Rhinitis Flashcards
what is rhinitis?
erythema of the nasal mucosa and hypertrophy of the inferior turbinates
most commonly allergy based but can be vasomotor based
what is seasonal/ intermittent rhinitis?
rhinitis for a limited period of the year - ‘hay-fever’ though not restricted to grass pollen
the most common allergic disorder
who gets seasonal/intermittent rhinitis?
Maxima is in teenagers in June and July as this id the time of year when there is the highest pollen count
how does seasonal/intermittent rhinitis present?
nasal irritation rhinorrhoea sneezing itchy eyes and ears irritated soft palate wheeze
how is seasonal/intermittent rhinitis diagnosed?
through history taking
how is seasonal/intermittent rhinitis managed?
antihistamines loratadine 10mg OD desloratadine 5mg daily certirizine 10mg daily fexofenadine 120mg daily
what is perennial/persistent rhinitis?
rhinitis present throughout the whole year
most commonly suffered by teenagers and people in their 20s
what are the symptoms of perennial/persistent rhinitis?
nasal blockage rhinorrhoea sneezing eye and throat symptoms rarely loss of smell and taste sinusitis is a complication for about 50% due to mucosal swelling and stopping sinus drainage
what causes perennial allergic rhinitis?
caused by the faeces of dust mites
cats
industrial dust and fumes
it can cause the nose to then be more sensitive to other substances such as smoke, B cells produce IgE antibodies against the allergens which bind to the mast cell
what is the pathogenesis of allergic perennial rhinitis?
mediators such as histamine, prostaglandins, proteases cysteinyl leukotrienes and cytokines are released and cause the acute symptoms such as sneezing
chronic swelling and irritation can be because of allergens triggering the T cells
type 1 hypersensitivity reaction
how does allergic perennial rhinitis present?
blockage
how is allergic perennial rhinitis diagnosed?
through history
skin prick testing for allergens
skin prick testing can’t prove that it is causing resp symptoms so needs to be in conjunction with history
alternative to skin prick testing if not possible - allergen specific IgE being measured
how is allergic perennial rhinitis managed?
allergen avoidance topical corticosteroids e.g. beclometasone anti-histamines e.g. certizine decongestants e.g. pseudoephinedrine anticholinergics e.g. ipratropium LTR blockers e.g. montelukast
what is non-allergic rhinitis with eosinophils?
no identifiable stimulus but eosinophilic granulocytes are present in nasal secretions
patients often intolerant to aspirin and NSAIDs
what is the general management of rhinitis?
avoid the allergens if it is allergic rhinitis
antihistamines (loratadine 10mg OD, cetirizine 10mg OD)
decongestants can be used if as therapy in preparation for corticosteroids
topical corticosteroids (beclometasone, fluticasone propionate)
1st line non-sedating anti-histamine and topical corticosteroid - topical steroid should be started before seasonal symptoms
CysLT1 antagonist (montelukast 10mg daily in the evening) when there is no response to 1st line treatment
anti-inflammatory (sodium cromoglicate)
