Rhinitis Overview and Classification

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Questions and Answers

What role do cell mediators like histamine play in the allergic response?

Cell mediators such as histamine lead to vasodilatation, increased vascular permeability, and plasma exudation, causing symptoms like itching and sneezing.

How do acute and late-phase allergic responses differ?

Acute responses occur immediately after allergen exposure, while late-phase reactions may prolong symptoms and cause tissue damage.

List two environmental factors that can contribute to allergic rhinitis.

Exposure to allergens and air pollution are significant environmental factors that can trigger allergic rhinitis.

What distinguishes seasonal allergic rhinitis from perennial allergic rhinitis?

Seasonal allergic rhinitis is caused by airborne pollen peaks, while perennial allergic rhinitis is triggered by allergens present year-round. Signup and view all the answers

Identify one drug that is associated with provoking allergic rhinitis.

Penicillin is one drug that can provoke allergic rhinitis symptoms. Signup and view all the answers

What is the clinical significance of co-morbidities in allergic rhinitis?

Co-morbidities like asthma and sinusitis can complicate the management and symptomatology of allergic rhinitis. Signup and view all the answers

What symptoms characterize immediate-type allergic responses?

Immediate-type allergic responses are characterized by sneezing, rhinorrhea, and itching. Signup and view all the answers

Describe one dietary source that may provoke IgE allergic rhinitis.

Certain foods like cheese and wine, which contain histamine, may provoke IgE allergic rhinitis. Signup and view all the answers

What clinical symptoms characterize rhinitis?

The symptoms of rhinitis include rhinorrhea, nasal obstruction, itching, and sneezing. Signup and view all the answers

What is the role of IgE in allergic rhinitis?

IgE is involved in the inflammatory response of allergic rhinitis by binding to allergens and mast cells. Signup and view all the answers

Differentiate between infectious rhinitis and non-infectious rhinitis.

Infectious rhinitis is caused by pathogens, while non-infectious rhinitis can result from allergies or non-allergic triggers. Signup and view all the answers

Name two types of chronic rhinosinusitis.

Chronic nonspecific rhinosinusitis and chronic specific rhinosinusitis are two types. Signup and view all the answers

What is atopy and how does it relate to allergy?

Atopy is the predisposition to develop an exaggerated IgE response, which leads to allergic diseases. Signup and view all the answers

List at least two types of non-allergic rhinitis.

Idiopathic rhinitis and vasomotor rhinitis are two types of non-allergic rhinitis. Signup and view all the answers

What triggers the symptoms of allergic rhinitis?

The symptoms are triggered by exposure to allergens that initiate an IgE-mediated response. Signup and view all the answers

How does rhinitis medicamentosa occur?

Rhinitis medicamentosa occurs due to the overuse of nasal decongestant medications. Signup and view all the answers

What are the common symptoms associated with idiopathic rhinitis?

Symptoms include nasal obstruction and clear nasal drainage. Signup and view all the answers

What occupations are most often linked to occupational rhinitis?

Bakers, farmers, woodworkers, and workers in the detergent industry. Signup and view all the answers

How does hormonal rhinitis during pregnancy manifest?

It leads to increased nasal edema and congestion due to high estrogen levels. Signup and view all the answers

Which medications are commonly associated with drug-induced rhinitis?

Aspirin, NSAIDs, methyldopa, ACE inhibitors, beta blockers, and oral contraceptives. Signup and view all the answers

What is rhinitis medicamentosa and what causes it?

It is caused by the persistent overuse of topical nasal decongestants. Signup and view all the answers

What distinguishes nonallergic rhinitis with eosinophilia (NARES) from allergic rhinitis?

Patients with NARES show marked eosinophilia but are not allergic to inhalant allergens. Signup and view all the answers

In the context of vasomotor rhinitis, what autonomic dysfunction is suggested?

Abnormal autonomic regulation of nasal function is suggested. Signup and view all the answers

What is the recommended approach for managing rhinitis medicamentosa?

Taper down the decongestant over a week and add topical steroids and antihistamines. Signup and view all the answers

What is the primary method for diagnosing noninfectious nonallergic rhinitis?

