Rhinitis

Question 1

What are the 2 main categories of rhinitis?

Answer 1

Allergic
Non-Allergic

Question 2

What is meant by allergic rhinitis?

Answer 2

IgE-mediated allergic reaction (type I hypersensitivity) involving the nose

Question 3

What are the 2 main types of allergic rhinitis?

Answer 3

Intermittent
Permanent

Question 4

What is meant by intermittent allergic rhinitis?

Answer 4

Symptoms <4 days per week or symptoms for <4 weeks

Question 5

What is meant by persistent allergic rhinitis?

Answer 5

Symptoms >4 days per week AND >4 week duration

Question 6

What are some allergens that can cause intermittent allergic rhinitis?

Answer 6

Grass pollen (Hayfever)
Tree pollen (Hayfever)
Fungal spores

Question 7

What are some allergens that can case persistent allergic rhinitis?

Answer 7

House dust mite
Cat
Dog

Question 8

What is meant by mild allergic rhinitis?

Answer 8

does not affect patient’s day to day life significantly

Question 9

What is meant by moderate-severe allergic rhinitis?

Answer 9

involves abnormal sleep, impairment of daily activities, missing school/work

Question 10

What are some symptoms of allergic rhinitis?

Answer 10

• Sneezing
• Nasal itching
• Nasal discharge (Rhinorrhoea)
• Nasal congestion

Question 11

What is a sign of allergic rhinitis?

Answer 11

Allergic crease (Indicates repeated itching or rubbing of the nose)

Question 12

What is shown?

Answer 12

Allergic crease (Indicates repeated itching or rubbing of the nose in allergic rhinitis)

Question 13

What investigations may be required in allergic rhinitis if there is diagnostic doubt?

Answer 13

• Skin prick test
• Measure blood IgE

Question 14

What are the 4 stages of management of allergic rhinitis?

Answer 14

1. Allergen avoidance
2. Symptomatic therapy
3. Immunotherapy
4. Surgery for specific indication to relieve obstruction

Question 15

What are some examples of symptomatic therapy for allergic rhinitis?

Answer 15

1. Anti-histamines e.g. cetirizine
2. Topical corticosteroids e.g. beclometasone
3. Topical steroids + antihistamines

Question 16

What is montelukast?

Answer 16

Leukotriene receptor blocker

Question 17

What is a possible indication for surgery in allergic rhinitis?

Answer 17

Mucosal hypertrophy (Requires diathermy)

Question 18

What is meant by non-allergic rhinitis?

Answer 18

Inflammation of the inside of the nose that is not caused by an allergy

Question 19

What are some types of non-allergic rhinitis?

Answer 19

1. Infective rhinitis
2. Vasomotor rhinitis
3. Occupational rhinitis
4. Hormonal rhinitis
5. Drug-induced rhinitis

Question 20

What is the usual cause of infective rhinitis?

Answer 20

Viral infection such as a cold

Question 21

What causes vasomotor rhinitis?

Answer 21

Parasympathetic overdrive within the nose (autonomic dysfunction), triggered by:
- Chemical irritants
- Changes in weather
- Excess humidity
- Very dry atmosphere
- Stress

Question 22

What causes occupational rhinitis?

Answer 22

Inhaled irritants only present at work e.g. latex, wood dust

Question 23

What causes hormonal rhinitis?

Answer 23

Pregnancy
Hormone medication (HRT, contraceptive pill)

Question 24

What causes drug-induced rhinitis?

Answer 24

ACEi
β-blockers
NSAIDs
Cocaine

Question 25

Describe the pathophysiology of non-infective rhinitis

Answer 25

1. Irritant or infection causes inflammation of the lining of the nose
2. This stimulates mucus glands in the nose and causes blockage of the nasal passage
3. This causes a blocked or runny nose

Question 26

How does non-allergic rhinitis usually present?

Answer 26

• Rhinorrhoea
• Sneezing
• Itchy nose
• Nasal congestion

Question 27

How is infective rhinitis managed?

Answer 27

Usually supportive management with possible use of decongestants

Question 28

How can vasomotor rhinitis be managed?

Answer 28

Ipratropium (Anti-cholinergic)

Question 29

What are some possible complications of non-allergic rhinitis?

Answer 29

• Sinusitis
• Nasal polyps
• Thrombosis
• Orbital cellulitis