Rhinitis and Rhinorrhoea.

Question 1

What is rhinitis?

Answer 1

Acute or chronic inflammation of the nasal mucosa characterized by:
rhinorrhoea (runny nose)
Sneezing
Itching
Nasal congestion and obstruction (swelling of nasal mucosa largely due to dilated blood vessels- particularly in cavernous sinusoids).

Question 2

How is rhinitis classified?

Answer 2

Allergic
Non-allergic
Mixed

Question 3

a) What are the types of allergic rhinitis?

b) Which other respiratory disease is allergic rhinitis similar to and strongly linked to?

Answer 3

a) Seasonal
Perennial (year round)
Episodic (sporadic- can’t predict when it will come)
b) allergic asthma.

Question 4

What are the symptoms of a) the acute stage and b) the delayed phase of allergic rhinitis?

Answer 4

a) Itching, sneezing, rhinorrhoea and nasal congestion

b) Congestion and obstruction

Question 5

Which inflammatory cells are involved in allergic rhinitis?

Answer 5

Mast cells, basophils and eosinophils.

Question 6

Which type of Ig is involved in allergic rhinitis?

Answer 6

IgE

Question 7

What is non-allergic rhinitis?

Answer 7

Any acute or chronic rhinitis that does not involve IgE-dependent events

Question 8

What are possible causes of non-allergic rhinitis?

Answer 8

Infection- infectious rhinitis (largely viral)
Hormonal imbalance - hormonal rhinitis (e.g. in pregnancy)
vasomotor disturbances- vasomotor rhinitis (idiopathic)
Non-allergic rhinitis with eosinophilia syndrome (NARES)
Medications- drug induced rhinitis

Question 9

Give an example of a mixed rhinitis

Answer 9

Occupational rhinitis

Question 10

How do rhinitis and rhinorrhoea cause difficulty breathing in through the nose?

Answer 10

They cause increased blood flow and increased vascular permeability. These increase the volume of the nasal mucosa.

Question 11

Describe the mechanism of action of glucocorticoids in the treatment of rhinitis

Answer 11

Reduce vascular permeability
reduce recruitment and activity of inflammatory cells
Reduce the release of cytokines and inflammatory mediators

Question 12

Which types of rhinitis are glucocorticoids used to treat?

Answer 12

SAR
PAR
NARES
Vasomotor rhinitis

Question 13

How are glucocorticoids delivered in the treatment of rhinitis?

Answer 13

Intranasally, as a spray
Usually once daily
May also be given orally (short term) in severe cases

Question 14

Name some examples of glucocorticoids used in the treatment of rhinitis

Answer 14

Beclametasone
Fluticasone
Prednisolone (oral)

Question 15

Describe the mechanism of anti-histamines used to treat rhinitis.

Answer 15

They are competitive antagonists of H1 receptors. They reduce the effects of mast cell derived histamine.
These effects include:
vasodilation and increased capillary permeability
activation of sensory nerves
mucous secretion from submucosal glands

Question 16

Which types of rhinitis are anti-histamines used to treat?

Answer 16

SAR
PAR
episodic AR

Question 17

How are anti-histamines administered in the treatment of rhinitis?

Answer 17

Orally

As an intra-nasal spray

Question 18

Why are second generation antihistamines preferred to first generation antihistamines?

Answer 18

These reduce sedation as they do not cross the blood brain barrier
They also lack anti-cholinergic effects

Question 19

Name some examples of second generation antihistamines.

Answer 19

Loratidine
Fexofenadine
Cetirizine

Question 20

Name an antihistamine delivered intra-nasally

Answer 20

azelastine

Question 21

Describe the mechanism of action of muscarinic receptor antagonists in the treatment of rhinitis.

Answer 21

Ach released from post-ganglionic parasympathetic fibres act on muscarinic receptor on the nasal mucosa, causing a water secretion that contributes to rhinorrhoea.
This is blocked by muscarinic receptor antagonists.

Question 22

Which types of rhinitis are muscarinic receptor antagonists used to treat?

Answer 22

PAR and SAR

Question 23

How are muscarinic receptor antagonists delivered in rhinitis?

Answer 23

Via the nasal route

Question 24

Name the only muscarinic receptor antagonist used to treat rhinitis.

Answer 24

Ipratropium

Question 25

a) Name a cromolin used to treat rhinitis.
b) What type of rhinitis does it treat?
c) How is it administered?

Answer 25

a) Sodium chromoglicate
b) Allergic
c) Via the nasal route

Question 26

Describe the mechanism of action of cysLT1 receptor antagonists in the treatment of rhinitis.

Answer 26

Reduce the effects of cysLTs on the nasal mucosa.

Question 27

cysLT1 receptor antagonists are equi-effective with which other type of drug?

Answer 27

H1 receptor antagonists.

Question 28

How are cysLT1 receptor antagonists administered in the treatment of rhinitis?

Answer 28

Via the oral route

Question 29

What group of patients should be considered in particular for treatment with cysLT1 receptor antagonists?

Answer 29

Patients with both allergic rhinitis and asthma.

Question 30

What is the only cysLT1 receptor antagonist used to treat rhinitis?

Answer 30

Montelukast

Question 31

Describe the mechanism of action of vasoconstrictors in the treatment of rhinitis.

Answer 31

They act as direct or indirect sympathomimetics to mimic the effects of NA
Produce vasoconstrcition via activation of alpha-1 adrenoceptors to reduce swelling in the vascular mucosa.

Question 32

a) Name an alpha 1 adrenoceptor agonist used to treat congestion in allergic rhinitis.
b) How is it delivered?

Answer 32

a) oxymetazoline.

b) via the nasal route

Question 33

Why is nasal administration of oxymetazoline for more than a few days not recommended?

Answer 33

This is due to the development of a rebound increase in nasal congestion upon discontinuation (rhinitis medicamentosa).
This occurs due to receptor desensitization and downregulation.