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Rhinitis
Classification and external resources
ICD-10 J00., J30., J31.0
ICD-9 472.0, 477
OMIM 607154
DiseasesDB 26380
MedlinePlus 000813
eMedicine ent/194 med/104, ped/2560
MeSH D012220

Rhinitis (pronounced /raɪˈnaɪtɪs/), commonly known as a runny nose, is the medical term describing irritation and inflammation of some internal areas of the nose. The primary symptom of rhinitis is nasal dripping. It is caused by chronic or acute inflammation of the mucous membrane of the nose due to viruses, bacteria or irritants. The inflammation results in the generating of excessive amounts of mucus, commonly producing the aforementioned runny nose, as well as nasal congestion and post-nasal drip. According to recent studies completed in the United States, more than 50 million Americans are current sufferers. Rhinitis has also been found to adversely affect more than just the nose, throat, and eyes. It has been associated with sleeping problems, ear conditions, and even learning problems.[1] Rhinitis is caused by an increase in histamine. This increase is most often caused by airborne allergens. These allergens may affect an individual's nose, throat, or eyes and cause an increase in fluid production within these areas.

Contents

Types

Rhinitis is categorized into three types: infective rhinitis includes acute and chronic bacterial infections; nonallergic (vasomotor) rhinitis includes autonomic, hormonal, drug-induced, atrophic, and gustatory rhinitis, as well as rhinitis medicamentosa; allergic rhinitis, the mic reaction triggered by pollen, mold, animal dander, dust and other similar inhaled allergens.[2]

Vasomotor rhinitis

Vasomotor rhinitis is better known as nonallergic rhinitis. The distinguishing characteristic leading to a diagnosis of nonallergic rhinitis is the absence of allergic response. Nonallergic rhinitis can be caused by airborne irritants, weather changes, infections, food and drink, medications, hormone changes, or stress, according to the Mayo Clinic.[3]

The pathology of vasomotor rhinitis is in fact not very well-understood and more research is needed. Vasomotor rhinitis appears to be significantly more common in women than men, leading some researchers to believe hormones to play a role. In general, age of onset occurs after 20 years of age, in contrast to allergic rhinitis which generally appears before age 20. Individuals suffering from vasomotor rhinitis typically experience symptoms year-round, though symptoms may exacerbate in the spring and fall when rapid weather changes are more common.

Patients cannot have vasomotor rhinitis and allergic rhinitis simultaneously because vasomotor rhinitis is a diagnosis of exclusion reached after other conditions have been ruled out.[4] An estimated 17 million United States citizens have vasomotor rhinitis.

Allergic rhinitis

When an allergen such as pollen or dust is inhaled by an individual with a sensitized immune system, it triggers antibody production. These antibodies mostly bind to mast cells, which contain histamine. When the mast cells are stimulated by pollen and dust, histamine (and other chemicals) are released. This causes itching, swelling, and mucus production. Symptoms vary in severity between individuals. Very sensitive individuals can experience hives or other rashes. Particulate matter in polluted air and chemicals such as chlorine and detergents, which can normally be tolerated, can greatly aggravate the condition.

Sufferers might also find that cross-reactivity occurs.[5] For example, someone allergic to birch pollen may also find that they have an allergic reaction to the skin of apples or potatoes.[6] A clear sign of this is the occurrence of an itchy throat after eating an apple or sneezing when peeling potatoes or apples. This occurs because of similarities in the proteins of the pollen and the food.[7] There are many cross-reacting substances.

Some disorders may be associated with allergies: Comorbidities include eczema, asthma, depression and migraine.[8]

Allergies are common. Heredity and environmental exposures may contribute to a predisposition to allergies. It is roughly estimated that one in three people have an active allergy at any given time and at least three in four people develop an allergic reaction at least once in their lives. The two categories of allergic rhinitis include:

  • Seasonal – occurs particularly during pollen seasons. Seasonal allergic rhinitis does not usually develop until after 6 years of age.
  • Perennial – occurs throughout the year. This type of allergic rhinitis is commonly seen in younger children.[9]

Allergy testing may reveal the specific allergens an individual is sensitive to. Skin testing is the most common method of allergy testing. This may include intradermal, scratch, patch, or other tests. Less commonly, the suspected allergen is dissolved and dropped onto the lower eyelid as a means of testing for allergies. (This test should only be done by a physician, never the patient, since it can be harmful if done improperly). In some individuals who cannot undergo skin testing (as determined by the doctor), the RAST blood test may be helpful in determining specific allergen sensitivity.

