Chronic Rhinitis

Overview

Rhinitis is the inflammation and swelling of the nose's mucous membrane. There are two forms of rhinitis: allergic and nonallergic. Allergic rhinitis is caused by a type 1 hypersensitivity reaction that causes nasal mucous membrane irritation.

Infectious rhinitis, atrophic rhinitis, vasomotor rhinitis, drug-induced rhinitis, occupational rhinitis, gustatory rhinitis, hormonal rhinitis, and nonallergic rhinitis with eosinophilia syndrome (NARES) are all examples of nonallergic chronic rhinitis. The most common cause of infectious rhinitis is an upper respiratory tract infection that develops as rhinosinusitis.

Nasal congestion, rhinorrhea, and postnasal drip are all clinical symptoms of rhinitis. Patients with allergic rhinitis frequently suffer nasal irritation, sneezing, and worsening of symptoms during specific seasons or when exposed to certain allergens (e.g., dust, animal dander, mold spores, or plant pollen). Atrophic rhinitis can be either primary (idiopathic) or secondary (acquired) (e.g., due to granulomatous diseases). This kind of rhinitis is characterized by a foul-smelling, crust-filled nasal cavity and anosmia.

Patients with NARES may have nasal polyposis and hyposmia. Allergen and irritant avoidance, anti-inflammatory (e.g., corticosteroids, antihistamines), and/or decongestant treatment are used to treat allergic rhinitis (e.g., phenylephrine). Nasal lavage and surgical techniques can help people with atrophic and vasomotor rhinitis ease their symptoms.

Types of Chronic Rhinitis

• Allergic rhinitis (IgE mediated) 
• Nonallergic rhinitis (not IgE mediated):

1. Nonallergic rhinitis with eosinophilia syndrome (NARES).
2. Drug-induced rhinitis.
3. Rhinitis medicamentosa.
4. Hormonal rhinitis including rhinitis of pregnancy.
5. Occupational rhinitis.
6. Gustatory rhinitis.
7. Atrophic rhinitis.
8. Vasomotor rhinitis.
9. Infectious rhinitis (usually as rhinosinusitis).

What's Allergic Rhinitis?

Allergic rhinitis is a common ailment, and even when a cause for your symptoms is identified, the problem can still become chronic. This might be due to the fact that you have several allergies and the triggers are difficult to avoid due to your poor response to therapy or other circumstances.

Many persons with allergic rhinitis have itchy or watery eyes in addition to nasal symptoms. Controlling the symptoms of chronic allergic rhinitis is critical for avoiding complications like chronic sinusitis.

Allergic rhinitis typically causes cold-like symptoms, such as sneezing, itchiness and a blocked or runny nose. These symptoms usually start soon after being exposed to an allergen. Some people only get allergic rhinitis for a few months at a time because they're sensitive to seasonal allergens, such as tree or grass pollen. Other people get allergic rhinitis all year round.

Most people with allergic rhinitis have mild symptoms that can be easily and effectively treated. But for some people symptoms can be severe and persistent, causing sleep problems and interfering with everyday life. The symptoms of allergic rhinitis occasionally improve with time, but this can take many years and it's unlikely that the condition will disappear completely.

If you have not yet recognized your specific allergens, this might be a crucial first step in controlling your illness. This is often performed by an immunologist, but it can also be requested by an allergist, ear, nose, and throat doctor (otolaryngologist), or even a general practitioner. Dust, mold, and pet dander are the most prevalent causes of year-round (perennial) chronic rhinitis. 

Medications such as antihistamines may also help to manage your symptoms. In the United States, several different antihistamines are now accessible over-the-counter, including diphenhydramine, loratadine, cetirizine, and fexofenadine. Astepro (azelastine hydrochloride) is a nasal spray that is also available without a prescription.

What's Chronic Non-Allergic Rhinitis?

Nonallergic rhinitis refers to a group of symptoms that are similar to nasal allergies and hay fever but do not have a known cause. Non-infectious rhinitis, idiopathic rhinitis, vasomotor rhinitis, and intrinsic rhinitis are all names for this condition. To be considered chronic, symptoms must last at least a year.

Chronic non-allergic rhinitis exhibits the same symptoms as allergic rhinitis, namely nasal symptoms such as congestion and runny nose. People with non-allergic rhinitis, on the other hand, seldom have ocular symptoms.

Types of Chronic Non-Allergic Rhinitis

• Rhinitis medicamentosa: Rebound nasal congestion is thought to be caused by long-term use of topical decongestants and some oral drugs that constrict blood vessels in the nose. Withdrawal of nasal drops, brief courses of systemic steroid medication, and, in certain circumstances, surgical reduction of turbinates if they have become hypertrophied are all treatments.

