Rhinitis Flashcards
What are the 2 main categories of rhinitis?
Allergic
Non-Allergic
What is meant by allergic rhinitis?
IgE-mediated allergic reaction (type I hypersensitivity) involving the nose
What are the 2 main types of allergic rhinitis?
Intermittent
Permanent
What is meant by intermittent allergic rhinitis?
Symptoms <4 days per week or symptoms for <4 weeks
What is meant by persistent allergic rhinitis?
Symptoms >4 days per week AND >4 week duration
What are some allergens that can cause intermittent allergic rhinitis?
Grass pollen (Hayfever)
Tree pollen (Hayfever)
Fungal spores
What are some allergens that can case persistent allergic rhinitis?
House dust mite
Cat
Dog
What is meant by mild allergic rhinitis?
does not affect patient’s day to day life significantly
What is meant by moderate-severe allergic rhinitis?
involves abnormal sleep, impairment of daily activities, missing school/work
What are some symptoms of allergic rhinitis?
- Sneezing
- Nasal itching
- Nasal discharge (Rhinorrhoea)
- Nasal congestion
What is a sign of allergic rhinitis?
Allergic crease (Indicates repeated itching or rubbing of the nose)
What is shown?
Allergic crease (Indicates repeated itching or rubbing of the nose in allergic rhinitis)
What investigations may be required in allergic rhinitis if there is diagnostic doubt?
- Skin prick test
- Measure blood IgE
What are the 4 stages of management of allergic rhinitis?
- Allergen avoidance
- Symptomatic therapy
- Immunotherapy
- Surgery for specific indication to relieve obstruction
What are some examples of symptomatic therapy for allergic rhinitis?
- Anti-histamines e.g. cetirizine
- Topical corticosteroids e.g. beclometasone
- Topical steroids + antihistamines
What is montelukast?
Leukotriene receptor blocker
What is a possible indication for surgery in allergic rhinitis?
Mucosal hypertrophy (Requires diathermy)
What is meant by non-allergic rhinitis?
Inflammation of the inside of the nose that is not caused by an allergy
What are some types of non-allergic rhinitis?
- Infective rhinitis
- Vasomotor rhinitis
- Occupational rhinitis
- Hormonal rhinitis
- Drug-induced rhinitis
What is the usual cause of infective rhinitis?
Viral infection such as a cold
What causes vasomotor rhinitis?
Parasympathetic overdrive within the nose (autonomic dysfunction), triggered by:
- Chemical irritants
- Changes in weather
- Excess humidity
- Very dry atmosphere
- Stress
What causes occupational rhinitis?
Inhaled irritants only present at work e.g. latex, wood dust
What causes hormonal rhinitis?
Pregnancy
Hormone medication (HRT, contraceptive pill)
What causes drug-induced rhinitis?
ACEi
β-blockers
NSAIDs
Cocaine
Describe the pathophysiology of non-infective rhinitis
- Irritant or infection causes inflammation of the lining of the nose
- This stimulates mucus glands in the nose and causes blockage of the nasal passage
- This causes a blocked or runny nose
How does non-allergic rhinitis usually present?
- Rhinorrhoea
- Sneezing
- Itchy nose
- Nasal congestion
How is infective rhinitis managed?
Usually supportive management with possible use of decongestants
How can vasomotor rhinitis be managed?
Ipratropium (Anti-cholinergic)
What are some possible complications of non-allergic rhinitis?
- Sinusitis
- Nasal polyps
- Thrombosis
- Orbital cellulitis