Hay fever

Pollen grains from a variety of common plants can cause hay fever.

Allergic rhinitis triggered by the pollens of specific seasonal plants is commonly known as "hay fever", because it is most prevalent during haying season. However, it is possible to suffer from hay fever throughout the year. The pollen which causes hay fever varies between individuals and from region to region; generally speaking, the tiny, hardly visible pollens of wind-pollinated plants are the predominant cause. Pollens of insect-pollinated plants are too large to remain airborne and pose no risk. Examples of plants commonly responsible for hay fever include:

In addition to individual sensitivity and geographic differences in local plant populations, the amount of pollen in the air can be a factor in whether hay fever symptoms develop. Hot, dry, windy days are more likely to have increased amounts of pollen in the air than cool, damp, rainy days when most pollen is washed to the ground.

The time of year at which hay fever symptoms manifest themselves varies greatly depending on the types of pollen to which an allergic reaction is produced. The pollen count, in general, is highest from mid-spring to early summer. As most pollens are produced at fixed periods in the year, a long-term hay fever sufferer may also be able to anticipate when the symptoms are most likely to begin and end, although this may be complicated by an allergy to dust particles.

Prevention and treatment

The goal of rhinitis treatment is to reduce the symptoms caused by the inflammation of affected tissues. In cases of allergic rhinitis, the most effective way to decrease allergic symptoms is to completely avoid the allergen.[10][11] Vasomotor rhinitis can be brought under a measure of control through avoidance of irritants, though many irritants, such as weather changes, are uncontrollable.

Allergic treatment

Allergic rhinitis can typically be treated much like any other allergic condition.

Eliminating exposure to allergens is the most effective preventive measure, but requires consistent effort.

Many people with pollen allergies reduce their exposure by remaining indoors during hay fever season, particularly in the morning and evening, when outdoor pollen levels are at their highest. Closing all the windows and doors prevents wind-borne pollen from entering the home or office. When traveling in a vehicle, closing all the windows reduces exposure. Air conditioners are reasonably effective filters, and special pollen filters can be fitted to both home and vehicle air conditioning systems.[12]

Because many allergens cling to clothing, skin, and hair, regular cleaning reduces exposure and therefore symptoms. Many people bathe before sleeping, to minimize their exposure to potential allergens that could have stuck to their bodies during the day. Some people use nasal irrigation to physically remove contaminants from their noses.

Frequently cleaning floors and washing bedding can significantly reduce local irritants such as house dust mite, as well as those tracked in by family, pets and visitors.

Several antagonistic drugs are used to block the action of allergic mediators, or to prevent activation of cells and degranulation processes. These include antihistamines, cortisone, dexamethasone, hydrocortisone, epinephrine (adrenaline), theophylline and cromolyn sodium. Anti-leukotrienes, such as Montelukast (Singulair) or Zafirlukast (Accolate), are FDA approved for treatment of allergic diseases.[13] One antihistamine, Azelastine (Astelin), is available as a nasal spray.

More severe cases of allergic rhinitis require immunotherapy (allergy shots) or removal of tissue in the nose (e.g., nasal polyps) or sinuses.

Many allergy medications can have unpleasant side-effects, most notably drowsiness; more serious side-effects such as asthma, sinusitis, and even nasal polyps have also been reported however.

