Rhinitis is inflammation of the nose. It can be due to allergy (allergic rhinitis) or it can be non-allergic (which we won’t cover). Similar to sinusitis, we can also get chronic rhinitis but this will be covered in the sinusitis CCC.
Pathophysiology
Allergic rhinitis is mediated by IgE (type 1 HS). Allergen exposure upon first instance leads to sensitisation. While the second exposure will lead to degranulation (release of histamines and leukotrienes etc.) as IgE binds to mast cells.
This commonly occurs due to pollen exposure and contact with nasal mucous membranes. It causes bronchoconstriction and increased mucous secretion.
It can be classified into 3 types:
- Seasonal - symptoms occur seasonally around the same time every year. Commonly due to pollens. This is known as hay fever.
- Perennial - this is when it occurs throughout the entire year.
- Occupational - specific allergens in the workplace initiate symptoms.
😷 Presentation
- ⭐️ Runny nose
- ⭐️ Bilateral blocked nose
- ⭐️ Clear discharge
- ⭐️ Sneezing
- ⭐️ Itchy, red, swollen eyes.
It is also associated with a family history of atopy and asthma.
🔍 Investigations
🏆 It is usually a clinical diagnosis that may be confirmed with allergy testing with skin pricks (especially for pollen, animals and dust mites).
🧰 Management
Of course the primary advice for management is allergen avoidance.
- Mild-moderate symptoms: we can give non-sedating oral antihistamines such as:
- Cetirizine
- Loratidine
- Fexofenadine
- Benadryl
Or we may give intranasal antihistamines such as:
- Moderate-severe symptoms or if it is persistent/refractory to initial drug treatment: we can give intranasal corticosteroids such as:
- Mometasone
- Fluticasone
If it is still refractory to treatment we can give sublingual immunotherapy or subcutaneous immunotherapy.
Non-allergic rhinitis occurs when he have rhinitis without the presence of triggers. It usually presents >35 years old. It’s symptoms are the same as prerennial allergic rhinitis. A diagnosis will be made using negative IgE responses to skin prick tests. Treatment involves intranasal corticosteroids and intranasal antihistamines.