Rhinitis

Rhinitis

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 ( /raɪˈnaɪtɪs/), commonly known as a stuffy 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.^{[clarification needed]} 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, which is most often triggered by airborne allergens. These allergens may affect an individual's nose, throat, or eyes and cause an increase in fluid production within these areas.

Types

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

Infectious

See also: Common cold and Sinusitis

Rhinitis is commonly caused by a viral or bacterial infection, including the common cold, which is caused by Rhinoviruses and Coronaviruses, or bacterial sinusitis. Symptoms of the common cold include rhinorrhea, sore throat (pharyngitis), cough, congestion, and slight headache.

Vasomotor rhinitis

Non-allergic rhinitis refers to runny nose that is not due to allergy. Non-allergic rhinitis can be classified as either non-inflammatory or inflammatory rhinitis. One very common type of non-inflammatory, non-allergic rhinitis that is sometimes confused with allergy is called vasomotor rhinitis,^[3] in which certain non-allergic triggers such as smells, fumes, smoke, dusts, and temperature changes, cause rhinitis. There is still much to be learned about this entity, but it is thought that these non-allergic triggers cause dilation of the blood vessels in the lining of the nose, which results in swelling, and drainage. Vasomotor rhinitis can coexist with allergic rhinitis, and this is called "mixed rhinitis." (Middleton's Allergy Principles and Practice, seventh edition.) The pathology of vasomotor rhinitis appears to involve neurogenic inflammation PMID 18651116 and is as yet not very well understood. More research is needed. Vasomotor rhinitis appears to be significantly more common in women than men, leading some researchers to believe that hormones play a role. In general, age of onset occurs after 20 years of age, in contrast to allergic rhinitis which can be developed at any age. Individuals suffering from vasomotor rhinitis typically experience symptoms year-round, though symptoms may be exacerbated in the spring and autumn when rapid weather changes are more common.^[4] An estimated 17 million United States citizens have vasomotor rhinitis. The antihistamine azelastine has been shown to be effective for allergic, mixed, and vasomotor rhinitis.^[5] Fluticasone propionate or budesonide (both are steroids) in nostril spray form may also be used for symptomatic treatment.

Allergic

Main article: Allergic rhinitis

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

Allergic rhinitis or hay fever is when an allergen such as pollen or dust is inhaled by an individual with a sensitized immune system, triggering 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.

Characteristic physical findings in individuals who have allergic rhinitis include conjunctival swelling and erythema, eyelid swelling, lower eyelid venous stasis, lateral crease on the nose, swollen nasal turbinates, and middle ear effusion.^[6]

Rhinitis medicamentosa

Main article: Rhinitis medicamentosa

It is a condition of rebound nasal congestion brought on by extended use of topical decongestants (e.g., oxymetazoline, phenylephrine, xylometazoline, and naphazoline nasal sprays) that work by constricting blood vessels in the lining of the nose.

Chronic atrophic rhinitis

Main article: Chronic atrophic rhinitis

Chronic rhinitis in form of atrophy of the mucous membrane and glands.

Rhinitis sicca

Chronic form of dryness of the mucous membranes

Polypous rhinitis

Chronic rhinitis associated with polyps in the nasal cavity.

Management

The management of rhinitis depends on the underlying cause. High-dose administration of Vitamin B12 has been additionally validated to stimulate the activity of the body's TH1 suppressor T-Cells, which then down-regulates the over-production of the allergen antibody IgE in allergic individuals which could decrease both near and long term manifestations of rhinitis symptomology..^[7]..^[8]

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. ^ http://www.nlm.nih.gov/medlineplus/ency/article/001648.htm Vasomotor rhinitis Medline Plus
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. ^ Bernstein JA (October 2007). "Azelastine hydrochloride: a review of pharmacology, pharmacokinetics, clinical efficacy and tolerability". Curr Med Res Opin 23 (10): 2441–52. doi:10.1185/030079907X226302. PMID 17723160. 
6. ^ Valet RS, Fahrenholz JM. Allergic rhinitis: update on diagnosis. Consultant. 2009;49:610-613
7. ^ O'Conner, Richard D. M.D. (1990). FDA Investigative New Drug IND No. 30,488. 
8. ^ Mansfield, Lyndon E. M.D. (1992). 

External links

• Rhinitis at Centers for Chronic Nasal and Sinus Dysfunction
• Sinus Infection And Allergic Rhinitis
• Specialist Library for ENT and Audiology Hay fever resources – online library of high quality research on hay fever and other ENT disorders
• Daily Pollen Count in the USA
• Information on hay fever and children from Seattle Children's Hospital