Rhinitis
Definition | Allergic Rhinitis | Non-Allergic Rhinitis | Infectious Rhinitis | Occupational Rhinitis | References
Definition
Rhinitis is the inflammation of the nasal mucosa, characterised by symptoms such as nasal congestion, rhinorrhoea (runny nose), sneezing, and itching. It can be classified into various types based on the underlying cause.
Allergic Rhinitis
Definition: Allergic rhinitis is an inflammatory condition of the nasal mucosa caused by an allergic reaction to airborne allergens.
Aetiology: Common allergens include pollen, dust mites, animal dander, and mould spores.
Pathophysiology: Exposure to allergens triggers an IgE-mediated immune response, leading to the release of histamine and other inflammatory mediators from mast cells.
Risk Factors: Family history of allergies, exposure to allergens, atopic conditions (e.g., asthma, eczema).
Signs and Symptoms: Nasal congestion, rhinorrhoea, sneezing, nasal itching, postnasal drip, watery eyes.
Investigations: Clinical history, skin prick tests, specific IgE blood tests, nasal endoscopy if needed.
Management:
- Avoidance of known allergens
- Intranasal corticosteroids (e.g., fluticasone, mometasone)
- Oral or intranasal antihistamines (e.g., cetirizine, loratadine)
- Leukotriene receptor antagonists (e.g., montelukast)
- Immunotherapy (allergy shots) for severe or refractory cases
- Referral to an allergist for specialist management
Non-Allergic Rhinitis
Definition: Non-allergic rhinitis is inflammation of the nasal mucosa not caused by allergens, often due to irritants or other non-allergic triggers.
Aetiology: Irritants (e.g., smoke, strong odours), medications (e.g., aspirin, beta-blockers), hormonal changes (e.g., pregnancy), temperature changes, idiopathic.
Pathophysiology: Non-allergic triggers cause direct irritation or inflammation of the nasal mucosa without an IgE-mediated immune response.
Risk Factors: Exposure to irritants, certain medications, hormonal changes.
Signs and Symptoms: Nasal congestion, rhinorrhoea, postnasal drip, sneezing, nasal itching (less common).
Investigations: Clinical history, exclusion of allergic causes through allergy testing, nasal endoscopy if needed.
Management:
- Avoidance of known irritants
- Intranasal corticosteroids (e.g., fluticasone, mometasone)
- Intranasal antihistamines (e.g., azelastine)
- Saline nasal irrigation
- Anticholinergic nasal sprays (e.g., ipratropium bromide)
- Referral to an ENT specialist for persistent or severe cases
Infectious Rhinitis
Definition: Infectious rhinitis, also known as the common cold, is inflammation of the nasal mucosa caused by viral or bacterial infections.
Aetiology: Viruses (e.g., rhinovirus, coronavirus), bacteria (less common).
Pathophysiology: Infection leads to inflammation of the nasal mucosa, increased mucus production, and nasal congestion.
Risk Factors: Close contact with infected individuals, weakened immune system, exposure to cold weather.
Signs and Symptoms: Nasal congestion, rhinorrhoea, sneezing, sore throat, cough, fever (occasionally).
Investigations: Clinical history and examination, usually no further tests required unless complications are suspected.
Management:
- Rest and hydration
- Analgesics and antipyretics (e.g., paracetamol, ibuprofen)
- Antibiotics (e.g., Pen V or Amoxicillin)
- Saline nasal sprays or rinses
- Referral to a specialist if symptoms persist or complications develop
Occupational Rhinitis
Definition: Occupational rhinitis is inflammation of the nasal mucosa caused by exposure to irritants or allergens in the workplace.
Aetiology: Exposure to dust, chemicals, animal dander, latex, or other workplace allergens and irritants.
Pathophysiology: Occupational exposures trigger an inflammatory response in the nasal mucosa, similar to allergic or non-allergic rhinitis depending on the nature of the irritant.
Risk Factors: Certain occupations (e.g., farming, healthcare, hairdressing), prolonged exposure to workplace irritants or allergens.
Signs and Symptoms: Nasal congestion, rhinorrhoea, sneezing, nasal itching, symptoms improve away from the workplace.
Investigations: Clinical history, workplace assessment, allergy testing if allergic rhinitis is suspected, nasal endoscopy if needed.
Management:
- Avoidance or reduction of exposure to workplace irritants or allergens
- Personal protective equipment (PPE) such as masks or respirators
- Intranasal corticosteroids (e.g., fluticasone, mometasone)
- Oral or intranasal antihistamines (e.g., cetirizine, loratadine)
- Referral to occupational health services for workplace assessment and modifications
- Referral to an ENT specialist for persistent or severe cases
References
- NICE. (2024). Rhinitis: Assessment and Management. Retrieved from NICE
- NHS. (2023). Rhinitis. Retrieved from NHS
- British Medical Journal (BMJ). (2022). Rhinitis: Diagnosis and Management. Retrieved from BMJ
- American Academy of Allergy, Asthma & Immunology (AAAAI). (2021). Clinical Practice Guideline: Rhinitis. Retrieved from AAAAI
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