Rhinitis

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Rhinitis
Classification and external resources

ICD-10

J00., J30., J31.0

ICD-9

472.0, 477

OMIM

607154

DiseasesDB

26380

MedlinePlus

000813

eMedicine
MeSH

ent/194 med/104, ped/2560

D012220

Rhinitis, commonly known as a runny 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. 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. This increase is most
often caused by airborne allergens. These allergens may affect an individual's nose, throat, or
eyes and cause an increase in fluid production within these areas.

Contents
[hide]

1 Types
o 1.1 Vasomotor rhinitis
o

1.2 Allergic rhinitis

1.2.1 Hay fever

2 Prevention and treatment

o

2.1 Allergic treatment

2.2 Nasal treatments

2.3 Alternative treatments

3 See also

4 References

5 External links

[edit] Types
Rhinitis is categorized into three types: infective rhinitis includes acute and chronic bacterial
infections; Nonallergic (vasomotor) rhinitis includes autonomic, hormonal, drug-induced,
atrophic, and gustatory rhinitis, as well as Rhinitis medicamentosa; allergic rhinitis, the most
common of the three, is an allergic reaction triggered by pollen, mold, animal dander, dust and
other similar inhaled allergens.[2]

[edit] Vasomotor rhinitis

This section needs additional citations for verification.
Please help improve this article by adding reliable references. Unsourced material may be challenged
and removed. (January 2009)

Vasomotor rhinitis is also known as non-allergenic rhinitis, because it often has the same
symptoms as allergies, but has different causes. Whereas allergenic rhinitis conditions (such as
hayfever) are the result of the immune system overreacting to environmental irritants (pollen,
etc), vasomotor rhinitis is believed to be caused by oversensitive or excessive blood vessels in
the nasal membrane. These blood vessels (which are controlled in turn by the autonomic nervous
system) contract or dilate in order to regulate mucus flow and congestion. But in the vasomotor
rhinitis sufferer, oversensitive or excessive blood vessel dilation or contraction causes an
overreaction to such stimuli as changes in weather, temperature, or barometric pressure, chemical
irritants such as smoke, ozone, pollution, perfumes, and aerosol sprays, psychological stress and
emotional shocks, certain types of medications, alcohol, and even spicy food. Thus, while a
normal person's nose may run on a very cold day, a vasomotor rhinitis sufferer's nose may start
running (or go completely dry) simply by walking into a slightly colder (or slightly warmer)
room, or from eating food that is slightly warmer or cooler than room temperature. While a
normal person may tolerate a certain degree of cigarette smoke, the vasomotor rhinitis sufferer
may experience significant discomfort from the same level of smoke, etc.

The pathology of vasomotor rhinitis is in fact not very well-understood and more research is
needed. Vasomotor rhinitis appears to be significantly more common in women than men,
leading some researchers to believe hormones to play a role. In general, age of onset occurs after
20 years of age, in contrast to allergic rhinitis which generally appears before age 20. Individuals
suffering from vasomotor rhinitis typically experience symptoms year-round, though symptoms
may exacerbate in the spring and fall when rapid weather changes are more common.
Many patients can be subject to vasomotor rhinitis and allergic rhinitis simultaneously.
Vasomotor rhinitis is a common condition that often goes unrecognized/underrecognized,
especially in women. Vasomotor Rhinitis is a diagnosis of exclusion reached after other
conditions have been ruled out.[3] An estimated 17 million United States citizens have vasomotor
rhinitis.

[edit] Allergic rhinitis

See also: Allergy
When an allergen such as pollen or dust is inhaled by a person with a sensitized immune system,
it triggers 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 from person to person. 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.
Sufferers might also find that cross-reactivity occurs.[4] For example, someone allergic to birch
pollen may also find that they have an allergic reaction to the skin of apples or potatoes.[5] A clear
sign of this is the occurrence of an itchy throat after eating an apple or sneezing when peeling
potatoes or apples. This occurs because of similarities in the proteins of the pollen and the food.[6]
There are many cross-reacting substances.
Some disorders may be associated with allergies: Comorbidities include eczema, asthma,
depression and migraine.[7]
Allergies are common. Heredity and environmental exposures may contribute to a predisposition
to allergies. It is roughly estimated that one in three people have an active allergy at any given
time and at least three in four people develop an allergic reaction at least once in their lives. The
two categories of allergic rhinitis include:

seasonal - occurs particularly during pollen seasons. Seasonal allergic rhinitis does not
usually develop until after 6 years of age.
perennial - occurs throughout the year. This type of allergic rhinitis is commonly seen in
younger children.[8]

Allergy testing may reveal the specific allergens a person is sensitive to. Skin testing is the most
common method of allergy testing. This may include intradermal, scratch, patch, or other tests.

