Rhinitis

Allergic rhinitis is a very common inflammatory condition of the lining of the nasal cavities, usually due to environmental allergens such as house dust, tree pollens etc.

There is another form of rhinitis, non allergenic in nature, called vasomotor rhinitis. This is a rhinitis that occurs because of room temperature changes or changes in humidity of the air or because of hot or cold drinks.

Anxiety or certain vasoactive compounds in food or drinks can also make the nose runny in vasomotor rhinitis. Non allergenic rhinitis with eosinophilia (=NARE) is a special form of non allergenic rhinitis (eosinophilia syndrome) where intranasal polyps are often found that are more difficult to treat as they often reoccur even after surgical removal.

Signs and Symptoms:

With rhinitis there is frequent blockage of the nasal passage with a runny nose where the secretions are clear and watery. The nose and eyes are often itchy, there often is a postnasal drip and the patients frequently sneeze. With allergic rhinitis there are seasonal occurrences of symptoms. For instance, with tree pollens the peak for allergic rhinitis is in spring, for grasses in mid summer, whereas dust allergies are year round.

Treatment:

Symptom control is the most important part of successful treatment of rhinitis. Mild allergic rhinitis can often be controlled with antihistamines or oral decongestants. However, with more persistent symptoms allergy testing by an allergist may be the route to go.

With inhalant allergies like tree pollen, grass pollen or with dust allergies skin testing may help identify the offending substances (allergens) to which the patient is allergic. This is followed with a desensitization program using allergy injections with a serum that contains the diluted mixture of the allergens. Eventually the patient can be maintained with a program of one injection every 2 or 3 weeks. This is extremely well tolerated and patients hardly ever need any antihistamines for breakthrough allergies. For allergic rhinitis Cromolyn can be used on a prophylactic basis. Intranasal steroid sprays are safe to use on an ongoing basis and are useful in all forms of rhinitis. When nasal polyps are present a referral to an ENT specialist is advisable.

Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

1. James Chin et al., Editors: Control of Communicable Diseases Manual, 17th edition, 2000, American Public Health Association.

2. Behrman: Nelson Textbook of Pediatrics, 16th ed., 2000, W. B. Saunders Company

3. J M Hickner et al. Ann Emerg Med 37(6): 703-710. June 2001.

4. Noble: Textbook of Primary Care Medicine, 3rd ed.,2001 Mosby, Inc.

5. Abeloff: Clinical Oncology, 2nd ed.,2000,Churchill Livingstone, Inc.

6. Ferri: Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

7. Rakel: Conn's Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier

Last Modified: April 28, 2012