Rhinitis and Rhinorrhoea

Question 1

What is Rhinitis?

Answer 1

acute, or chronic, inflammation of the nasal mucosa

Question 2

What are the symptoms of rhinitis?

Answer 2

• rhinorrohea (‘runny nose’)
• sneezing
• itching
• nasal congestion and obstruction (swelling due to dilated blood vessels [cavernous sinusoids])

Question 3

What are the 3 types of rhinitis?

Answer 3

allergic
non-allergic
mixed

Question 4

What are the 3 classifications of allergic rhinitis?

Answer 4

seasonal (SAR)
perennial (PAR)
episodic (EAR)

Question 5

Allergic rhinitis is mediated by what?

Answer 5

IgE

Question 6

What can causes non-allergic rhinitis?

Answer 6

• 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)

Question 7

Give a common example of mixed rhinitis?

Answer 7

Occupational Rhinitis

- can have allergic and non-allergic components

Question 8

How is rhinitis treated?

Answer 8

• Anti-inflammatory (steroids)
• Mediator receptor blockers
• Nasal blood flow
• Anti allergic

Question 9

How do steroids exert an anti-inflammatory effect in treatment of rhinitis?

Answer 9

• reduce vascular permeability
  => less blood flow to nasal mucosa
• Reduce recruitment of inflammatory cells
• Reduce release of cytokines and mediators

Question 10

Steroids are used to treat what types of rhinitis?

Answer 10

Allergic

• SAR
• PAR

NARES
vasomotor rhinitis

Question 11

HOw are steroids usually administered in rhinitis?

Answer 11

• applied topically as a spray to the nasal mucosa
• intranasally
• e.g. beclometasone, fluticasone

can be given orally (prednisolone)

Question 12

How do antihistamines help in rhinitis?

Answer 12

• reduce effects of mast cell (histamine)
  these effects are:
• vasodilatation and increased capillary permeability
• activation of sensory nerves
• mucus secretion

Question 13

When are anti-histamines used in rhinitis?

Answer 13

Allergic (SAR, PAR, EAR)

Question 14

How are anti-histamines administered in rhinitis?

Answer 14

orally

• loratidine
• fexofenadine
• cetirizine

intranasal spray (azelastine)

Question 15

How are muscarinic receptor antagonists useful in treating rhinitis?

Answer 15

• stimulation of nasal muscarinic receptors causes a watery secretion that contributes to rhinorrhoea
• this cant occur if muscarinic receptors are blocked

Question 16

When are muscarinic antagonists used in rhinitis?

Answer 16

Reduce rhinorrhoea in PAR and SAR

Question 17

How are muscarinic antagonists given and what is the most common side effect?

Answer 17

• Administered intranasally (Ipratropium)

- S/E = dryness of nasal membranes

Question 18

What anti-allergic agent is used to treat rhinitis and how is it given?

Answer 18

Sodium cromoglycate

• given intranasally but not as effective as intranasal steroids
• aims to stabilise mast cells
• given as maintenance treatment of allergic rhinitis

Question 19

What CysLT1 antagonist is used to treat rhinitis and in what patients should it be considered?

Answer 19

• Montelukast (ORAL)

- Should be considered in patients with allergic rhinitis and asthma

Question 20

What can be used to treat vasomotor rhinitis? How is this administered?

Answer 20

Oxymetazoline- selective Alpha 1-adrenoceptor agonist

(given intranasally)

Question 21

What is the aim of oxymetazoline?

Answer 21

mimic the effect of noradrenaline to cause vasoconstriction

=> decrease swelling in vascular mucosa

Question 22

Why is the use of oxymetazoline not recommended for longer than a few days?

Answer 22

• rebound increase in nasal congestion upon discontinuation

=> rhinitis medicamentosa