Rhinitis & Rhinorrhoea

Question 1

Define rhinitis

Answer 1

a common & often debilitating disease involving acute or chronic inflammation of the nasal mucosa

Question 2

What four things is rhinitis characterised by?

Answer 2

• rhinorrhoea
• sneezing
• itching
• nasal congestion

Question 3

State the three types of allergic rhinitis

Answer 3

• seasonal (winter and summer)
• perennial (all year)
• episodic

Question 4

When the allergen is inhaled what antibody increases? What does it do?

Answer 4

IgE - binds to receptors and mast cells

Question 5

What does re-exposure to the antigen cause?

Answer 5

Degranulation of mast cells and basophils

Question 6

When inflammatory cells degranulate what is released?

Answer 6

Mediators

eg. histamine, cysLTs, tryptase, prostaglandins

Question 7

Name three symptoms the release of mediators cause

Answer 7

itching, sneezing & nasal congestion

Question 8

What other response contributes to congestion and obstruction?

Answer 8

recruitment of lymphocytes and eosinophils

Question 9

What is meant by non-allergic rhinitis?

Answer 9

any rhinitis acute or chronic that does not involve IgE dependent events

Question 10

Stat six causes of non-allergic rhinitis

Answer 10

• infection (viral)
• hormonal imbalance (pregnancy)
• vasomotor disturbances (idiopathic)
• non-allergic rhinitis with eosinophilia syndrome (NARES)
• medications (aspirin)
• genetic (CF)

Question 11

Describe the mechanism behind breathing difficulty in rhinitis

Answer 11

Increased mucosal blood flow and increased blood vessel permeability increase the volume of nasal mucosa and cause difficulty breathing

Question 12

Name four treatment targets

Answer 12

Anti inflammatory (glucocorticoids)
Mediator receptor blockade (H1 & CysLT1 receptor antagonists)
Nasal blood flow (vasoconstrictors)
Anti-allergic (sodium cromiglicate)

Question 13

How do glucocorticoids work?

Answer 13

Reduce vascular permeability, recruitment and activity of inflammatory cells, release of cytokines and other mediators

Question 14

What types of rhinitis can glucocorticoids treat?

Answer 14

SAR,PAR,NARES and vasomotor rhinitis

Applied topically as a spray

Question 15

How do anti-histamines work?

Answer 15

Competitive antagonist s reduce the effect of mast cell derived histamine

• vasodilatation & increased capillary permeability
• activation of sensory nerves
• mucus secretion from submucosal glands

Question 16

What types of rhinitis are anti-histamines effective for?

Answer 16

SAR, PAR and EAR

Administered orally or by intranasal spray. Second generation agents are preferred due to reduction in sedation.

Question 17

What role does acetyl choline play in rhinorrhoea?

Answer 17

It is released from post ganglionic parasympathetic fibres which activates muscarinic receptors on nasal glands causing watery secretion

Question 18

In what types of rhinitis do anti-cholinergic drugs reduce rhinorrhoea?

Answer 18

PAR and SAR but have no influence on the other symptoms

Ipratropium is administered intranasally but may cause dryness

Question 19

How do CysLT1 receptor antagonist work?

Answer 19

Reduce the effects of CysLTs upon the nasal mucosa - equi-effective with H1 receptor antagonists in treating PAR and SAR

Question 20

What is an example of a CysLT1 receptor antagonist?

Answer 20

Montelukast

Question 21

How do vasoconstrictors work?

Answer 21

Mimic the effect of noradrenaline to produce vasoconstriction via activation of alpha 1 adrenoreceptors to decrease swelling in vascular mucosa

Question 22

What is an example of a vasoconstrictor?

Answer 22

Oxymetazoline