A Guide to Rhinitis

Overview

Rhinitis involves mucous membrane inflammation in the nose which causes a congested runny nose and/or constant sneezing. The inflammation is caused by increased blood flow to blood vessels within the nose. Rhinitis occurs in the nasal cavity which is the outermost part of our respiratory system and is located right behind the nose. Rhinitis is subdivided further into two categories: Allergic and Non-allergic Rhinitis. 

Allergic rhinitis is when inflammation within the nasal cavity is caused by specific allergens. These allergens can range from mold, dust, pollen, or even dandruff. Allergic rhinitis is also more commonly referred to as hay fever. In contrast, Non-allergic Rhinitis is not triggered by any irritant or allergen but causes very similar flu-like symptoms as seen in allergic rhinitis. 

Rhinitis can occur in between 3% to 19% of the population depending on the country. In Australia, nearly one out of five Australians suffer from rhinitis with children having a lesser tendency than adults. In this article, we will look closer into how rhinitis occurs and relevant treatments.   

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Signs and Symptoms

Rhinitis causes several key symptoms. These symptoms are mostly situated within the nasal cavity but can span lower into the respiratory tract. These symptoms include: 

  • Congested and runny nose 
  • Sneezing constantly 
  • Excessive mucous production in both nasal cavity and throat 
  • Postnasal drip (movement of mucous down the throat) 
  • Coughing 
  • Headache 

Some other symptoms which are not seen in non-allergic rhinitis but are in allergic rhinitis are itchy eyes, nose, and throat. 

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Causes

The causes of allergic rhinitis are usually allergens but for non-allergic rhinitis, the cause is not that apparent. However, their possible causes which cause the same line of symptoms: 

  • Over-sensitive nasal nerve endings – a similar mechanism to asthma in which your airways constrict due to over-sensitivity 
  • Environmental/external irritants e.g smog, strong scents, and chemical fumes 
  • Temperature and Humidity change due to changes in weather 
  • Viral infections 
  • Food and drinks – spicy and hot foods and alcohol are known to cause non-allergic rhinitis 
  • Medications e.g. aspirin, ibuprofen, beta-blockers for hypertension 
  • Hormone fluctuations e.g. pregnancy, menstruation, and hormonal contraceptives 
  • Sleep Apnea (difficulty breathing while sleeping) 
  • Acid Reflux (acid in the stomach travels back up the esophagus 

Risk Factors

Many factors could increase your likelihood to develop allergic and/or non-allergic rhinitis. Some reasons are genetic while others are related to the environment. These factors include but are not limited to: 

  • Atopy or the tendency to hereditary tendency to develop allergic diseases 
  • Having a history of other allergic diseases like asthma and eczema 
  • Increased inhalation of nitric oxide and aeroallergens 
  • Having an increased serum level of IgE (antibodies produced by the human body in reaction to allergic reactions) in the blood 
  • Being overweight 

Complications

Prolonged and constant occurrences of rhinitis can cause adverse effects which can hamper the quality of life of the individual. Nasal polyps are caused when there is a Chronis inflammation in the mucous lining in the nasal cavity which is very similar to the inflammation in rhinitis. These polyps are simply soft non-cancerous outgrowths in the lining of the nose as well as sinuses. Polyps can vary in size. The smaller the polyp the less troublesome it is. However, if a polyp grows to be too large it can constrict airflow through the nose, making breathing difficult. Sinusitis is a complication related to extended nasal congestion. The congestion then increases the chance of developing an infection that can lead to the inflammation of sinuses behind the nasal cavity.  

In addition to this, rhinitis can also cause a decrease in the quality of life for an individual. The symptoms can cause disturbances in daily activities like school or work including having to take leaves to manage aggravated symptoms. 

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Diagnosis

Rhinitis is diagnosed by a process of elimination. To determine whether or not the symptoms that are presented are either allergic or non-allergic rhinitis, your doctor may require some tests. These tests include blood and skin tests. A blood test determines the extent to which your body shows an immune response to allergens. It does this by measuring the number of antibodies (IgE antibodies) that are present in the blood when exposed to allergens. The blood sample is sent to a laboratory to run the tests and to find a quantified amount. The skin test on the other hand is when the doctor slightly cuts the skin to expose it to allergens on top. The allergens include dust, pollen, mold, and animal materials. If a raised red bump (hive) forms it means the individual is allergic to these elements. 

If any of these two tests yield results, the doctor can attribute the patient’s symptoms to allergic rhinitis. On the other hand, there are no distinct tests for non-allergic rhinitis. Non-allergic rhinitis is usually diagnosed on the basis that the symptoms caused do not have an allergy or sinus component. To eliminate sinus issues as a cause, the doctor may order a nasal endoscopy. In nasal endoscopy, a thin imaging instrument is inserted through your nostril to observe the appearance of your nasal passages and sinuses. In addition, a CT scan can be done by using X-rays to form images of the patient’s sinuses. 

Treatment

The length to which you need treatment most definitely depends on the severity of the symptoms in the individual. The milder the symptoms the milder the treatment. Some methods that assist in managing the symptoms include: 

  • Saline nasal sprays – these sprays help flush out irritants and allergens 
  • Corticosteroid nasal sprays – these are used when symptoms cannot be managed by oral medications. 
  • Antihistamines – These medications usually stop allergic reactions 
  • Anticholinergic nasal sprays – These medications help manage symptoms of post-nasal drip but may cause dryness in the nose  
  • Decongestants – help relieve congestion by narrowing blood vessels of the nasal cavity 
  • Home remedies – rinsing of nasal passages, humidification, and drinking liquids  
References
  1. Lieberman PL. Chronic nonallergic rhinitis. https://www.uptodate.com/contents/search. Accessed Dec. 17, 2020. 
  1. AskMayoExpert. Nonallergic rhinitis. Mayo Clinic; 2020. 
  1. Nonallergic rhinitis. Merck Manual Professional Version. https://www.merckmanuals.com/professional/ear,-nose,-and-throat-disorders/nose-and-paranasal-sinus-disorders/nonallergic-rhinitis#. Accessed Dec. 17, 2020. 
  1. Nonallergic rhinitis (vasomotor rhinitis) definition. American Academy of Allergy, Asthma & Immunology. https://www.aaaai.org/conditions-and-treatments/conditions-dictionary/nonallergic-rhinitis-vasomotor. Accessed Dec. 19, 2020. 
  1. Crisci CD, et al. A precision medicine approach to rhinitis evaluation and management. Current Treatment Options in Allergy. 2020; doi:10.1007/s40521-020-00243-1. 
  1. Sur DKC, et al. Chronic nonallergic rhinitis. American Family Physician. 2018;98:171. https://www.aafp.org/afp/2018/0801/p171.html. Accessed Dec. 19, 2020. 
  1. https://www.aafa.org/rhinitis-nasal-allergy-hayfever/ 
  1. Baumann, L M et al. “Prevalence and risk factors for allergic rhinitis in two resource-limited settings in Peru with disparate degrees of urbanization.” Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology vol. 45,1 (2015): 192-9. doi:10.1111/cea.12379 
  1. Evans, R. I. I. I. “Epidemiology and natural history of asthma, allergic rhinitis, and atopic dermatitis.” Allergy principles and practice (1993): 1109-1136. 
  1.  https://www.nhs.uk/conditions/allergic-rhinitis/ 

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