Rhinitis is an inflammation of the mucous membrane inside the nose, characterized by symptoms such as a runny nose, sneezing, nasal congestion, and itching. It can be caused by allergies (allergic rhinitis, commonly known as hay fever) or by non-allergic factors (non-allergic rhinitis).
Causes:
Rhinitis can be broadly categorized by its cause:
- Allergic Rhinitis: This is an immune system response to specific allergens.
- Seasonal Allergic Rhinitis (Hay Fever): Triggered by outdoor allergens that are present during certain seasons, such as pollen from trees, grasses, and weeds.
- Perennial Allergic Rhinitis: Triggered by indoor allergens present year-round, such as dust mites, pet dander, mold spores, and cockroach droppings.
- Non-Allergic Rhinitis: This type is not caused by an immune system reaction to allergens. Causes include:
- Irritants: Exposure to environmental irritants like tobacco smoke, strong odors (perfumes, cleaning products), air pollution, and chemical fumes.
- Weather changes: Sudden changes in temperature or humidity.
- Infections: Viral infections (e.g., common cold, flu) are a very common cause of acute rhinitis. Bacterial infections can also occur.
- Hormonal changes: Fluctuations during pregnancy, puberty, or with thyroid conditions.
- Certain medications: Such as NSAIDs (e.g., aspirin), beta-blockers, oral contraceptives, and some blood pressure medications.
- Food: Spicy foods or alcohol can sometimes trigger non-allergic rhinitis symptoms.
- Structural problems: Deviated septum, nasal polyps, or enlarged turbinates can contribute to chronic congestion.
- Atrophic Rhinitis: A rare condition where the nasal lining thins and hardens.
- Vasomotor Rhinitis: Occurs when blood vessels in the nose overreact to non-allergic triggers, leading to congestion and runny nose.
Symptoms:
The symptoms of rhinitis can vary in intensity and duration, but commonly include:
- Runny nose (rhinorrhea): Clear, watery discharge is common in allergic rhinitis and viral infections.
- Nasal congestion (stuffy nose): Difficulty breathing through the nose.
- Sneezing: Often occurs in bouts, especially with allergic rhinitis.
- Itchy nose, throat, eyes, or roof of mouth: Particularly characteristic of allergic rhinitis.
- Postnasal drip: Mucus dripping down the back of the throat, leading to a cough or throat clearing.
- Watery, red, or itchy eyes (allergic conjunctivitis): Common with allergic rhinitis.
- Reduced sense of smell (hyposmia).
- Headache or facial pressure: Can occur with severe congestion or sinus involvement.
- Fatigue: Especially if symptoms interfere with sleep.
Diagnosis:
Diagnosing rhinitis involves a medical history, physical examination, and sometimes specific tests to determine the cause.
- Medical history and physical exam: The doctor will ask about your symptoms (when they occur, what triggers them), family history of allergies, and examine your nasal passages.
- Allergy testing (for allergic rhinitis):
- Skin prick test: Small amounts of allergens are pricked onto the skin to see if a reaction occurs.
- Specific IgE blood test (RAST test): Measures levels of specific allergy antibodies in the blood.
- Nasal endoscopy: A thin, lighted tube is used to examine the nasal passages and sinuses for structural problems, polyps, or inflammation.
- CT scan of the sinuses: May be performed if sinus infection or structural abnormalities are suspected.
- Ruling out other conditions: The doctor may conduct tests to rule out other conditions that cause similar symptoms, such as the common cold, sinusitis, or nasal polyps.
Treatment:
Treatment for rhinitis depends on the underlying cause and the severity of symptoms.
- For Allergic Rhinitis:
- Allergen avoidance: Identifying and minimizing exposure to specific allergens.
- Nasal corticosteroids: (e.g., fluticasone, budesonide) are often the most effective treatment for reducing nasal inflammation, congestion, sneezing, and runny nose.
- Antihistamines: Oral antihistamines (e.g., cetirizine, fexofenadine) or antihistamine nasal sprays (e.g., azelastine) relieve itching, sneezing, and runny nose.
- Decongestants: Oral (e.g., pseudoephedrine) or nasal sprays (e.g., oxymetazoline) can relieve congestion. Nasal decongestant sprays should be used for only a few days to avoid rebound congestion.
- Cromolyn sodium nasal spray: Helps prevent the release of allergy-causing chemicals.
- Allergen immunotherapy (allergy shots or sublingual tablets): Long-term treatment that can desensitize the immune system to specific allergens.
- Nasal saline rinses: Help clear mucus and allergens from the nasal passages.
- For Non-Allergic Rhinitis:
- Avoidance of irritants: Limiting exposure to smoke, strong odors, and other triggers.
- Nasal saline rinses: Help clear nasal passages.
- Nasal corticosteroids: Can be effective for some types of non-allergic rhinitis.
- Antihistamine nasal sprays: Some (e.g., azelastine) also have anti-inflammatory properties that can help.
- Ipratropium bromide nasal spray: Reduces watery nasal discharge.
- Decongestants: For temporary relief of congestion.
- Treating underlying conditions: Addressing issues like reflux or thyroid problems if they contribute to symptoms.
- For Infectious Rhinitis (e.g., common cold):
- Rest, fluids, and over-the-counter symptom relievers (decongestants, pain relievers). Antibiotics are not effective for viral infections.
Managing rhinitis often involves a combination of strategies. Consulting a healthcare professional can help determine the specific type of rhinitis and develop the most effective treatment plan.
