Rhinitis: Causes, Symptoms, Diagnosis & Treatment
Rhinitis / Inflammation Of The Nasal Cavity
Rhinitis
Rhinitis is a common disorder and refers generally to inflammation in the nasal cavity. This inflammation affects the mucous membranes of the nose and upper respiratory system. Rhinitis refers to the heterogeneous group of nasal disorders.
Common clinical manifestations of rhinitis can include rhinorrhea (nasal discharge), itching, sneezing, congestion, and postnasal drip. Rhinitis can be caused by allergic, non-allergic, or mixed allergic and non-allergic triggers. Distinguishing the subtype can help target symptomatic treatment.
Up to 30% of adults are affected by allergic rhinitis, making it the sixth most common chronic illness. Rhinitis is largely self-managed in its mildest form. That is the reason the rates of prevalence of rhinitis are difficult to quantify. Rhinitis is an important health problem. It affects a patient's social life, school performance, and work productivity.
The ratio of allergic to non-allergic rhinitis suggests that up to 87% of patients may experience symptoms from mixed causes. If rhinitis is left untreated, it can lead to sleep disorders, mood disorders, decreased concentration, loss of appetite, general weakness, fatigue, and difficulty learning.
Rhinitis is not a single disease. It has numerous causes and fundamental pathophysiologic components. There is a condition named nasal polyps that impersonates the side effects of rhinitis.
There are two main types of rhinitis depending upon the severity of illness, acute and chronic rhinitis. If the rhinitis lasts for about a few days, it is termed acute rhinitis. Likewise, if the nasal inflammation lasts for a longer period (more than four consecutive weeks), it indicates chronic rhinitis.
Viral upper respiratory infection is the most well-known reason for acute rhinitis like the common cold. Viral infections are self-limited and relieved on their own by taking symptomatic treatment.
Chronic rhinitis can be classified as allergic, non-allergic, or mixed allergic and non-allergic. Mixed rhinitis is a subset of allergic rhinitis. The features of both allergic and non-allergic diseases are found in mixed rhinitis. The triggering agents for mixed rhinitis include allergens as well as other irritants.
Allergic rhinitis is the most common subtype of chronic rhinitis. It is mostly associated with atopy. Atopy is an inherited tendency to develop a clinical hypersensitivity condition. It acts as a major risk factor for asthma as 38% of allergic rhinitis patients have asthma.
Causes Of Rhinitis
Both allergic and non-allergic chronic rhinitis have many different causes and fundamental pathophysiologic components.
Causes Of Allergic Rhinitis
The immune system is involved in the development of allergic rhinitis. Genetic, environmental, and lifestyle influences are the major risk factors for the development of allergic rhinitis. Atopy is a critical inheritable factor, and the danger of a youngster encountering hypersensitive side effects is 50% with one atopic parent and 66% with two atopic parents.
In an atopic patient, the result of initial exposure to allergens is the production of IgE. After initial exposure, antigen-presenting cells of the immune system react to allergens deposited on the nasal mucosa. This results in helper T-lymphocyte differentiation into TH2 cells, which are associated with the production of cytokines and other mediators of inflammation. As a result, memory cells programmed for IgE production are produced.
Environmental exposures, especially from the get-go throughout everyday life, are likewise significant in the development of symptoms. Lower financial status might be a dangerous factor for the advancement of allergic rhinitis.
In patients with seasonal or intermittent allergic rhinitis, pollens and airborne mold spores are the most widely recognized allergens. Albeit the dust season fluctuates with geographic area, grasses, trees, and weeds can be hazardous for some individuals during dynamic fertilization. Similarly, ragweed is an essential driver of intermittent manifestations, and affectability to this dust is generally alluded to as "hay fever."
In patients with persistent allergic rhinitis, the major allergens are house dust mites, indoor molds, animal dander, and cockroach antigen. Another common cause is occupational exposure, in which side effects can be accelerated by specialists like flour, wood, and cleansers.
In the normal developmental process of the immune system, the lymphocytes separate into either partner T (TH1 or TH2) cells subject to normal lifts or ecological upgrades. Components related to a TH1 (allergy protective) response consolidate exposure to various minute life forms like microbes and infections, the presence of older siblings, and early participation in daycare.
Factors related to a TH2 (predisposition to allergies) reaction combine regular exposure to house dust vermin, cockroaches, or early, steady antimicrobial use.
Causes Of Non-Allergic Rhinitis
Non-allergic rhinitis doesn't include the immune system. Non-allergic rhinitis is thought to happen when the veins inside the nose expand in size. This causes expansion, swelling, and congestion in the nose. It's not known precisely why the veins in the nose widen, yet the response might be set off by irritants or air contamination in the climate, for example, aromas, cleansers, solid scents, tobacco smoke, smog and fog, cold and dry air and some hot or spicy foods or drinks.
Certain upper respiratory diseases similar to a cold, flu, or influenza can also cause non-allergic rhinitis. Some medicines such as anti-inflammatory medicine, ibuprofen, oral contraceptives, antidepressants, and beta-blockers are also involved in causing non-allergic rhinitis. Likewise, some medical conditions such as gastrointestinal reflux (GERD), asthma, or persistent sinusitis can also cause non-allergic rhinitis.
