Rhinitis

Question 1

What is Rhinitis?

Answer 1

inflammation of the nose causing sneezing, nasal discharge or blockage for more than an hour during the day.

Question 2

Rhinitis is subdivided into various types:

Answer 2

1) According to time span:

— seasonal rhinitis: only during a limited period, usually springtime
— perennial rhinitis: throughout the year

2) According to pathophysiology:
— allergic rhinitis: an IgE-mediated atopic disorder
— vasomotor rhinitis: due to parasympathetic overactivity

Both allergic and vasomotor rhinitis have a strong association with asthma

Question 3

classification

Answer 3

1) Seasonal allergic rhinoconjunctivitis = hay fever
2) Perennial rhinitis:

— allergic (usually due to house dust mites)

— non-allergic = vasomotor: eosinophilic, non eosinophilic

Question 4

Clinical features

Answer 4

1) Nasal symptoms:

• sneezing
• nasal obstruction and congestion
• watery rhinorrhoea
• postnasal drip
• reduced sense of smell
• itching nose (usually allergic)

2) Throat symptoms:

• dry and sore throat
• itching throat

3) Irritated eyes (allergic)
4) Abnormal nasal mucous membrane:

• pale, boggy, mucoid discharge.
• A transverse nasal crease indicates a nasal allergy, esp in a child

Question 5

Allergens

Answer 5

• Pollens from trees (spring) and grass (in summer)
• Moulds
• House dust mites (perennial rhinitis)
• Hair, fur, feathers (from cats, dogs, horses, birds)
• Some foods (e.g. cow’s milk, eggs, peanuts/p. butter)

Question 6

Diagnosis

Answer 6

1) Allergic rhinitis—nasal allergy:

• detection of allergen-specific IgE antibodies (not specific)
• RAST test or skin testing for specific allergens (can get false negatives)

2) Vasomotor rhinitis—a diagnosis of exclusion.

Question 7

Other causes of rhinitis

Answer 7

• Chronic infection (viral, bacterial, fungal)
• Rhinitis of pregnancy
• Rhinitis medicamentosa—following overuse of OTC decongestant nasal drops or oxymetazoline sprays

• Drug-induced rhinitis:
— various antihypertensives
— aspirin
— phenothiazines
— oral contraceptives
— cocaine, marijuana
• Chemical or environmental irritants (vasomotor rhinitis)

Question 8

Vasomotor rhinitis, causes

Answer 8

• Usually due to chemical or environmental irritants (e.g. smoke and other noxious fumes, paints & sprays, cosmetics).
• Aggravated by emotional upsets, chilly damp
• weather, air conditioning, etc.

Question 9

Vasomotor rhinitis, diagnosis

Answer 9

a diagnosis of exclusion

Question 10

Vasomotor rhinitis, treatment

Answer 10

• Patient education
• Trigger avoidance (if possible)
• Inhaled corticosteroids
• Anticholinergics (e.g. ipratropium bromide nasal spray)
• Nasal surgery if nec. (e.g. electrocautery, cryosurgery)