6. Understand the Aetiology and Treatment of Rhinitis[]
Aetiology[]
Two key subtypes:
- Allergic rhinitis
- Non-allergic rhinitis
Allergic rhinitis can be triggered by a variety of common allergens, such as house dust mites, tree and grass pollen, animals and occupational allergens. They trigger a pathological immune response, leading to the symptoms of rhinitis.
Non-allergic rhinitis has a variety of causes, including
- Infectious rhinitis - caused by an infective agent
- Vasomotor rhinitis - where blood vessels react pathologically to triggers such as cold weather
- Atrophic rhinitis - Nasal membranes thin and harden, causing nasal passages to widen and dry out. Can sometimes occur as a complication of surgery or infection.
- Rhinitis medicamentosa - caused by overuse of nasal decongestants, such as oxymetalozone
Treatment[]
Treatment for rhinitis depends on the type encountered.
Allergic rhinitis - Prescribe an oral antihistamine for those with concomitant conjunctivitis. If only nasal symptoms are present, prescribe intranasal azelastine antihistamine spray. If symptoms of blockage or nasal discharge persist, consider prescribing an intranasal corticosteroid. Antimuscarinic drugs such as ipratropium may help in refractory cases. Remember to check medication technique and compliance. If patient is on maximal medical therapy, consider referral to a specialist.
Infectious rhinitis - Infectious rhinitis is largely viral, and almost all cases are self-limiting and symptoms will resolve within 14 days. Symptomatic treatment may help the comfort of the patient.
Vasomotor rhinitis - Advise identification of triggers, and subsequent avoidance. Antihistamine nasal sprays reduce inflammation. Anticholinergic nasal sprays enlarge the nasal passages. Sodium cromoglycate inhaler helps reduce mucous production and inflammation.
Atrophic rhinitis - Nasal irrigation with saline solution is the commonest treatment for atrophic rhinitis. A course of antibiotics will help control any superinfection which may be causing malodour.
Rhinitis medicamentosa - The causative nasal decongestants should be stopped. If this proves difficult, methods to ease withdrawal include: -
- Stopping usage in the 'good' nostril for 7 days before stopping usage altogether
- Using antihistamine to reduce nighttime congestion
- Lubrication with saline solution
- In severe cases, a short course of corticosteroids may be provided.