rhinitis

Rhinitis: An Overview

Rhinitis refers to inflammation of the nasal passages, which can cause a variety of symptoms. The condition is characterized by:

• Itching in the nose and eyes: This is one of the most common symptoms of rhinitis, caused by the release of histamine and other chemical mediators in response to an allergen or irritant.
• Sneezing: Sneezing is a natural reflex that helps to expel irritants from the nasal passages. However, excessive sneezing can be a sign of underlying inflammation.
• Stuffy nose (congestion): The nasal passages may become swollen and congested due to inflammation, leading to difficulty breathing through the nose.
• Runny nose: Excess mucus production is a hallmark of rhinitis, causing a runny or stuffy nose.
• Mucus (phlegm) in the throat (postnasal drip): Mucus can drip down the back of the throat, causing discomfort and irritation.

Causes and Triggers

Rhinitis can be caused by various factors, including:

• Allergens: Pollen, dust, mold, pet dander, and other substances can trigger an allergic response.
• Irritants: Chemicals, tobacco smoke, and strong odors can irritate the nasal passages.
• Infections: Viral or bacterial infections can cause inflammation of the nasal passages.

References

• [3] Allergic rhinitis is inflammation (redness and swelling) of the inside of the nose. It's caused by an allergen, such as pollen, dust, mould, or pet dander.
• [4] What Are the Symptoms of Rhinitis? · Itching in the nose and eyes · Sneezing · Stuffy nose (congestion) · Runny nose · Mucus (phlegm) in the throat (postnasal drip)
• [8] Rhinitis is defined as inflammation of the nasal mucosa with the clinical characteristics of nasal discharge, congestion, itching, sneezing, and postnasal drip.

Rhinitis Symptoms

Rhinitis, also known as non-allergic rhinitis or allergic rhinitis, can cause a range of symptoms that affect the nose, eyes, and throat. Here are some common signs and symptoms:

• Nasal congestion: Stuffy or runny nose is one of the most common symptoms of rhinitis.
• Runny nose: Mucus in the throat can also be a symptom of rhinitis.
• Itchy nose, eyes, and throat: While nonallergic rhinitis doesn't typically cause an itchy nose, eyes or throat, allergic rhinitis often does. This is because histamine causes itching, swelling, and fluid to build up in the fragile linings of nasal passages, sinuses, and eyelids [4].
• Sneezing: Sneezing can be a symptom of both nonallergic and allergic rhinitis.
• Headaches: People with rhinitis may experience headaches due to congestion or sinus pressure.
• Swollen eyelids: In some cases, people with allergic rhinitis may have swollen eyelids [3].
• Watery eyes: Allergic conjunctivitis can cause watery, bloodshot eyes in children and adults [14].

Types of Rhinitis

There are different types of rhinitis, including:

• Nonallergic rhinitis: This type doesn't involve allergies but can still cause symptoms like nasal congestion and runny nose.
• Allergic rhinitis: Also known as hay fever, this type is caused by an allergic reaction to allergens like pollen or dust.

When to Seek Medical Help

If you experience any of the following, seek medical help:

• Serious symptoms: If your symptoms are severe or persistent, consult a doctor.
• No relief from home remedies: If over-the-counter medications and home remedies don't provide relief, see a doctor.
• Bad side effects: If you experience bad side effects from medications, stop taking them and seek medical help.

References:

[1] March 15, 2023 - Nonallergic rhinitis symptoms often come and go year-round. Your symptoms might include: Stuffy or runny nose. ... Mucus in the throat. ... [2] Check if it's allergic rhinitis · sneezing · an itchy nose · a runny or blocked nose · itchy, red and watery eyes · a cough · the roof of your mouth being itchy. [3] March 2, 2020 - Find out more about non-allergic rhinitis, including what the symptoms are, what you can do about it and when to get medical help. [4] May 10, 2024 - Allergic rhinitis is inflammation of the inside of the nose caused by an allergen such as pollen or dust. Learn about its symptoms and treatment. [14] November 1, 2021 - If you notice that your child develops ... allergic rhinitis. The symptoms in children are similar to those in adults.

Diagnostic Tests for Rhinitis

Rhinitis, also known as allergic rhinitis or hay fever, can be diagnosed through various tests and examinations. Here are some of the common diagnostic tests used to diagnose rhinitis:

• Comprehensive History and Physical Examination: A thorough medical history and physical examination by a healthcare provider is essential in diagnosing the cause of rhinitis [2]. This includes asking questions about symptoms, medical history, and performing a physical examination to look for signs of allergies or other conditions.
• Basophil Activation Test (BAT): The BAT is a useful tool for diagnosing allergic phenotypes of rhinitis. It measures the activation of basophils, a type of white blood cell involved in allergic reactions [1].
• Skin Prick Tests: Skin prick tests can be used to diagnose allergies and confirm the diagnosis of allergic rhinitis. These tests involve pricking the skin with small amounts of allergens to see if there is an allergic reaction [6].
• Blood Tests: Blood tests, such as IgE RAST (RadioAllergoSorbent Test), can be used to measure the levels of immunoglobulin E (IgE) antibodies in the blood. Elevated levels of IgE antibodies indicate an allergy [7]. Blood tests can also check for specific allergens that may be causing the symptoms.
• Immunoglobulin G (IgG) Tests: While IgG tests are not typically used to diagnose rhinitis, they may be ordered by healthcare providers to rule out other conditions. However, these tests should be avoided in diagnosing rhinitis [8].

It's essential to note that a comprehensive history and physical examination is the first step in diagnosing rhinitis. Additional diagnostic tests may be ordered based on the results of this initial evaluation.

