Rhinitis

What is rhinitis?

Rhinitis is a reaction that occurs in the eyes, nose and throat when airborne irritants (allergens) trigger the release of histamine. Histamine causes inflammation and fluid production in the fragile linings of nasal passages, sinuses, and eyelids.

What are the different types of rhinitis?

The two categories of rhinitis are:

allergic rhinitis
- There are two types of allergic rhinitis:
  - seasonal - occurs particularly during pollen seasons
  - perennial - occurs throughout the year
- The most common causes of allergic rhinitis are:
  - pollen
  - dust mites
  - mold
  - animal dander
- Reactions from allergic rhinitis include:
  - sneezing
  - congestion
  - runny nose
  - itchy nose, throat, eyes, and ears
  - nosebleeds
  - clear drainage from the nose
- Persons with perennial allergic rhinitis may also have the following:
  - recurrent ear infections
  - snoring
  - breathing through the mouth
  - fatigue
  - poor performance in school
- Preventive measures for avoiding allergic rhinitis include:
  - environmental controls, such as air conditioning, during pollen season
  - avoiding areas where there is heavy dust, mites, molds
  - avoiding pets
nonallergic rhinitis
- Types of nonallergic rhinitis are:
  - vasomotor rhinitis (irritant rhinitis)
  - eosinophilic
  - rhinitis medicamentosa
  - neutrophilic rhinosinusitis
  - structural rhinitis
  - nasal polyps
  - primary vasomotor instability
- Causes of nonallergic rhinitis include:
  - fumes
  - odors
  - temperature
  - atmospheric changes
  - smoke
  - other irritants
- Reactions from nonallergic rhinitis include:
  - sneezing
  - congestion
  - runny nose
  - itchy nose, throat, eyes, and ears
- The preventive measure for avoiding nonallergic rhinitis is avoiding the primary cause.
- Treatments for nonallergic rhinitis, as determined by your physician and based on your condition, may include:
  - oral medications
  - inhaled medications
  - immunotherapy
  - allergy injections
  - surgery (for some conditions)

How is allergic rhinitis diagnosed?

Typically, the diagnosis is made by your physician based on a thorough history and physical examination. In addition to the above signs, the physician may find on physical examination dark circles under the eyes, creases under the eyes, swollen tissue inside the nose, and mouth breathing.

Treatment for allergic rhinitis:

Avoidance of the allergens that are causing the problem is the best treatment. Specific treatment will be determined by your physician based on:

your overall health and medical history
extent of the reaction
your tolerance for specific medications, procedures, or therapies
expectations for the course of the reaction
your opinion or preference

Treatment may include:

antihistamines
Antihistamines help to decrease the release of histamine, possibly decreasing the symptoms of itching, sneezing, or runny nose. Some examples of antihistamines are diphenhydramine (Benadryl) or hydroxyzine (Atarax). These medications may cause drowsiness.
nonsedating antihistamines
Nonsedating antihistamines work like antihistamines but without the side effect of causing drowsiness. Nonsedating antihistamines may include cetirizine (Zyrtec) or loratidine (Claritin).
anti-inflammatory nasal sprays
Anti-inflammatory nasal sprays help to decrease the swelling in the nose. Consult your physician about proper dosages.
steroid nasal sprays
Steroid nasal sprays also help to decrease the swelling in the nose. Steroid nasal sprays work best when used before the symptoms start, but can also be used during a flare-up.
topical nasal decongestants
Topical nasal decongestants are not recommended for children. In some cases, they cause symptoms to worsen for children.
decongestants
Decongestants help by making the blood vessels in the nose smaller, thus, decreasing congestion. Decongestants can be purchased either over-the-counter or by prescription.

If you do not respond to avoidance or to the above medications, your physician may refer you to an allergist for testing. The allergist then may recommend immunotherapy based on the findings. Immunotherapy usually involves a three to five year course of repeated injections of specific allergens to decrease the reaction to these allergens when you come into contact with them. Consult your physician for more information.

The link between allergic rhinitis and asthma:

Controlling asthma may mean controlling allergic rhinitis in some patients, according to allergy and asthma experts. Allergic rhinitis affects up to 26 percent of Americans. The majority of asthma patients have rhinitis, and patients with rhinitis have a much higher prevalence of asthma than those who do not have rhinitis.

The link between asthma and allergic rhinitis was discussed at an annual meeting of the American College of Allergy, Asthma and Immunology. Newly released guidelines from the World Health Organization (WHO) recognize the link between allergic rhinitis and asthma. Although the link is not fully understood, one theory asserts that rhinitis makes it difficult to breathe through the nose, which hampers the normal function of the nose. Breathing through the mouth does not warm the air, or filter or humidify it before it enters the lungs, which can make asthma worse.

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