• Rhinitis of pregnancy: Pregnant women may experience chronic rhinitis as a result of hormonal changes. Nasal mucus becomes edematous, obstructing the airway. In such instances, some people may get secondary infection and possibly sinusitis. When prescribing medications, extreme caution should be exercised. Local therapies, such as the restricted use of nasal drops, topical steroids, and limited surgery (cryosurgery) to turbinates, are generally adequate to relate the symptoms. The safety of newer antihistamines for developing fetuses has not been demonstrated, and they should be avoided.

• Honeymoon rhinitis: This is generally followed by nasal stuffiness as a result of sexual arousal. The disorder appears to be genetically determined and induced by the existence of erectile tissue in the nose, which may become engorged during sexual excitement as a side consequence of autonomic nervous system signals that activate changes in both men's and women's genitals. There is also a syndrome known as sexually induced sneezing, in which people sneeze, often uncontrollably, when engaging in or thinking about sexual activity. A frequent adverse effect of Viagra or comparable phosphodiesterase type 5 antagonists is nasal congestion, which is thought to be related to honeymoon rhinitis.

• Gustatory rhinitis: Spicy and pungent foods may cause rhinorrhea, nasal stuffiness, lacrimation, perspiration, and flushing of the face in certain persons. It can be eased by using an anticholinergic nasal spray like ipratropium bromide a few minutes before a meal.

• Non-air flow rhinitis: It is observed in individuals who have had a laryngectomy, a tracheostomy, or choanal atresia. The nose is not utilized for air flow, and the turbinates swell as a result of the absence of vasomotor control. There is an added risk of infection in choanal atresia due to the retention of discharge in the nasal cavity, which should ordinarily flow easily into the nasopharynx.

Causes and risk factors for Chronic Non-Allergic Rhinitis

It usually appears in adulthood, and the symptoms continue all year. Nonallergic rhinitis, in contrast to allergic rhinitis, does not engage the immune system. Allergy rhinitis affects about 58 million Americans. In comparison, millions of people suffer from nonallergic rhinitis.

It is frequently unknown what causes nonallergic rhinitis. And, in many cases, the condition is only established after other disorders, such as allergic rhinitis or infection, have been ruled out. Nonallergic rhinitis is frequently triggered by environmental irritants. Some are found at home, while others are more frequent at work.

Examples of what can trigger symptoms include:

• Car exhaust.
• Chlorine.
• Cigarette smoke.
• Cleaning solutions.
• Glues.
• Hair spray.
• Latex.
• Laundry detergents.
• Metal salts.
• Perfume.
• Smog.
• Wood dust.

Some medications can trigger non-allergic rhinitis. Examples include:

• NSAIDs such as aspirin and ibuprofen.
• Oral contraceptives.
• Blood pressure medicines such as ACE inhibitors and beta-blockers.
• Antidepressants.
• Tranquilizers.
• Drugs used to treat erectile dysfunction.

Foods and beverages may also be triggers. Examples include:

• Hot foods such as soup.
• Spicy foods.
• Alcoholic beverages, especially beer and wine.

Other triggers include:

• Illegal drugs: Cocaine and other snorted street drugs often cause chronic nonallergic rhinitis.
• Weather changes: Nonallergic rhinitis can be triggered by sudden changes in weather or temperature. Skiers, for example, frequently acquire a runny nose. Furthermore, some persons are adversely impacted by any form of cold exposure. People may even begin sneezing after leaving a cool, air-conditioned environment in some cases.
• Hormone changes: Nonallergic rhinitis often happens during periods of hormonal imbalance. For instance, it may happen during puberty, menstruation, or pregnancy. It usually starts during the second month of pregnancy and lasts until childbirth. Hormonal conditions such as hypothyroidism can also trigger symptoms.

Evaluation of Chronic Non-Allergic Rhinitis

There is no specific test that can determine whether you have nonallergic rhinitis. Your doctor will perform a physical checkup on you and ask you about your symptoms. An allergy test is the only method to ensure that allergies aren't the source of your symptoms. There are several types of tests that your doctor may prescribe for you:

• Blood test: This test assesses the level of immunoglobulin E (IgE) antibodies in your blood to determine if your immune system has responded to certain allergens.
• Skin test: Your doctor will use a needle to prick your skin and expose it to a little quantity of something that many people are allergic to, such as mold, pollen, or pet dander. If you are allergic to any of these, you will develop a lump on your skin that looks like an insect bite.
• Nasal endoscopy: To examine your sinuses and nasal passages, your doctor will insert a tiny fiber-optic tube called an endoscope into your nostrils.
• CT scan: This is a computerized X-ray that produces extremely detailed images of your sinuses.

Is Chronic Non-Allergic Rhinitis curable?

Nonallergic rhinitis can't be cured. But it can be controlled by:

• Avoiding rhinitis triggers
• Using home remedies such as nasal irrigation
• Taking over-the-counter and prescription medications

Allergy shots(immunotherapy) are not used to treat nonallergic rhinitis. If you have nonallergic rhinitis, it's important that you not smoke and not allow smoking in your home. Other strategies to reduce exposure to triggers include:

• If you have symptoms, avoid using wood-burning stoves and fireplaces.
• If cleaning chemicals, household sprays, perfumes, and scented products create problems, avoid them.
• Ask that family, friends, and coworkers refrain from using scented products that aggravate symptoms.
• Avoid using any chemical or material that causes you to sneeze or have a runny nose.
• Discuss your current drugs with your doctor. If a medication you require causes your nonallergic rhinitis, your doctor may recommend a substitution.

