Rhinitis

• Rhinitis is the inflammation and swelling of mucous membranes of the nose
• Symptoms:

  • Congested/blocked nose
  • Rhinorrhoea (runny nose)
  • Nasal itching
  • Postnasal drip
  • Cough
  • Irritable throat
  • Sneezing
  • Usually affects both nostrils at the same time
• Different causes:

  • Infective - seen with common cold/URTI
  • Autonomic or irritant rhinitis
  • Drugs
  • Rhinitis medicamentosa
  • Endocrine/hormonal
  • Food and drink e.g. spicy food
  • Systemic
  • Structural
  • Aging
  • Idiopathic
  • Allergic
  • NARES
• Autonomic or irritant rhinitis:

  • Symptoms follow physical exposure
  • Temperature change or with exercise
  • Chemical irritant exposure e.g. smoke, perfumes
  • These triggers cause nasal airway hyperreactivity but not through IgE mediated pathway
• Drugs:

  • Alpha blockers
  • Beta blockers
  • ACE inhibitors
  • Aspirin
  • NSAIDs
  • Cocaine
• Rhinitis medicamentosa:

  • Also called 'rebound congestion)
  • Inflammation of nasal mucosa caused by overuse of nasal decongestant sprays, usually more than 7-10 days
  • Chronic use causes nasal vessel vascular permeability and oedema resulting in worsening rhinitis symptoms
  • Need to wean off decongestants
• Endocrine/hormonal:

  • Pregnancy
  • Contraceptive pill
  • HRT
  • Hypothyroidism
• Systemic:

  • Primary defects in mucus production/clearance
  • Cystic fibrosis
  • Primary ciliary dyskinesia
  • Granulomatous disease e.g. granulomatosis with polyangiitis
• Structural:

  • Deviated septum
  • Nasal polyps
  • Hypertrophic turbinate's
  • Adenoidal hypertrophy
  • Foreign body
  • Sinonasal tumour
• Structural:

  • Causes morphological and functional changes in the nose which can cause symptoms of rhinitis in older people
• NARES:

  • Non-allergic rhinitis with eosinophilia syndrome
  • Rare condition where there are high levels of eosinophils in the nasal mucosa causing chronic rhinitis symptoms
  • No evidence than allergy or other nasal conditions are the cause
  • Diagnosis of exclusion
  • Are at risk of developing aspirin-sensitive disease with asthma and nasal polys later in life