Rhinitis

Question 1

Allergic Rhinitis Categories

Answer 1

• Seasonal
• Perennial
• Occupational

Question 2

Allergic Rhinitis Pathogenesis

Answer 2

• IgE mediated inflammation
• Acute phase (minutes): sneezing, increased secretion
• Late phase (6-12 hours): nasal obstruction

Question 3

Allergic Rhinitis Epidemiology

Answer 3

• Very common

- Mostly in children and adolescents

Question 4

Allergic Rhinitis Aetiology

Answer 4

• Most common allergen is dust mite followed by pets

- Associated with conjunctivitis, atopy, polyps

Question 5

Allergic Rhinitis Presentation

Answer 5

• Sneezing
• Itchy nose
• Eye symptoms
• Rinorrhoea
• Clear: infection unlikely
• Unilateral: uncommon, rule out CSF
• Yellow tinged: implies allergy or infection
• Green-coloured: infection
• Blood tinged: tumour, foreign body, trauma

Question 6

Allergic Rhinitis Differentials

Answer 6

• Non-allergic
• Infectious
• Polyps

Question 7

Allergic Rhinitis Investigations

Answer 7

• History and examination should sufficient
• Allergy testing if cause not clear: skin prick testing
• Blood assays if unavailable

Question 8

Allergic Rhinitis Management

Answer 8

• Stepwise approach
• Refer to allergy clinic once all therapeutic options are exhausted
• Avoid causative agent
• Topical antihistamine to relieve congestion
• Oral antihistamine if extra-nasal symptoms
• Topical steroids if obstruction is main symptom

Question 9

Non-Allergic Rhinitis Definition

Answer 9

• General term encompassing a number of conditions
• Vasomotor rhinitis
• Occupational rhinitis
• Hormonal rhinitis
• Drug-induced rhinitis
• Non-allergic rhinitis with eosinophilia syndrome

Question 10

Non-Allergic Rhinitis Presentation

Answer 10

• Rhinorrhoea
• Sneezing
• Itchy nose
• Nasal congestion

Question 11

Vasomotor Rhinitis

Answer 11

• Excessive vascular engorgement, profuse, watery, rhinorrhoea
• Imbalance of parasympathetic and sympathetic
• Large numbers of triggers
• Topical antihistamines or corticosteroids

Question 12

Occupational Rhinitis

Answer 12

• Symptoms only occur in workplace, inhalation of irritants
• Avoid trigger
• Topical treatments

Question 13

Hormonal Rhinitis

Answer 13

• Linked to increased oestrogen levels

- Pregnancy, menstruation and puberty

Question 14

Drug-induced Rhinitis

Answer 14

• Prolonged use of topical nasal decongestants may result in rebound congestion, starts worsening cycle
• Remove medication