Rhinitis & rhinorrhoea Flashcards
Define what rhinitis is
It is a common and often debilitating disease involving acute, or chronic, inflammation of the nasal mucosa
What is rhinitis clinically defined by?
Two or more of the following symptoms
- Rhinorrohea (nasal discharge) - ‘runny nose’ - watery mucus accumulation in nasal cavity
- Sneezing
- Itching
- Nasal congestion/obstruction (swelling of nasal mucosa largely due to dilated blood vessels - particularly in cavernous sinusoids)
List the main differentials when presented with someone with rhinitis
- Infective rhinitis - acute rhinitis is often infective in origin
- Allergic rhinitis.
- Non-allergic rhinitis.
- Foreign bodies in the nose - there is persistent unilateral nasal obstruction and discharge, which may be bloody and accompanied by an offensive odour.
- Serous otitis media on the same side often accompanies the nasal obstruction when the foreign material has been present for any length of time.
- Nasal septum abnormalities - Nasal septal deviation, haematoma (trauma) or perforation (eg, trauma, nose picking, cocaine abuse).
- Occlusion of the nasal valve - septal deviation, ageing and nasal valve scarring after nasal surgery.
- Turbinate hypertrophy - may be idiopathic or caused by long-standing allergic rhinitis (seasonal and perennial), inflammation (eg, rhinitis caused by the common cold) and long-term use of over-the-counter (OTC) vasoconstrictive nasal sprays.
- Adenoid hypertrophy
- Nasal polyps.
- Rhinosinusitis.
- Neoplasm
What are the 3 different classifications of rhinitis ?
- Allergic
- Non-allergic
- Mixed
Describe what is meant by allergic rhinitis
Allergic rhinitis is an inflammatory disorder of the nose where the nose become sensitized to allergens such as house dust mites and grass, tree and weed pollens.
Describe the pathophysiology of allergic rhinitis
Allergic rhinitis is a common condition characterised by an immunoglobulin E (IgE)-mediated inflammation of the nasal mucosa following exposure to allergens.
What are the 3 categories of allergic rhinitis ?
- Seasonal allergic rhinitis/hay fever (SAR) - this occurs at certain times of the year. When due to tree pollen or grass it is known as hay fever. Other allergens include mould spores and weeds.
- Perennial rhinitis (persistent) (PAR) - this occurs throughout the year. Allergens commonly include house dust mites and domestic pets.
- Occupational rhinitis (OAR) - symptoms occur due to exposure to allergens at work (eg, flour, wood dust, latex gloves).
Describe what is meant by non-allergic rhinitis and list some of the causes
It is any rhinitis, acute, or chronic, that does not involve IgE–dependent events – causes are diverse and include:
- Infection – infectious rhinitis (largely viral)
- hormonal imbalance – hormonal rhinitis (e.g. pregnancy)
- vasomotor disturbances – vasomotor rhinitis (cause unknown, i.e. idiopathic)
- Nonallergic rhinitis with eosinophilia syndrome (NARES)
- Medications – drug induced rhinitis (e.g. aspirin)
What investigations are needed to diagnose rhinitis ?
History and examination should be sufficient to make the diagnosis.
What tests may be useful in differentiating between allergic and non-allergic rhinitis and when may they be done ?
- Allergy testing may involve skin prick testing or measuring serum-specific immunoglobulin (Ig) E to allergens such as house dust mites, pollen, and animal dander (known as radioallergosorbent test [RAST]).
- Serum testing may be used when skin prick testing is not possible, or skin prick testing taken with the clinical history give ambiguous results.
What is the general treatment of non-allergic rhinitis ?
What is the key thing to rememeber about the treatment of allergic rhinitis ?
Allergen avoidance always
What is the pharmacological management of mild-moderate intermittent or mild persistent allergic rhinitis ?
- 1st line = intranasal anti-histamine (azelastine)
- 2nd line = 2nd gen non-sedating oral anti-histamine (loratadine or cetirizine)
- 3rd line = intranasal Sodium Chromoglycate if anti-histamines are contraindated or not tolerated
What is the pharmacological treatment of moderate-severe persistent allergic rhinitis or when initial treatment is ineffective ?
1st line = intranasal corticosteroid (mometasone furoatem fluticasone furoatem fluticasone propionate)
If there is persistent watery rhinorrhoea despite combined use of an intranasal corticosteroid and oral antihistamine in the treatment of allergic rhinitis, then add in what?
An intranasal anticholinergic such as ipratropium bromide.
