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Rhinitis

Rhinitis. Presentation. RHINITIS = the presence of one or more of the following nasal symptoms: Sneezing Rhinorrhea Nasal congestion Nasal itching. Rhinitis. Commonly seen types Allergic Vasomotor Chemical (including Rhinitis Medicamentosa ) Dx = clinical. Allergic Rhinitis.

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Rhinitis

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  1. Rhinitis

  2. Presentation • RHINITIS = the presence of one or more of the following nasal symptoms: • Sneezing • Rhinorrhea • Nasal congestion • Nasal itching

  3. Rhinitis • Commonly seen types • Allergic • Vasomotor • Chemical (including Rhinitis Medicamentosa) • Dx = clinical

  4. Allergic Rhinitis • Sensitization of the lining of the nose to allergens → production of antibodies • These antibodies attach to mast cells → release of: • Histamine • Leukotrienes • Other inflammatory factors • → inflammation and congestion of the nasal mucosa • Most common allergies: • pollens (trees, grasses, weeds) • molds • animal dander • dust mite / dust • cockroach feces

  5. Nasal symptoms Non-nasal symptoms Allergic Rhinitis • Clear rhinorrhea • Nasal pruritis • Sneezing • Nasal congestion • Conjunctival swelling and erythema • Eyelid swelling/pruritis, • Middle ear effusion/ Eustachian tube dysfunction • Post-nasal drip • Cough • Loss of taste/smell

  6. Vasomotor Rhinitis • “Runny nose not due to allergy”. • Often confused with allergic rhinitis • Non-allergic triggers → dilation of the blood vessels in the lining of the nose → swelling, and drainage • AKA “Chemical rhinitis”, “Occupational rhinitis” • Triggers include: • Cigarette or other smoke • Perfumes/smells /fumes • Changes in temperature

  7. Viral Rhinitis – See Common Cold Section

  8. Rhinitis Treatment • Most importantly, limit exposure to causative agent! • Nasal irrigation (neti pot may be useful) • Inflammatory cascade inhibitors • Intranasal corticosteroids • Substances which prevent activation of cells or the degranulation processes • Antihistamine intranasal sprays, or tablets by mouth • Leukotriene-antagonists • Cromolyn sodium • Anticholinergics • Ipratoprium • Adrenomimetics – result in blood vessel constriction • Oxymetazoline (Afrin) – WARNING! (see next slide)

  9. Rhinitis Medicamentosa • Caution should be used when using adrenomimetics • oxymetazoline (Afrin) • Vasoconstriction of vessels → • reduced fluid from postcapillary venules • increased diameter of the airway lumen • As vasoconstricting effects wear off, the blood vessel vasodilates • “Rebound rhinitis” • This vicious cycle → chronic rhinitis • Don’t use adrenomimetics for > 3 days • Patient education

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