Alerjik Rinit Tedavisinde Fototerapi
Özet
Alerjik rinit, nazal mukozanın alerjen maruziyetine bağlı IgE aracılı inflamasyonu ile gelişen; hapşırma, rinore, nazal obstrüksiyon ve kaşıntı ile karakterize kronik bir hastalıktır. Standart tedavide çevresel kontrol, intranazal kortikosteroidler, antihistaminikler, lökotrien reseptör antagonistleri, immünoterapi ve biyolojik ajanlar kullanılmakla birlikte, bazı hastalarda semptom kontrolü yetersiz kalabilmektedir. İntranazal fototerapi, özellikle UVA, UVB ve görünür ışığı içeren kombine mUV/vis uygulamalarıyla, T lenfosit ve eozinofil apoptozunu indükleyen, proinflamatuar mediyatör salınımını azaltan ve lokal immün yanıtı modüle eden alternatif bir tedavi seçeneğidir. Klinik çalışmalarda rinore, hapşırma, nazal kaşıntı ve obstrüksiyon skorlarında anlamlı düzelme sağladığı; özellikle nazal obstrüksiyon üzerinde bazı farmakolojik ajanlara üstün sonuçlar verebildiği bildirilmiştir. En sık yan etki nazal kuruluk olup genellikle nemlendiricilerle kontrol edilebilir. Mevcut veriler, fototerapinin dirençli, ilaç kullanımının kısıtlı olduğu veya tamamlayıcı tedavi aranan alerjik rinit olgularında umut verici ve güvenli bir seçenek olduğunu göstermektedir.
Allergic rhinitis is a chronic disease characterized by sneezing, rhinorrhea, nasal obstruction, and pruritus, resulting from IgE-mediated inflammation of the nasal mucosa following allergen exposure. Although standard treatment includes environmental control measures, intranasal corticosteroids, antihistamines, leukotriene receptor antagonists, immunotherapy, and biologic agents, adequate symptom control may not be achieved in some patients. Intranasal phototherapy, particularly combined mUV/vis applications incorporating UVA, UVB, and visible light, represents an alternative treatment modality that induces apoptosis of T lymphocytes and eosinophils, reduces the release of proinflammatory mediators, and modulates the local immune response. Clinical studies have reported significant improvements in rhinorrhea, sneezing, nasal itching, and nasal obstruction scores, with superior outcomes to some pharmacological agents particularly in nasal obstruction. The most commonly reported adverse effect is nasal dryness, which can generally be controlled with nasal moisturizers. Current evidence suggests that phototherapy may be a promising and safe option for allergic rhinitis cases that are refractory to conventional therapy, have limitations in medication use, or require complementary treatment approaches.
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