A case-control study found "symptomatic allergic rhinitis and rhinitis medication use are associated with a significantly increased risk of unexpectedly dropping a grade in summer examinations".[14]

Nasal treatments

Systemic Glucocorticoids such as Triamcinolone or Prednisone are effective at reducing nasal inflammation, but their use is limited by their short duration of effect and the side effects of prolonged steroid therapy. Steroid nasal sprays are effective and safe, and may be effective without oral antihistamines. These medications include, in order of potency: beclomethasone (Beconase), budesonide (Rhinocort, Noex), flunisolide (Syntaris), mometasone (Nasonex), fluticasone (Flonase, Flixonase), triamcinolone (Nasacort AQ). They take several days to act and so need be taken continually for several weeks as their therapeutic effect builds up with time.

Topical decongestants: may also be helpful in reducing symptoms such as nasal congestion, but should not be used for long periods as stopping them after protracted use can lead to a rebound nasal congestion (Rhinitis medicamentosa).

Saltwater sprays, rinses or steam: this removes dust, secretions and allergenic molecules from the mucosa, as they are all instant water soluble.

For some patients, especially those with severe non-allergenic rhinitis which at times can produce large amounts of thick mucous, rinsing is the preferred treatment. The nasal passages and sinuses are flooded with warm salty water. The solution should be pH balanced. It should contain Sodium Chloride and Sodium Bicarbonate. There are commercially available preparations which speed the rinsing process as patients may need to repeate the rinse many times during a day.

Rinsing is very often recommend as part of the healing process after sinus or nasal surgery. For this rinse, boiled or distilled water is only necessary during recovery from surgery, as the entire contents of the bottle is used..[15]

Alternative treatments

A large number of over-the-counter treatments are sold, including herbs like eyebright (Euphrasia officinalis), nettle (Urtica dioica), and bayberry (Myrica cerifera), which have not been shown to reduce the symptoms of nasal-pharynx congestion. In addition, feverfew (Tanacetum parthenium) and turmeric (Curcuma longa) has been shown to inhibit phospholipase A2, the enzyme which releases the inflammatory precursor arachidonic acid from the bi-layer membrane of mast cells (the main cells which respond to respiratory allergens and lead to inflammation) but this is only in test tubes and it is not established as anti-inflammatory in humans.

It has been claimed that homeopathy provides relief free of side-effects. However, this is strongly disputed by the medical profession on the grounds that there is no valid evidence to support this claim.[16]

Therapeutic efficacy of complementary-alternative treatments for rhinitis and asthma is not supported by currently available evidence.[17][18]

Nevertheless, there have been some attempts with controlled trials[19] to show that acupuncture is more effective than antihistamine drugs in treatment of hay fever. Complementary-alternative medicines such as acupuncture are extensively offered in the treatment of allergic rhinitis by non-physicians but evidence-based recommendations are lacking. The methodology of clinical trials with complementary-alternative medicine is frequently inadequate. Meta-analyses provides no clear evidence for the efficacy of acupuncture in rhinitis (or asthma). Currently, evidence-based recommendations for acupuncture or homeopathy cannot be made in the treatment of allergic rhinitis.

Eating locally produced unfiltered honey is believed by many to be a treatment for hayfever, supposedly by introducing manageable amounts of pollen to the body. Clinical studies have not provided any evidence for this belief.[20] However, the 2002 study, widely cited as evidence against the efficacy of honey treated patients, was conducted strictly during the pollen season while advocates of honey recommend beginning treatment well before the season begins, or even year round. [21]