Diagnosis is primarily through clinical history and exclusion of other causes of rhinitis. Signup and view all the answers

What is the role of ipratropium bromide in the pharmacological treatment of noninfectious nonallergic rhinitis?

Ipratropium bromide is used as an intranasal anticholinergic drug, particularly effective for rhinoorrhea. Signup and view all the answers

List two surgical treatments for nonallergic rhinitis and their purposes.

Septoplasty corrects septal abnormalities, while inferior turbinate surgery addresses turbinate hypertrophy. Signup and view all the answers

What are the recommendations for treating drug-induced noninfectious nonallergic rhinitis?

The offending drug should be discontinued to treat drug-induced rhinitis. Signup and view all the answers

Describe the role of saline irrigation in managing noninfectious nonallergic rhinitis.

Saline irrigation helps prevent intranasal stasis and reduces crusting in the nasal passages. Signup and view all the answers

What key symptoms should be evaluated when diagnosing allergic rhinitis?

Frequency, severity, duration, persistence, intermittence, and seasonality of symptoms should be evaluated. Signup and view all the answers

Describe the typical appearance of the nasal mucosa in allergic rhinitis during an ENT examination.

The nasal mucosa is usually bilaterally swollen, pale or bluish in color, oedematous, and covered with watery secretions. Signup and view all the answers

What laboratory findings would support a diagnosis of allergic rhinitis?

Increased eosinophils in nasal secretions and the presence of allergen-specific IgE in serum through ELISA or RAST. Signup and view all the answers

Why is a skin prick test important in diagnosing allergic rhinitis?

The skin prick test helps to identify specific allergens by observing the skin's reaction to various allergen solutions. Signup and view all the answers

What are the primary components of managing allergic rhinitis?

Management includes allergen identification, avoidance, education, pharmacotherapy, and possibly immunotherapy. Signup and view all the answers

How do topical corticosteroids function in the treatment of allergic rhinitis?

Topical corticosteroids control nasal symptoms effectively and reduce inflammation, congestion, and blockage. Signup and view all the answers

What challenges exist in the avoidance of allergens for patients with allergic rhinitis?

Identifying and avoiding causal allergens can be difficult in practice due to the ubiquity of certain allergens. Signup and view all the answers

What is the significance of measuring pulmonary function in patients with persistent rhinitis?

It helps to rule out underlying asthma or respiratory issues that may complicate rhinitis. Signup and view all the answers

Study Notes

Rhinitis Definition

Rhinitis is inflammation of the nasal lining, characterized by two or more nasal symptoms: runny nose, congestion, itching and sneezing.

Rhinitis Classification

Rhinitis can be classified into two main subtypes: infectious rhinitis and non-infectious rhinitis.

Infectious Rhinitis

Acute Rhinitis: A common, short-term inflammation of the nasal lining caused by a virus, usually lasting less than 10 days.
Chronic Rhinosinusitis: A long-term inflammation of the nasal lining and sinuses caused by viruses, bacteria, and fungi.
- Chronic Nonspecific Rhinosinusitis: This is a general type of chronic rhinosinusitis that cannot be linked to specific causes.
- Chronic Specific Rhinosinusitis: This type is caused by specific organisms.

Non-Infectious Rhinitis

Allergic Rhinitis: An IgE-mediated allergic reaction to allergens that triggers nasal symptoms.
Non-Allergic Rhinitis: A group of conditions that cause nasal symptoms, but are not caused by allergies.
- Idiopathic (Vasomotor) Rhinitis: This is characterized by nasal obstruction and clear drainage often caused by temperature changes, exposure to odors, chemicals, or alcohol.
- Occupational Rhinitis: Caused by exposure to allergens in the workplace, such as dust, fumes, and chemicals.
- Hormonal Rhinitis: Often associated with pregnancy due to increased estrogen levels, leading to increased fluid retention (edema) in the nasal lining.
- Drug-Induced Rhinitis: Rhinitis triggered by medications, including aspirin, NSAIDs, methyledopa, ACE inhibitors, beta blockers, and oral contraceptives.
- Rhinitis Medicamentosa: Rebound rhinitis caused by prolonged use of topical nasal decongestants, resulting in worsening symptoms.
- Non-Allergic Rhinitis with Eosinophilia (NARES): A newly described syndrome characterized by nasal symptoms and an increased eosinophil count, but not allergic to inhalant allergens, and the cause is unknown.

