Rhinitis and Rhinorrhoea Flashcards
What is Rhinitis?
acute, or chronic, inflammation of the nasal mucosa
What are the symptoms of rhinitis?
- rhinorrohea (‘runny nose’)
- sneezing
- itching
- nasal congestion and obstruction (swelling due to dilated blood vessels [cavernous sinusoids])
What are the 3 types of rhinitis?
allergic
non-allergic
mixed
What are the 3 classifications of allergic rhinitis?
seasonal (SAR)
perennial (PAR)
episodic (EAR)
Allergic rhinitis is mediated by what?
IgE
What can causes non-allergic rhinitis?
- Infection (usually viral)
- hormonal imbalance (e.g. pregnancy)
- vasomotor disturbances (cause unknown, i.e. idiopathic)
- Nonallergic rhinitis with eosinophilia syndrome (NARES)
- Drug induced rhinitis (e.g. aspirin)
Give a common example of mixed rhinitis?
Occupational Rhinitis
- can have allergic and non-allergic components
How is rhinitis treated?
- Anti-inflammatory (steroids)
- Mediator receptor blockers
- Nasal blood flow
- Anti allergic
How do steroids exert an anti-inflammatory effect in treatment of rhinitis?
- reduce vascular permeability
=> less blood flow to nasal mucosa - Reduce recruitment of inflammatory cells
- Reduce release of cytokines and mediators
Steroids are used to treat what types of rhinitis?
Allergic
- SAR
- PAR
NARES
vasomotor rhinitis
HOw are steroids usually administered in rhinitis?
- applied topically as a spray to the nasal mucosa
- intranasally
- e.g. beclometasone, fluticasone
can be given orally (prednisolone)
How do antihistamines help in rhinitis?
- reduce effects of mast cell (histamine)
these effects are: - vasodilatation and increased capillary permeability
- activation of sensory nerves
- mucus secretion
When are anti-histamines used in rhinitis?
Allergic (SAR, PAR, EAR)
How are anti-histamines administered in rhinitis?
orally
- loratidine
- fexofenadine
- cetirizine
intranasal spray (azelastine)
How are muscarinic receptor antagonists useful in treating rhinitis?
- stimulation of nasal muscarinic receptors causes a watery secretion that contributes to rhinorrhoea
- this cant occur if muscarinic receptors are blocked
When are muscarinic antagonists used in rhinitis?
Reduce rhinorrhoea in PAR and SAR
How are muscarinic antagonists given and what is the most common side effect?
- Administered intranasally (Ipratropium)
- S/E = dryness of nasal membranes
What anti-allergic agent is used to treat rhinitis and how is it given?
Sodium cromoglycate
- given intranasally but not as effective as intranasal steroids
- aims to stabilise mast cells
- given as maintenance treatment of allergic rhinitis
What CysLT1 antagonist is used to treat rhinitis and in what patients should it be considered?
- Montelukast (ORAL)
- Should be considered in patients with allergic rhinitis and asthma
What can be used to treat vasomotor rhinitis? How is this administered?
Oxymetazoline- selective Alpha 1-adrenoceptor agonist
(given intranasally)
What is the aim of oxymetazoline?
mimic the effect of noradrenaline to cause vasoconstriction
=> decrease swelling in vascular mucosa
Why is the use of oxymetazoline not recommended for longer than a few days?
- rebound increase in nasal congestion upon discontinuation
=> rhinitis medicamentosa
