Rhinitis

Very commonly heard as stuffy nose, rhinitis is inflammation of the mucous membrane in the nose, causing irritation and swelling. It can present in multiple ways, like a blockage in the nose, runny nose, postnasal dripping, itchy nose, or sneezing. Rhinitis can be short-lived (acute) or long-lived (chronic) and caused by the common cold or seasonal allergy. Acute rhinitis may be due to certain infections, either bacterial infections or viral infections, allergies, or other causes. Chronic rhinitis is also called chronic rhinosinusitis if it is due to sinusitis. The most important causative factors for rhinitis are colds and allergies.

Rhinitis is broadly divided into two main categories.

1. Allergic Rhinitis (also called hay fever)

Allergic rhinitis is due to certain Allergens that trigger the body’s immune system to react. The trigger factors could be dust, molds, trees, grasses, pollens, Or other animal products. These allergies could be seasonal or can stay the whole year. The symptoms of these allergies are watery eyes, sneezing, runny nose, itchy or stuffy nose, headaches. Cough or sneeze may also be present.

2. Non-allergic Rhinitis.

Non-allergic rhinitis is common after 20 years of age. Trigger factors include weather variation, certain medications, specific taste or smell of food, or chronic health conditions. Diagnosis of non-allergic rhinitis can only be made after excluding the allergic cause. It can be acute or chronic.

• Acute Rhinitis: It can be due to different viruses causing common colds.  The presenting symptoms could be low-grade fever, postnasal dripping, coughing, congestion, runny nose, or sneezing.
• Chronic Rhinitis: It can present as atrophic rhinitis, vasomotor rhinitis or rhinitis medicamentosa. It can be due to the extension of previous rhinitis, Inflammation, or viral infection. It May also occur With certain diseases like syphilis, tuberculosis, Rhinosporidiosis, Rhinoscleroma, Leishmaniasis, blastomycosis, histoplasmosis, leprosy. These diseases destroy the soft tissue, cartilage, and bone and form granulomas. Both humidity and airborne irritants also play a part in causing chronic rhinitis.

i. In Atrophic Rhinitis, nasal passages enlarge due to the thinness of the mucous membrane, which makes it hard and dry. This nasal atrophy is common in old age. People with Wegener granulomatosis are at high risk of getting atrophic rhinitis. This can also occur in people who have undergone sinus surgery, in which some nasal structures or mucous membranes were removed. The shedding of the atrophied nasal layer occurs, which may cause nose bleeds, or sometimes the loss of sense of smell occurs. Antibiotics like bacitracin or Mupirocin help kill bacteria. Estrogen sprays, vitamin A and D sprays can help reduce the crusting and keep the mucus lining Moist.

 ii. Vasomotor Rhinitis occurs in the absence of common allergic symptoms. In this type, some people are extra sensitive to certain smells like perfumes, irritants like dust and pollen, pollution, or spicy food. There is no crusting like atrophic rhinitis, but the mucous membrane becomes inflamed, like bright red or purple. Sinuses may also be slightly inflamed. Avoiding smoke and irritants can help the aggregation of the condition. Corticosteroid or nasal sprays may help as well.

iii. Rhinitis medicamentosa. It is also known as rebound congestion. It is due to the overuse of decongestant sprays or drops, causing nasal congestion. Discontinuing the causative factors can help relieve the symptoms completely.

Causative factors for rhinitis are:

• Crouch missed
• Dust mite
• Animal dander And saliva
• Temperature
• Hormonal changes
• Overuse of nasal sprays
• Smoke
• Spicy food
• Dust mites
• Weeds, pollens
• Foreign body in the nose
• Structural problems in the nose. For example, polyp or deviated nasal septum.
• Food allergies which can be life-threatening.

Some general risk factors include:

• Parental rhinitis
• Obesity
• High serum immunoglobin E
• Pet exposure
• Parental smoking
• Eczema
• Asthma
• Household aeroallergens
• High nitric oxide exhalation
• Hereditary factor
• Damp houses
• Poor ventilation
• Fossil fuel exposure
• Young age
• Overcrowding
• Immunocompromised
• Livestock breeders
• Chronic obstructive pulmonary disease

30% of adults and 40% of children are affected by allergic rhinitis throughout the world. The highest prevalence was noted in Africa and Latin America. Rhinitis is slightly more in men than women. In the United States, it affects around 19.2 million people every year.

Some specific signs and symptoms are mentioned below.

• Cough
• Sneezing
• Stuffy nose
• Their throat is full of mucus
• Itchy Ears, eyes, throat, and nose
• Nose bleeds
• Snoring
• Breathing through mouth
• Tiredness
• Runny nose
• Recurrent air infections.
• Liquid draining from nose
• Facial pain
• Sore throat
• Postnasal drip
• Watery eyes
• Dark circles under eyes
• Trouble breathing

A detailed history and nose examination can start the workup. Some of the complementary tests include;

• Blood test to check immunoglobin E antibodies.
• Skin prick test determines allergens causing symptoms( on forearm or back)
• Nasal endoscopy
• CT scan

Some of the disorders presenting like rhinitis are;

• Acute Sinusitis
• Chronic Sinusitis
• Immotile cilia syndrome
• Nasal polyps
• Cerebrospinal fluid leak
• Granulomatous rhinitis 

Treatment depends on the type of rhinitis but usually involves one or more of the following;

• Avoid trigger factors
• Nasal irrigation
• Immunotherapy (allergy shots)
• Medications like antihistamines (oral or nasal), glucocorticoids, ipratropium bromide, and decongestants
• Intranasal corticosteroids
• Intranasal anticholinergics
• Leukotriene receptor antagonist (montelukast)
• Cromolyn sodium

Rhinitis itself is not a lethal disorder. However, it can impair one’s life severely. It can result in increased fatigue, drowsiness either due to insufficient sleep or the effects of medications, missed school, or workdays. Allergic rhinitis itself can be associated with other atopic disorders like asthma, atopic dermatitis, nasal polyps. It can complement some diseases like middle ear infections, eustachian tube dysfunction, sinusitis, conjunctivitis, etc. 

The recurrent episodes can be prevented by taking care of the following;

• Avoid trigger factors
• High vitamin C intake.
• Frequent washing of bed linens and pillowcases.
• Keep windows closed to avoid pollutants entering the house, especially in summer and spring.
• Use filter vacuums
• Wash hands frequently
• Use hat and sunglasses to avoid exposure of eyes to pollutants
• Keep pets away from beddings