf tr\u1ebb d\u01b0\u1edbi 6 tu\u1ed5i, n\u00ean n\u1ebfu k\u00ea \u0111\u01a1n, b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i c\u00e1c tri\u1ec7u ch\u1ee9ng n\u00e0y.<\/p>\n<h2>\u0110\u00fac k\u1ebft l\u00e2m s\u00e0ng<\/h2>\n<p>AR c\u00f3 m\u1ed1i li\u00ean quan ch\u1eb7t ch\u1ebd v\u1edbi hen v\u00e0 vi\u00eam k\u1ebft m\u1ea1c.<\/p>\n<p>Test d\u1ecb nguy\u00ean (allergen skin testing) l\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n t\u1ed1t nh\u1ea5t \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh AR. Tuy nhi\u00ean, x\u00e9t nghi\u1ec7m IgE \u0111\u1eb7c hi\u1ec7u trong huy\u1ebft thanh c\u0169ng l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn h\u1ee3p l\u00fd.<\/p>\n<p>Corticosteroid x\u1ecbt m\u0169i l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb ch\u00ednh cho h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n m\u1eafc AR. Thu\u1ed1c kh\u00e1ng histamin u\u1ed1ng th\u1ebf h\u1ec7 th\u1ee9 hai c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nh\u01b0 li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u tay.<\/p>\n<p>Li\u1ec7u ph\u00e1p mi\u1ec5n d\u1ecbch v\u1edbi d\u1ecb nguy\u00ean l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u ch\u1ec9nh mi\u1ec5n d\u1ecbch hi\u1ec7u qu\u1ea3, \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p ho\u1eb7c thay th\u1ebf cho li\u1ec7u ph\u00e1p d\u01b0\u1ee3c l\u00fd.<\/p>\n<p>\u1ede b\u1ea5t k\u1ef3 giai \u0111o\u1ea1n n\u00e0o trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n AR, n\u00ean c\u00e2n nh\u1eafc chuy\u1ec3n b\u1ec7nh nh\u00e2n \u0111\u1ebfn b\u00e1c s\u0129 chuy\u00ean khoa d\u1ecb \u1ee9ng \u0111\u1ec3 x\u00e1c nh\u1eadn ch\u1ea9n \u0111o\u00e1n v\u00e0 th\u1ea3o lu\u1eadn v\u1ec1 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb qu\u1ea3n l\u00fd.<\/p>\n<h2>T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n<ol>\n<li>Rosenfield L, Keith PK, Quirt J, Small P, Ellis AK. Vi\u00eam m\u0169i d\u1ecb \u1ee9ng. Hen suy\u1ec5n d\u1ecb \u1ee9ng l\u00e2m s\u00e0ng mi\u1ec5n d\u1ecbch. 27 th\u00e1ng 12 n\u0103m 2024; 20 (Ph\u1ee5 l\u1ee5c 3): 74. doi: 10.1186\/s13223-024-00923-6. PMID: 39731198; PMCID: PMC11681636.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>L\u01b0\u1ee3t d\u1ecbch: NT H\u039d T\u1ed5ng quan Vi\u00eam m\u0169i d\u1ecb \u1ee9ng (AR) l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd th\u01b0\u1eddng g\u1eb7p c\u00f3 m\u1ed1i li\u00ean h\u1ec7 ch\u1eb7t ch\u1ebd v\u1edbi hen v\u00e0 vi\u00eam k\u1ebft m\u1ea1c. C\u00e1c tri\u1ec7u ch\u1ee9ng \u0111i\u1ec3n h\u00ecnh bao g\u1ed3m ng\u1ea1t m\u0169i, ng\u1ee9a m\u0169i, ch\u1ea3y n\u01b0\u1edbc m\u0169i v\u00e0 h\u1eaft h\u01a1i. Vi\u1ec7c h\u1ecfi b\u1ec7nh s\u1eed chi ti\u1ebft, kh\u00e1m l\u00e2m s\u00e0ng [&#8230;]\n","protected":false},"author":1,"featured_media":109683,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-109678","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/109678","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=109678"}],"version-history":[{"count":2,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/109678\/revisions"}],"predecessor-version":[{"id":109685,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/109678\/revisions\/109685"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/109683"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=109678"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=109678"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=109678"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}