It's crucial to remember that if you're irrigating, flushing, or washing your sinuses, the CDC recommends using distilled, sterile, or previously boiled water to prepare the irrigation solution. It is also critical to rinse the irrigation device after each usage and to leave it open to air dry.

Nasal irrigation, when performed once or twice a day, may be extremely beneficial in the treatment of postnasal drip. It's also a good way to clean your sinuses before utilizing medication nasal sprays.

Medications for nonallergic rhinitis include:

• Nasal antihistamines: Prescription medications such as azelastine (Astelin) and olopatadine (Patanase) help reduce postnasal drip, congestion, and sneezing in minutes. They work best when used on a regular basis.
• Nasal glucocorticoids: Taking budesonide (Rhinocort Allergy), fluticasone (Flonase), or triamcinolone (Nasacort Allergy 24HR) on a daily basis may help ease symptoms. These nasal sprays are accessible without a prescription. It might take many days or weeks to observe the full results. People may benefit from a combination of nasal antihistamines and nasal glucocorticoids in some cases.
• Nasal ipratropium: Ipratropium bromide (Atrovent) is widely regarded as the most effective therapy for watery nasal discharge caused by certain meals and beverages.
• Decongestants: Oral decongestant medications such as pseudoephedrine may help relieve congestion. But these are not generally recommended unless nasal antihistamines and nasal glucocorticoids don’t help symptoms. Decongestant nasal sprays containing oxymetazoline and phenylephrine should not be used for more than 2 to 3 days at a time. Doing so can cause overuse (rebound) congestion.

In certain circumstances, surgery to remove nasal polyps, correct a deviated septum or reduce the turbinates (the portion of the nose that warms and moisturizes air) might enhance the way nonallergic rhinitis drugs work. Surgery, on the other hand, is only considered as a therapy after all other options have failed to alleviate symptoms.

How Chronic Non-Allergic Rhinitis is prevented?

You can't always stop your symptoms if you have nonallergic rhinitis, but there are things you can do to make them less likely to occur:

• Stay away from your triggers: If you know what triggers your symptoms, you can avoid them and feel better.
• Reduce your use of nasal decongestants: You may be tempted to seek comfort from them, but if you take nasal decongestant sprays for more than a few days, your symptoms will worsen.
• Speak with your doctor: If your present therapy isn't working, your doctor may be able to devise a new treatment plan that will.

Conclusion

Rhinitis is the inflammation and swelling of the nasal mucous membrane. There are two forms of rhinitis: allergic rhinitis and nonallergic rhinitis. Allergic rhinitis is characterized by a type 1 hypersensitivity reaction that causes inflammation of the nasal mucous membranes.

Allergic rhinitis, of which the seasonal type is called hay fever, is a type of inflammation in the nose that occurs when the immune system overreacts to allergens in the air. A runny or stuffy nose, sneezing, red, itchy, and watery eyes, and swelling around the eyes are all signs and symptoms. The nasal fluid is normally clear. Symptoms typically appear within minutes after allergen contact and might interfere with sleep and ability to work or study. Some people may only have symptoms at certain periods of the year, frequently as a result of pollen exposure. Many persons who suffer from allergic rhinitis also suffer from asthma, allergic conjunctivitis, or atopic dermatitis.

Nonallergic rhinitis is an inflammation of the inside section of the nose caused by something other than an allergy. Nonallergic rhinitis is characterized by symptoms such as recurrent sneezing or a congested, drippy nose in the absence of an identifiable allergic response. Nonallergic rhinitis is also known as vasomotor rhinitis and perennial rhinitis. Nonallergic rhinitis is common in otolaryngology, accounting for 40% of all cases. Allergic rhinitis is more frequent than nonallergic rhinitis; yet, both disorders present, exhibit, and treat similarly. Nasal irritation and paroxysmal sneezing are more commonly linked with nonallergic rhinitis than allergic rhinitis.

Early animal exposure may reduce the risk of acquiring these specific allergies. Nasal steroids, antihistamines such as diphenhydramine and cromolyn sodium, and leukotriene receptor antagonists such as montelukast are all used to treat allergic symptoms. Medications do not always entirely manage symptoms, and they may have negative effects. Allergen immunotherapy (AIT), which involves exposing patients to increasing quantities of allergen, is frequently beneficial. The allergen might be administered as an injection under the skin or as a pill administered under the tongue.

If symptoms of rhinitis are accompanied by fever, facial pain, headaches, toothache, extreme fatigue, or foul-smelling nasal discharge, see your healthcare provider immediately. This may be a sign of a sinus infection in need of antibiotic treatment.