Less commonly, the suspected allergen is dissolved and dropped onto the lower eyelid as a
means of testing for allergies. (This test should only be done by a physician, never the patient,
since it can be harmful if done improperly). In some individuals who cannot undergo skin testing
(as determined by the doctor), the RAST blood test may be helpful in determining specific
allergen sensitivity.
[edit] Hay fever
For the play, see Hay Fever.

Pollen grains from a variety of common plants can cause hay fever.
Allergic rhinitis triggered by the pollens of specific seasonal plants is commonly known as "hay
fever", because it is most prevalent during haying season. Although hay fever can not spread
from person to person the symptoms can pass from person to person and it is the biggest cause of
sickleave in the US and the UK. However, it is possible to suffer from hay fever throughout the
year. The pollen which causes hay fever varies from person to person and from region to region;
generally speaking, the tiny, hardly visible pollens of wind-pollinated plants are the predominant
cause. Pollens of insect-pollinated plants are too large to remain airborne and pose no risk.
Examples of plants commonly responsible for hay fever include:

Trees: such as birch (Betula), alder (Alnus), cedar (Cedrus), hazel (Corylus), hornbeam
(Carpinus), horse chestnut (Aesculus), willow (Salix), poplar (Populus), plane (Platanus),
linden/lime (Tilia) and olive (Olea). In northern latitudes birch is considered to be the
most important allergenic tree pollen, with an estimated 1520% of hay fever sufferers
sensitive to birch pollen grains. Olive pollen is most predominant in Mediterranean
regions.
Grasses (Family Poaceae): especially ryegrass (Lolium sp.) and timothy (Phleum
pratense). An estimated 90% of hay fever sufferers are allergic to grass pollen.
Weeds: ragweed (Ambrosia), plantain (Plantago), nettle/parietaria (Urticaceae), mugwort
(Artemisia), Fat hen (Chenopodium) and sorrel/dock (Rumex)

In addition to individual sensitivity and geographic differences in local plant populations, the
amount of pollen in the air can be a factor in whether hay fever symptoms develop. Hot, dry,
windy days are more likely to have increased amounts of pollen in the air than cool, damp, rainy
days when most pollen is washed to the ground.

The time of year at which hay fever symptoms manifest themselves varies greatly depending on
the types of pollen to which an allergic reaction is produced. The pollen count, in general, is
highest from mid-spring to early summer. As most pollens are produced at fixed periods in the
year, a long-term hay fever sufferer may also be able to anticipate when the symptoms are most
likely to begin and end, although this may be complicated by an allergy to dust particles.

[edit] Prevention and treatment

The goal of rhinitis treatment is to reduce the symptoms caused by the inflammation of affected
tissues. In cases of allergic rhinitis, the most effective way to decrease allergic symptoms is to
completely avoid the allergen.[9][10] Vasomotor rhinitis can be brought under a measure of control
through avoidance of irritants, though many irritants, such as weather changes, are
uncontrollable.

[edit] Allergic treatment

Main article: Allergy treatment
Allergic rhinitis can typically be treated much like any other allergic condition.
Eliminating exposure to allergens is the most effective preventive measure, but requires
consistent effort.
Many people with pollen allergies reduce their exposure by remaining indoors during hay fever
season, particularly in the morning and evening, when outdoor pollen levels are at their highest.
Closing all the windows and doors prevents wind-borne pollen from entering the home or office.
When traveling in a vehicle, closing all the windows reduces exposure. Air conditioners are
reasonably effective filters, and special pollen filters can be fitted to both home and vehicle air
conditioning systems.[11]
Because many allergens cling to clothing, skin, and hair, regular cleaning reduces exposure and
therefore symptoms. Many people bathe before sleeping, to minimize their exposure to potential
allergins that could have stuck to their bodies during the day. Some people use nasal irrigation to
physically remove contaminants from their noses.
Frequently cleaning floors and washing bedding can significantly reduce local irritants such as
dust, as well as those tracked in by family, pets and visitors.
Several antagonistic drugs are used to block the action of allergic mediators, or to prevent
activation of cells and degranulation processes. These include antihistamines, cortisone,
dexamethasone, hydrocortisone, epinephrine (adrenaline), theophylline and cromolyn sodium.
Anti-leukotrienes, such as Montelukast (Singulair) or Zafirlukast (Accolate), are FDA approved
for treatment of allergic diseases.[12] One antihistamine, Azelastine (Astelin), is available as a
nasal spray.