Hormonal changes related to pregnancy, menstrual cycle, or thyroid conditions, sinus medical procedures and stress can cause or even aggravate non-allergic rhinitis.
Diagnosis Of Rhinitis
History should be obtained from the patient that includes a discussion of the onset, character, frequency, duration, and severity of the patient’s symptoms and any identifiable factors that provoke or relieve these symptoms. Past medical history (including the age of onset of symptoms) and family history (e.g. atopy) is also helpful.Percutaneous skin test and the allergen-specific immunoglobulin E (IgE) antibody test are used for the diagnosis of allergic rhinitis.
Symptoms Of Rhinitis
Patients diagnosed with rhinitis develop nasal obstruction, sneezing, mucopurulent rhinorrhea, chronic sinus pain, itchy eyes, nose and throat, recurrent epistaxis, headache, cough, postnasal drip, and anosmia.
Because both allergic and non-allergic forms of rhinitis are common and can potentially coexist, some experts suggest that distinguishing rhinitis subtypes during initial evaluation can help to target initial treatment.
Allergic rhinitis includes sneezing, itchy nose, seasonal symptoms, itchy eyes, clear rhinorrhea, and a family history of allergic rhinitis, eczema, and food allergy. You may also have bluish discoloration under the lower eyelids in allergic rhinitis.
Ear popping, frequent upper respiratory tract infection, fatigue, headache, and sleep disturbance are features commonly associated with both allergic and non-allergic rhinitis.
Treatment Of Rhinitis
The purpose of treatment for rhinitis is to prevent or relieve symptoms and improve quality of life without prohibitory concerns about adverse effects or expense. Common management strategies used are patient education, allergen and irritant avoidance, and pharmacotherapy.
Patient education plays a significant role in treatment adherence. Patients are educated about the disease and specific triggers, the range of symptoms, and the role of various treatments.
Various strategies for minimizing exposure to known allergens (e.g., pollens, house dust mites, molds, animal dander, and cockroaches) are commonly used for prevention. Efforts to reduce exposure to irritants (e.g., tobacco smoke, indoor or outdoor pollutants) should also be recommended.
Different classes of medications are used in the management of rhinitis disorders. Choices should be based on goals of treatment, safety, efficacy, cost-effectiveness, and adherence, severity, comorbidity, and patient preferences.
Antihistamines
Antihistamines are the most common drugs used for the treatment of allergic rhinitis and are effective for relieving sneezing, itching, and rhinorrhea. They also diminish eye symptoms, but when taken orally, have minimal effects on nasal congestion.
Antihistamines are available in oral, ophthalmic, and intranasal formulations and can also be found in combinations with oral decongestants. Although oral antihistamines represent the most commonly used therapy for allergic rhinitis. The commonly used antihistamines in the treatment of rhinitis are Fexofenadine, Levocetirizine, and Loratadine.
Intranasal Corticosteroids
Intranasal corticosteroids are the most effective medications used for the treatment of allergic rhinitis and are particularly useful for more severe or persistent symptoms. They are most beneficial when dosed on a regular schedule. Beclomethasone dipropionate, budesonide, flunisolide, fluticasone propionate, mometasone furoate, and triamcinolone acetonide are the commonly prescribed intranasal corticosteroids.
Decongestants
Oral and nasal decongestants can effectively reduce nasal congestion produced by allergic and non-allergic rhinitis. Oxymetazoline, phenylephrine, oxymetazoline, pseudoephedrine, xylometazoline, and naphazoline nasal sprays are the commonly used corticosteroids.
Anticholinergic Agents
Intranasal ipratropium bromide is an anticholinergic agent effective in reducing watery, nasal secretions in allergic rhinitis, non-allergic rhinitis, and viral upper respiratory infections.
Leukotriene Modifiers
Leukotriene modifiers are effective in relieving many of the nasal symptoms of allergic rhinitis. These agents can be considered as an alternative to oral antihistamines based on similar efficacy profiles for seasonal symptoms. Leukotriene modifiers used are zafirlukast, montelukast and zileuton.
Cromolyn
Intranasal cromolyn, a nonsteroidal agent, acts as a mast-cell stabilizer and, although safe. It is generally less efficacious than other therapies. It is only useful for symptoms related to allergic causes.
Ophthalmic Therapies
Ophthalmic products used to treat symptoms of allergic conjunctivitis include antihistamines, decongestants, mast-cell stabilizers, and nonsteroidal anti-inflammatory agents. These agents are very effective in relieving ocular symptoms. They may be used in combination with oral and intranasal agents.
Immunotherapy
Specific allergen immunotherapy (SIT) should be considered for patients who have severe symptoms of allergy despite optimal pharmacotherapy. The clinical efficacy of immunotherapy by subcutaneous injection (SCIT), sometimes called “allergy shots,” is well established.
Anti-IgE Therapy
Omalizumab is a recombinant monoclonal anti-IgE antibody that complexes free circulating IgE in the body. The complex cannot interact with mast cells and basophils, thus reducing IgE-mediated allergic reactions. When omalizumab is administered as a subcutaneous injection once or twice monthly, it decreases all nasal symptoms and improves the quality of life in patients with allergic rhinitis.