Rhinitis
Rhinitis is also known as common cold/ viral rhinitis.
Rhinitis is inflammation and swelling of mucus membrane of nose, characterized by runny nose, and stiffness.
It usually caused by common cold/ allergy.
Classification of Rhinitis
1. Allergic rhinitis
2. Non-allergic rhinitis
1. Allergic Rhinitis
Allergic rhinitis is inflammation of nasal passages, usually associated with watery nasal discharge and itching of eyes and nose.
Etiology
1. Exposure of dust
2. Seasonal pollens
3. Occupational allergic; caused by sporadic (irregular interval), seasonal, perennial (long-lasting)
4. Animal dander
5. Dust mites
6. Molds
Pathophysiology
Inflammation of mucus membrane of the nose, eyes, eustachian tubes, middle ear, sinuses and pharynx.
Inflammatory responses by inflammatory mediators and allergic protein cause allergic reaction triggered immunoglobulin E (lgE).
IgE coats surface of mast cell, which present in nasal mucosa.
When the allergic protein inhaled into nose, it bind to IgE on the mast cell, it release mediators, lead symptoms of rhinorrhea.
Clinical Manifestations
1. Runny nose
2. Nasal congestion
3. Sneezing/Coughing
4. Itchy eye, ear, nose, throat
5. Sore throat
6. Decrease sense of smell
7. Puffy lower eyelids
8. Sinus headache
9. Post nasal drip
Diagnostic Evaluation
1. Allergic skin testing
Detect immediate hypersensitivity. To determine specific allergic trigger.
Note- Patient note take antihistamines 12-72 hours before test.
2. Radioallergosorbent test (RAST)
To detect immunoglobulin E (IgE) level.
3. Eosinophils count
To detect elevated level of eosinophils.
4. CT scan
For evaluating acute or chronic sinusitis.
5. Nasal Cytology
Cell is scrapped from surface of nasal mucosa by using sampling probe.
Management
1. Allergen avoidance
2. Nasal washes
Use saline water or warm water, it will remove mucus from nose.
3. Nasal irrigation with saline water through neti pots.
4. Immunotherapy
Initially introducing small amount of antigen (allergen) and gradually increasing dose of allergic substance to which person is allergic. It's work by making immune system less sensitive to that substance.
5. Antihistamines
Diphenhydramine, Chlorpheniramine
6. Nasal Corticosteroids
Budesonide, Beclomethasone
7. Nasal Decongestant
Applied directly into nasal passages, reduce swelling of nasal tissue by shrinking the blood vessels.
8. Intranasal anticholinergics agent
Ipratropium bromide used as nasal spray and help to control nasal drainage.
9. Mucus thinning agent
Make mucus secretion thinner and less sticky, help to prevent pooling of secretion back to nose and throat.
Guaifenesin is commonly used.
2. Non- Allergic Rhinitis
Non allergic rhinitis resulting from nasal inflammation, symptoms similar to allergic rhinitis.
Classification of Non-Allergic Rhinitis
1. Infectious Rhinitis
2. Occupational Rhinitis
3. Drug-induced rhinitis
4. Gustatory rhinitis
5. Vasomotor rhinitis
When the blood vessels inside nose dilate, or expand.
6. Hormonal rhinitis
7. Non-allergic rhinitis with eosinophilia syndrome (NARES)
Due to abnormal prostaglandin metabolism
Etiology
1. Occupational irritants
2. Weather changes
3. Viral infection
4. Certain medications
NSAIDs; Aspirin,
Hypertension; Beta blocker
5. Hormone changes
Changes in hormone due to menstruation, pregnancy, oral contraceptive use.
6. Food and beverage
Hot and spicy food, cold beverages
7. Certain health condition
Emotional and physical stress
Diagnostic Evaluation
1. Prevent occupational irritants
2. Skin test
3. Blood test
4. CT scan; to view sinuses
5. Nasal endoscopy
Looking inside nasal passages.
Thin, fiber-optic instruments called endoscope, passed through nostrils to examine nasal passages and sinuses.
Management
1. Oral decongestants
2. Flush the nose
With normal saline flush the nose, help the soothe the mucus membrane in nose.
3. Antihistamines nasal spray
4. Anticholinergic nasal spray
5. Corticosteroid nasal spray
6. Decongestant nasal spray
Prevention
1. Avoid triggers
2. Don't overuse nasal decongestant
3. Use PPE in occupational premises
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