More severe cases of allergic rhinitis require immunotherapy (allergy shots) or removal of tissue
in the nose (e.g., nasal polyps) or sinuses.
Many allergy medications can have unpleasant side-effects, most notably drowsiness; more
serious side-effects such as asthma, sinusitis, and even nasal polyps have also been reported
however.
A case-control study found "symptomatic allergic rhinitis and rhinitis medication use are
associated with a significantly increased risk of unexpectedly dropping a grade in summer
examinations".[13]

[edit] Nasal treatments

See also: Anti-inflammatory use of glucocorticoids
Systemic Glucocorticoids such as Triamcinolone or Prednisone are effective at reducing nasal
inflammation, but their use is limited by their short duration of effect and the side effects of
prolonged steroid therapy. Steroid nasal sprays are effective and safe, and may be effective
without oral antihistamines. These medications include, in order of potency: beclomethasone
(Beconase), budesonide (Rhinocort, Noex), flunisolide (Syntaris), mometasone (Nasonex),
fluticasone (Flonase, Flixonase), triamcinolone (Nasacort AQ). They take several days to act and
so need be taken continually for several weeks as their therapeutic effect builds up with time.
Topical decongestants: may also be helpful in reducing symptoms such as nasal congestion, but
should not be used for long periods as stopping them after protracted use can lead to a rebound
nasal congestion (Rhinitis medicamentosa).
Saltwater sprays, rinses or steam: this removes dust, secretions and allergenic molecules from the
mucosa, as they are all instant water soluble. A suitable solution is 2-3 spoonful of salt dissolved
in one litre of lukewarm water.[14]

[edit] Alternative treatments

A large number of over-the-counter treatments are sold, including herbs like eyebright
(Euphrasia officinalis), nettle (Urtica dioica), and bayberry (Myrica cerifera), which have not
been shown to reduce the symptoms of nasal-pharynx congestion. In addition, feverfew
(Tanacetum parthenium) and turmeric (Curcuma longa) has been shown to inhibit phospholipase
A2, the enzyme which releases the inflammatory precursor arachidonic acid from the bi-layer
membrane of mast cells (the main cells which respond to respiratory allergens and lead to
inflammation) but this is only in test tubes and it is not established as anti-inflammatory in
humans.
It has been claimed that homeopathy provides relief free of side-effects. However, this is strongly
disputed by the medical profession on the grounds that there is no valid evidence to support this
claim.[15]

Therapeutic efficacy of complementary-alternative treatments for rhinitis and asthma is not

supported by currently available evidence.[16][17]
Nevertheless, there have been some attempts with controlled trials[18] to show that acupuncture is
more effective than antihistamine drugs in treatment of hay fever. Complementary-alternative
medicines such as acupuncture are extensively offered in the treatment of allergic rhinitis by
non-physicians but evidence-based recommendations are lacking. The methodology of clinical
trials with complementary-alternative medicine is frequently inadequate.[citation needed] Metaanalyses provides no clear evidence for the efficacy of acupuncture in rhinitis (or asthma).[citation
needed]
Currently, evidence-based recommendations for acupuncture or homeopathy cannot be
made in the treatment of allergic rhinitis.[citation needed]
Eating locally produced unfiltered honey is believed by many to be a treatment for hayfever,
supposedly by introducing manageable amounts of pollen to the body. Clinical studies have not
provided any evidence for this belief.[19] However, the 2002 study widely cited as evidence
against the efficacy of honey treated patients strictly during the pollen season, while advocates of
honey recommend beginning treatment well before the season begins, or even year round. [20]