Allergic Rhinitis Pathophysiology

Allergic rhinitis is a type 1 hypersensitivity reaction.
IgE binds to allergens and mast cells, triggering the release of mediators (histamine, prostaglandins, leukotrienes), resulting in blood vessel dilation, increased fluid leakage, leading to itching, sneezing and mucus secretion, and inflammation of the nasal lining.

Allergic Rhinitis Clinical Presentation

Seasonal Allergic Rhinitis (Hay Fever): Triggered by seasonal allergens, such as pollen.
Perennial Allergic Rhinitis (Atopic Rhinitis): Caused by allergens present year-round, such as dust mites.
Allergic rhinitis symptoms typically include sneezing, runny nose, nasal congestion and itching, along with congestion, hyperreactivity, and impairment of the sense of smell.
Eye symptoms: Allergic rhinitis can cause eye irritation and symptoms, such as tearing and burning sensations.

Allergic Rhinitis Etiology

Underlying Causes:
- Genetic Factors: Familial predispositions to allergies.
- Environmental Factors:
  - Exposure to Allergens: Dust, pollens, feathers, fungal spores, house dust mites.
  - Air Pollution:
  - Occupational Exposure: Flour, wood dust, latex, tobacco, detergents, and bleach.
  - Some Foods: Preservatives, histamine-rich foods, such as certain cheeses and wines.
  - Medications: Penicillin, aspirin, antihypertensives, beta-blockers, and ACE inhibitors.

Allergic Rhinitis Diagnosis

Diagnosis is based on clinical presentation and confirmed by laboratory tests.
Nasal Cytology: Shows increased eosinophil count in nasal secretions and mucosa.
Skin Prick Test (SPT): A confirmatory test where different allergens are introduced to the skin.
Blood Test: Shows allergen-specific IgE levels through an ELISA (Enzyme-Linked Immunosorbent Assay) or RAST (Radioallergosorbent Test).
Nasal Swab: For bacterial and viral culture.
Nasal Allergen Challenge: A controlled exposure to an allergen.

Allergic Rhinitis Treatment

Prevention:
- Allergen Identification and Avoidance: Identifying and avoiding known allergens is the first step.
- Patient Education: Understanding the triggers and management strategies.
Pharmacologic Therapy:
- Topical Corticosteroids: Nasal sprays, such as mometasone, beclomethasone, budesonide, and fluticasone propionate, are highly effective.
- Antihistamines: Block histamine receptors, reducing symptoms, such as sneezing, runny nose and itching.
- Decongestants: Short-term use, for nasal congestion Relief.
- Leukotriene Modifiers: Block the actions of leukotrienes, reducing inflammation and symptoms.
Immunotherapy:
- Allergen Immunotherapy (AIT): Repeatedly administered injections of small doses of allergens to desensitize the immune system.

Non-Infectious Non-Allergic Rhinitis (NIANR)

This group includes rhinitis conditions that are not related to allergies.
Diagnosis: Clinical history and ruling out other causes.
Treatment:
- Avoidance: Environmental and occupational. & Use a mask if necessary.
- Drug Discontinuation: If drug-induced rhinitis, stop the offending medication.
- Pharmacologic Therapy:
  - Topical Intranasal Anticholinergics (Ipratropium Bromide), primarily for rhinorrhea.
  - Topical Intranasal Steroids: Used for both allergic and some non-allergic forms.
  - Alpha-Adrenergic Agents: Short-term use for congestion relief.
  - Saline Irrigation: Helps to prevent crust formation and nasal congestion
  - Intranasal Antihistamine Sprays: Tried for vasomotor rhinitis but effectiveness is questionable.
- Surgery:
  - Septoplasty: Correction of structural abnormalities of the nasal septum.
  - Turbinate Surgery: To reduce the size of the inferior turbinates, often used to treat NIANR.

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Description

Explore the definitions and classifications of rhinitis, encompassing both infectious and non-infectious forms. This quiz delves into the specifics of acute and chronic rhinitis, as well as allergic and non-allergic types. Test your knowledge on the causes and symptoms associated with this nasal condition.