Chronic Rhinitis Flashcards
What are the three major types of chronic rhinitis?
Allergic, Non-Allergic (Vasomotor), Mixed
How do you differentiate allergic from non-allergic rhinitis clinically?
Allergic: Nasal itching, sneezing, atopy association.
Non-allergic: Triggers include odors, smoke, no nasal itching, year-round symptoms
What is the predominant symptom of allergic rhinitis?
Nasal itching
What is the predominant symptom of non-allergic vasomotor rhinitis?
Nasal congestion
What are the hallmark features of allergic rhinitis?
Nasal itching, sneezing, clear rhinorrhea, seasonal or perennial pattern, associated with atopy (asthma, eczema, conjunctivitis). This tends to be a Ig-E mediated hypersensitivity reaction leading to mast cell degranulation causing vasodilation, edema, and increased nasal secretions (clear rhinorrhea) and post nasal drip.
What hypersensitivity reaction is associated with IgE hypersensitivity secondary to chronic rhinitis?
Type I hypersensitivity reaction is associated with IgE-mediated hypersensitivity secondary to chronic rhinitis (also known as allergic rhinitis).
This reaction occurs when allergens (e.g., pollen, dust mites, pet dander) trigger IgE production, leading to mast cell degranulation and the release of histamine, leukotrienes, and prostaglandins, causing symptoms such as nasal congestion, rhinorrhea, sneezing, and itching. Chronic exposure can lead to persistent inflammation and nasal mucosal hypertrophy.
What are the hallmark features of vasomotor rhinitis?
Triggered by odors, smoke, weather changes, and emotional stress; predominant nasal congestion and postnasal drip; no nasal itching; year-round symptoms. This is a non-IgE mediated reactivity, rather induced by parasympathetic activity leading to fluid leakage from nasal vasculature.
What is the first-line treatment for allergic rhinitis?
Remove possible allergens (change pillowcases), then provide intranasal glucocorticoids (Fluticasone, Budesonide, Mometasone)
What is the adjunctive treatment for allergic rhinitis?
Oral antihistamines (Cetirizine, Loratadine) or intranasal antihistamines (Azelastine). Mast cell stabilizers include Cromolyn for preventative measures. Allergy immunotherapy for very severe cases.
What is the treatment for non-allergic vasomotor rhinitis?
Intranasal glucocorticoids (fluticasone or mometasone) with adjunctives being intranasal antihistamines (Azelastine); intranasal ipratropium for watery rhinorrhea
What is rhinitis medicamentosa?
Rebound congestion from prolonged use (>3-5 days) of nasal decongestants (Oxymetazoline, Phenylephrine)
How do you treat rhinitis medicamentosa?
Stop decongestant, start intranasal steroids
What is Samter’s Triad?
Aspirin-exacerbated respiratory disease: Asthma, Nasal Polyps, NSAID Sensitivity
What conditions are associated with nasal polyps?
Cystic fibrosis (especially in children), chronic sinusitis, Samter’s triad
What medication can be used for severe allergic rhinitis not responding to standard therapy?
Allergen immunotherapy (SCIT)
How does pregnancy contribute to nasal congestion?
Estrogen increases nasal blood flow causing congestion (hormonal rhinitis)
What medications can induce chronic rhinitis?
Beta-blockers, ACE inhibitors, NSAIDs, Aspirin
How does allergic rhinitis appear on nasal exam?
Pale, boggy nasal mucosa with clear discharge
What diagnostic test can confirm allergic rhinitis if severe?
Skin prick testing or serum IgE testing
When should you suspect cystic fibrosis in a child with chronic rhinitis?
If child <2 years old has nasal polyps or chronic sinus infections