See also

References

  1. ^ "Rhinitis and quality of life". http://www.stallergenes.com/en/sciences-innovation/the-respiratory-allergens/rhinitis-asthma-and-quality-of-life.html.  
  2. ^ Allergic
  3. ^ "Nonallergic rhinitis". http://www.mayoclinic.com/health/nonallergic-rhinitis/DS00809/DSECTION=causes.  
  4. ^ Patricia W. Wheeler, M.D. and Stephen F. Wheeler, M.D.. ""Vasomotor Rhinitis" American Family Physician". http://www.aafp.org/afp/20050915/1057.html. Retrieved 2009-03-10.  
  5. ^ Czaja-Bulsa G, Bachórska J (1998). "[Food allergy in children with pollinosis in the Western sea coast region]". Pol Merkur Lekarski 5 (30): 338–40. PMID 10101519.  
  6. ^ Yamamoto T, Asakura K, Shirasaki H, Himi T, Ogasawara H, Narita S, Kataura A (2005). "[Relationship between pollen allergy and oral allergy syndrome]". Nippon Jibiinkoka Gakkai Kaiho 108 (10): 971–9. PMID 16285612.  
  7. ^ Malandain H (2003). "[Allergies associated with both food and pollen]". Allerg Immunol (Paris) 35 (7): 253–6. PMID 14626714.  
  8. ^ "Allergists Explore Rising Prevalence and Unmet Needs Attributed to Allergic Rhinitis". ACAAI. November 12, 2006. http://www.acaai.org/public/linkpages/NR+Rising+Prevalence+and+Unmet+Needs+of+Allergic+Rhinitis.htm. Retrieved 2008-10-01.  
  9. ^ "Rush University Medical Center". http://www.rush.edu/rumc/page-1098987384061.html. Retrieved 2008-03-05.  
  10. ^ "The Facts about Hay Fever". Healthlink. University of Wisconsin. http://healthlink.mcw.edu/article/1031002426.html. Retrieved 2007-06-19.  
  11. ^ "NHS advice on hayfever". http://www.nhs.uk/Conditions/Hay-fever/Pages/Prevention.aspx?url=Pages/Lifestyle.aspx.  
  12. ^ Steven Jay Weiss. "Seasonal Allergic Rhinitis". http://www.suggestadoctor.com/health_article_28.htm. Retrieved 2009-01-28.  
  13. ^ eMedicine Health Hay Fever Causes, Symptoms, and Treatment on eMedicineHealth.com
  14. ^ Walker S, Khan-Wasti S, Fletcher M, Cullinan P, Harris J, Sheikh A (2007). "Seasonal allergic rhinitis is associated with a detrimental effect on examination performance in United Kingdom teenagers: case-control study". J. Allergy Clin. Immunol. 120 (2): 381–7. doi:10.1016/j.jaci.2007.03.034. PMID 17560637.  
  15. ^ | Australian Society of Clinical Immunology and Allergy
  16. ^ Susan O'Meara, Paul Wilson, Chris Bridle, Jos Kleijnen and Kath Wright (2002). "Effective Health Care: Homeopathy" (PDF). NHS Centre for Reviews and Dissemination. http://www.york.ac.uk/inst/crd/EHC/ehc73.pdf. Retrieved 2007-06-10. "There are currently insufficient data ... to recommend homeopathy as a treatment for any specific condition"  
  17. ^ Passalacqua G, Bousquet PJ, Carlsen KH, Kemp J, Lockey RF, Niggemann B, Pawankar R, Price D, Bousquet J (2006). "ARIA update: I--Systematic review of complementary and alternative medicine for rhinitis and asthma". J. Allergy Clin. Immunol. 117 (5): 1054–62. doi:10.1016/j.jaci.2005.12.1308. PMID 16675332.  
  18. ^ Terr A (2004). "Unproven and controversial forms of immunotherapy". Clin Allergy Immunol. 18 (1): 703–10. PMID 15042943.  
  19. ^ World Health Organisation (2002). Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials. Geneva: WHO. 87. ISBN 9789241545433.  
  20. ^ (Furthermore, it should be noted that honeybees visit precisely those plants that are not pollinated by the wind and are, therefore, less likely to cause allergic rhinitis.) TV Rajan, H Tennen, RL Lindquist, L Cohen, J Clive (February 2002). "Effect of ingestion of honey on symptoms of rhinoconjunctivitis". Annals of allergy, asthma & immunology 88 (2): 198–203. ISSN 1081-1206. PMID 11868925. "This study does not confirm the widely held belief that honey relieves the symptoms of allergic rhinoconjunctivitis".  
  21. ^ Jardine, Cassandra. "Honey: the sweetest cure for hayfever". http://www.telegraph.co.uk/health/5135837/Honey-the-sweetest-cure-for-hayfever.html. Retrieved 2009-05-06.  

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