Rhinitis Flashcards
Define rhinitis
Inflammation of nasal mucosa
Symptoms of rhinitis
- nasal blockage
- rhinorrhoea
- itchy
- sneezing
What is rhino-conjunctivitis?
Inflammation of nasal mucosa + conjunctivae
What is rhinosinusitis?
Inflammation of nasal mucosa + sinus linings
Types of rhinitis
Allergic (hayfever)
Infective
Non allergic
What is allergic rhinitis also called?
Hay fever
What is allergic rhinitis caused by?
Allergens
- hay
- pollen
- dust
- animal hair
- mould species
Allergic rhinitis classification
Intermittent
Persistent
Mild
Moderate-severe
Compare intermittent + persistent allergic rhinitis symptoms
- intermittent: <4days per week OR <4 consecutive weeks
- persistent: >4days per week AND >4 consecutive weeks
Symptoms of mild allergic rhinitis
ALL of following
- normal sleep
- no impairment of daily activities, sport, leisure, work or school
- symptoms present but not troublesome
Symptoms of moderate-severe allergic rhinitis
- sleep disturbance
- impairment of daily activities, school or work
- troublesome symptoms
Aetiology of allergic rhinitis
- genetic predisposition
- environmental factors
- urban environments
- epigenetic modifications
Pathophysiology of allergic rhinitis
- allergen presented to naive CD4+ T cell by APCs
- TH2 > B cells > plasma cells> IgE synthesis
- IgE cause mast cell degranulation > release of mediators:
-early phase response: histamines, PGs, leukotrienes > mucosal oedema, mucous hyper secretion
-late phase response: chemokines + cytokines > chronic allergic symptoms - leads to sneezing, rhinorrhoea, nasal obstruction + itching
Associated Comorbidities of allergic rhinitis
- asthma
- conjunctivitis
- anosmia
- otitis media with effusion
Diagnosis of allergic rhinitis
Either >2 or >1 on most days of:
- sneezing
- nasal itching
- itching of palate
- rhinorrhoea
- nasal obstruction
- snoring
- sleep problems
What is seen when examining a patient with rhinitis?
- Dennie-Morgan lines
- clear, coloured or purulent secretions
- allergic salute and/or horizontal nasal crease across nasal dorsum
Investigations of rhinitis
- skin prick test (first line approach)
- serum allergen specific IgE test
Treatment of allergic rhinitis
- avoidance
- saline rinses
- antihistamines
- immunotherapy
- ipratropium bromide SAMA
- montelukast
- intranasal steroids
- septoplasty
- turbinate reduction
- nasal decongestants
How do nasal decongestants reduce nasal congestion symptoms
Agonists action at a1 + a2 adrenergic receptors on endothelial cells of nasal mucosa > reduced mucosa swelling
Nasal drop technique
- blow nose to clear
- shake container
- take approved position
- place drops into nostril
- remain in portion + allow drops to act
- repeat in other nostril
Nasal spray technique
- blow nose to tear
- shake bottle well
- close off one nostril + put nozzle in other airings towards outside wall
- tilt head forwards
- squirt once or twice in two directions
- repeat in other side
- do not sniff hard
What can overuse of nasal decongestants cause?
Rhinitis medicamentosa
Condition of rebound congestion upon withdrawal of nasal decongestants
Treatment of rhinitis medicamentosa
Intranasal corticosteroids
What is allergic salute?
Upwards swiping alone tip of nose whilst sniffing
What are Dennie-Morgan lines?
Extra creases or folds below the lower eyelid
What is horizontal nasal crease due to?
Prolonged allergic salute in rhinitis