[edit] See also

Aeroallergen

[edit] References
1. ^ "Rhinitis and quality of life". http://www.stallergenes.com/en/sciences-innovation/therespiratory-allergens/rhinitis-asthma-and-quality-of-life.html.
2. ^ Allergic
3. ^ 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 on 2009-03-10.
4. ^ Czaja-Bulsa G, Bachrska J (1998). "[Food allergy in children with pollinosis in the Western
sea coast region]". Pol Merkur Lekarski 5 (30): 33840. PMID 10101519.
5. ^ Yamamoto T, Asakura K, Shirasaki H, Himi T, Ogasawara H, Narita S, Kataura A (2005).
"[Relationship between pollen allergy and oral allergy syndrome]". Nippon Jibiinkoka Gakkai
Kaiho 108 (10): 9719. PMID 16285612.
6. ^ Malandain H (2003). "[Allergies associated with both food and pollen]". Allerg Immunol
(Paris) 35 (7): 2536. PMID 14626714.
7. ^ "Allergists Explore Rising Prevalence and Unmet Needs Attributed to Allergic Rhinitis".
ACAAI. November 12, 2006.
http://www.acaai.org/public/linkpages/NR+Rising+Prevalence+and+Unmet+Needs+of+Allergic+
Rhinitis.htm. Retrieved on 2008-10-01.
8. ^ "Rush University Medical Center". http://www.rush.edu/rumc/page-1098987384061.html.
Retrieved on 2008-03-05.

9. ^ "The Facts about Hay Fever". Healthlink. University of Wisconsin.

http://healthlink.mcw.edu/article/1031002426.html. Retrieved on 2007-06-19.
10.^ "NHS advice on hayfever". http://www.nhs.uk/Conditions/Hay-fever/Pages/Prevention.aspx?
url=Pages/Lifestyle.aspx.
11.^ Steven Jay Weiss. "Seasonal Allergic Rhinitis".
http://www.suggestadoctor.com/health_article_28.htm. Retrieved on 2009-01-28.
12.^ eMedicine Health Hay Fever Causes, Symptoms, and Treatment on eMedicineHealth.com
13.^ Walker S, Khan-Wasti S, Fletcher M, Cullinan P, Harris J, Sheikh A (2007). "Seasonal allergic
rhinitis is associated with a detrimental effect on examination performance in United Kingdom
teenagers: case-control study". J. Allergy Clin. Immunol. 120 (2): 3817.
doi:10.1016/j.jaci.2007.03.034. PMID 17560637.
14.^ Template:Url = http://www.allergy.org.au/aer/infobulletins/hayfever treatment.htm
15.^ Susan O'Meara, Paul Wilson, Chris Bridle, Jos Kleijnen and Kath Wright (2002). "Effective
Health Care: Homeopathy" (PDF). NHS Centre for Reviews and Dissemination.
http://www.york.ac.uk/inst/crd/ehc73.pdf. Retrieved on 2007-06-10. "There are currently
insufficient data ... to recommend homeopathy as a treatment for any specific condition"
16.^ Passalacqua G, Bousquet PJ, Carlsen KH, Kemp J, Lockey RF, Niggemann B, Pawankar R,
Price D, Bousquet J (2006). "ARIA update: I--Systematic review of complementary and
alternative medicine for rhinitis and asthma". J. Allergy Clin. Immunol. 117 (5): 105462.
doi:10.1016/j.jaci.2005.12.1308. PMID 16675332.
17.^ Terr A (2004). "Unproven and controversial forms of immunotherapy". Clin Allergy Immunol.
18 (1): 70310. PMID 15042943.
18.^ World Health Organisation (2002). Acupuncture: Review and Analysis of Reports on Controlled
Clinical Trials. Geneva: WHO. 87. ISBN 9789241545433.
19.^ (Furthermore, it should be noted that honeybees visit precisely those plants that are not
pollinated by the wind and are, therefore, less likely to cause allergic rhinitis.) TV Rajan, H
Tennen, RL Lindquist, L Cohen, J Clive (February 2002). "Effect of ingestion of honey on
symptoms of rhinoconjunctivitis". Annals of allergy, asthma & immunology 88 (2): 198203.
ISSN 1081-1206. PMID 11868925. "This study does not confirm the widely held belief that
honey relieves the symptoms of allergic rhinoconjunctivitis".
20.^ Jardine, Cassandra. "Honey: the sweetest cure for hayfever".
http://www.telegraph.co.uk/health/5135837/Honey-the-sweetest-cure-for-hayfever.html.
Retrieved on 2009-05-06.

[edit] External links

Rhinitis additional details and information

Rhinitis at Centers for Chronic Nasal and Sinus Dysfunction

Rhinitis Presentation at American Academy of Family Physicians

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

Seasonal Allergy and Pollen Allergy at allergies-tips.com

Self help guide (NHS Direct)

Start thinking about tackling hay fever (NHS Direct)