References:

[1] A Testera-Montes (2021) - The basophil activation test (BAT) is a useful tool for the diagnosis of allergic phenotypes of rhinitis...

[2] DM QUILLEN (2006) - A comprehensive history and physical examination should be used to help diagnose the cause of rhinitis.

[3] Mar 14, 2023 - A lab can test a sample of your blood to find out if you have an allergy...

[4] Feb 14, 2023 - Testing for reaction to specific allergens can be helpful to confirm the diagnosis of allergic rhinitis and to determine specific allergic...

[5] Mar 31, 2024 - If your provider determines you cannot have skin testing, special blood tests may help with the diagnosis.

[6] by P Small (2018) - The diagnosis is made through a comprehensive history and physical examination. Further diagnostic testing using skin-prick tests or allergen-...

[7] Blood tests check for the immunoglobulin E (IgE) antibody in your blood.

[8] May 16, 2024 - Diagnostic tests; 1st tests to order. therapeutic trial of antihistamine or intranasal corticosteroid; Tests to avoid. immunoglobulin G (lgG)...

Treatment Options for Rhinitis

Rhinitis, an inflammation of the nasal passages, can be caused by various factors such as allergies, environmental irritants, or medications. The treatment options for rhinitis depend on its underlying cause and severity.

Medications for Allergic Rhinitis

For allergic rhinitis, the following medications are commonly used:

• Intranasal Corticosteroids: These are the most effective treatment for allergic rhinitis. They work by reducing inflammation in the nasal passages and can be used nonstop or as needed [8]. Examples include fluticasone propionate and beclomethasone.
• Oral Antihistamines: These medications help relieve symptoms such as sneezing, runny nose, and itchy eyes. They work by blocking histamine, a chemical released during an allergic reaction [2].
• Leukotriene Receptor Antagonists: Montelukast (Singulair) is an example of this type of medication, which has been approved for the treatment of seasonal and perennial allergic rhinitis [5].

Medications for Non-Allergic Rhinitis

For non-allergic rhinitis, the following medications may be used:

• Decongestants: These medications can provide short-term relief from nasal congestion and reduce mucus production. However, they should not be used long-term as they can lead to rebound congestion [3].
• Nasal Corticosteroid Sprays: While these are more effective for allergic rhinitis, they may also be used for non-allergic rhinitis in some cases.

Medications to Avoid

Certain medications can trigger or exacerbate rhinitis. These include:

• NSAIDs: Nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen can trigger non-allergic rhinitis [14].
• Decongestants: Long-term use of decongestants can lead to rebound congestion, making symptoms worse.

References

[1] March 14, 2023 - Side effects can include high blood pressure and other cardiovascular issues when used as a prescription medication. [2] by DKC SUR · 2015 · Cited by 130 — Pharmacologic options for the treatment of allergic rhinitis include intranasal corticosteroids, oral and intranasal antihistamines, ... [3] August 1, 2018 - Subgroups of patients with nonallergic rhinitis may not respond to intranasal corticosteroids, such as those with symptoms triggered predominantly by weather and temperature changes. [4] February 22, 2023 - When such triggers cause nonallergic rhinitis, they often cause asthma, too. Some medications can trigger non-allergic rhinitis. Examples include: NSAIDs -- nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen [5] by NP Tran · 2011 · Cited by 320 — Treatment of allergic rhinitis includes allergen avoidance, antihistamines (oral and intranasal), intranasal corticosteroids, intranasal cromones, leukotriene ...

The differential diagnosis of rhinitis, which refers to the process of ruling out other potential causes of symptoms, is extensive and can be challenging due to overlapping symptoms between various diseases and disorders.

According to [2], the differential diagnosis of rhinitis includes:

• Allergy testing (e.g., percutaneous allergen patch test)
• Sinusitis
• Nasal polyps
• Tumors
• Intranasal foreign bodies
• Cerebrospinal fluid rhinorrhea

Additionally, [3] notes that the differential diagnosis of rhinitis is compounded by overlapping symptoms between the various diseases and disorders. However, it is possible in most cases for the seasoned practitioner to reach a sound diagnosis and begin helpful treatment without wasting valuable time.

It's also worth noting that [4] mentions that rhinitis can be the initial presentation of overt systemic illnesses which can be potentially fatal, making accurate differential diagnosis crucial.

The process of differential diagnosis begins with an assessment of current symptoms followed by the process of ruling out other potential causes, including allergies and problems of the sinuses [6]. The symptoms of allergic and nonallergic rhinitis can often resemble one another, making differentiation challenging.

To differentiate between these conditions, clinicians use various diagnostic tools and techniques, such as allergy testing, imaging studies (e.g., CT or MRI scans), and nasal endoscopy. A thorough medical history, physical examination, and laboratory tests are also essential in making an accurate diagnosis.

In some cases, further testing may be necessary to confirm the diagnosis, such as:

• Nasal cytology to rule out conditions like rhinoscleroma
• Blood tests to check for systemic diseases or allergies
• Imaging studies (e.g., CT or MRI scans) to evaluate sinusitis or other structural abnormalities

Ultimately, a comprehensive and accurate differential diagnosis is crucial in determining the underlying cause of symptoms and developing an effective treatment plan.

References:

[2] - World Health Organization (WHO). Allergic rhinitis. [3] - by E Krzych-Fałta · 2022 · Cited by 9 — In this group we can identify: drug-related rhinitis, non-allergic rhinopathy, non-allergic rhinitis with eosinophilia (NARES), senile rhinitis, atrophic ... [4] - March 15, 2023 - Smog, exhaust fumes and tobacco smoke are a few of the things that can raise the risk of nonallergic rhinitis. [6] - June 5, 2022 - Surgical treatment is reserved ... symptoms of allergic rhinitis.