Allergic Rhinitis and Non-Allergic Rhinitis

Question 1

what is the pathophysiology of allergic rhinitis?

Answer 1

• inflammation of the nasal membranes: sneezing, rhinorrhea, nasal itching and congestion
• inflammation of the mucous membranes: nose, eyes, ET, mid-ear, sinuses, pharynx
• inflammation is triggered by immunoglobulin E (IgE) mediated response
• IgE is stimulated by specific extrinsic proteins (pollen, mold, dust..) in contact with nasal mucosa

Question 2

what happens in early stage (within minutes) of allergic rhinitis reaction?

Answer 2

• mucous glands: stimulated, increasing secretions
• vascular permeability: increased plasma exudation
• vasodilation: increased congestion and pressure
• sensory nerves: stimulated leading to sneezing and itching

Question 3

what happens during late phase reactions in allergic rhinits?

Answer 3

• after 4-8 hours- neutraphils, eosinophils, lymphocytes and macrophages are recruited to the inflamed mucosal cells
• resulting in continued inflammation
• typically get more congestion and mucous production here
• also results in more systemic effects: fatigue, sleepiness, and malaise

Question 4

• Hay fever secondary to pollens
• occurs in seasonal variations
• IgE mediated response
• presentation: Rhinorrhea, sneezing, pruritis, conjuctivitis, allergic shiners, transverse nasal crease
• affects 10-30% of population

Answer 4

allergic rhinitis

Question 5

• secondary to nasal irritants or increased mucosal blood flow
• occurs year-round, not a seasonal pattern
• IgG1 & IgG4 mediated response
• presentation: Rhinorrhea and nasal congestions
• Affects- 25% of population
• numerous subclassifications

Answer 5

non-allergic rhinitis

Question 6

• chronic presence of sneezing, rhinorrhea, nasal congestion and postnasal drainage
• symptoms should be present for > one-year
• presents later in life (70% after 20 y/o)
• no readily identifiable triggers
• sxs throughout the year & exacerbated by weather

Answer 6

non-allergic rhinitis

Question 7

• usually viral URI origin
• rhinovirus, coronavirus, adenovirus
• self-limited to a week
• clear to mucopurulent nasal discharge
• facial pain, altered sense of smell, PND, cough
• treat symptomatically

Answer 7

infectious rhinitis

Question 8

• disturbance in parasympathetic/sympathetic regulation
• rhinorrhea, sneezing and congestions
• due to cold air, strong odors, stress, inhaled irritants

Answer 8

vasomotor rhinitis

treat with topical anticholinergic

Question 9

• result of eating hot, spicy foods
• causes profuse, watery rhinorrhea due to nasal vasodilation (vagally mediated)

Answer 9

gustatory rhinitis

treat with topical anticholinergic

Question 10

How should you treat occupational rhinitis?

Answer 10

1. avoidance
2. nasal steroids or PO 2nd gen antihistamines

Question 11

• estrogens affect the autonomic nervous system, increasing parasympathetic activity
• most common causes pregnancy, menstruation, puberty, exogenous estrogen & occult hypothyroid
• nasal congestion and rhinorrhea most common
• tx: correct underlying disorder

Answer 11

Hormonal rhinitis

Question 12

home therapies for non-allergic rhinitis?

Answer 12

• nasal rinsing & irrigation
• avoid certain meds: alpha & beta blockers, birth control, ED drugs, antidepressants, oxymetazoline

Question 13

treatment of non-allergic rhinitis?

Answer 13

ipratropium
azelastine
intranasal glucocorticoids