Rhinitis: Causes, Symptoms, Diagnosis, and Treatment Options

What is Rhinitis

Rhinitis refers to the inflammation of the nasal mucosa

Types of Rhinitis

There are several types of rhinitis, the most common ones include

Allergic rhinitis

Allergic rhinitis is an inflammatory response to environmental allergens that involves the upper respiratory tract. Allergic rhinitis is caused by a reaction of the body’s immune system to an environmental trigger. The most common environmental triggers include dust, molds, pollens, grasses, trees, and animals. It can be seasonal or perennial and it is often referred to as hay fever

Non-allergic rhinitis

Non allergic rhinitis is inflammation of the nasal mucosa, which does not caused by allergic substances. Non allergic rhinitis does not involve the immune system and affects adults which can last for months to year. response may be caused by a variety of factors, such as hormonal changes, environmental factors, or a viral infection such as a cold, cocaine, some alcoholic beverages, spicy foods, oral contraceptives, nsaids such as aspirin, BP medications (ACE, beta blockers), etc

Pathophysiology of Rhinitis

The pathophysiology of rhinitis involves a complex interplay between immune responses, inflammatory mediators release from mast cells and other cells involved in allergic response (eosinophils), as well as genetic predisposition and environmental triggers.

Allergic Rhinitis:

Sensitization:Allergic rhinitis is typically triggered by an allergic response to specific allergens such as pollen, dust mites, animal dander, or mold spores. Upon initial exposure (sensitization), the immune system recognizes these allergens as foreign substances.
IgE-Mediated Response: On subsequent exposures to the same allergen, mast cells in the nasal mucosa release immunoglobulin E (IgE) antibodies that bind to receptors on their surface.
Release of Inflammatory Mediators:Cross-linking of IgE molecules on mast cells leads to degranulation and release of inflammatory mediators like histamine, leukotrienes, prostaglandins, and cytokines.
Vasodilation and Increased Vascular Permeability:Histamine causes vasodilation and increased vascular permeability in blood vessels near affected areas leading to tissue edema and congestion.
Activation of Inflammatory Cells:Cytokines released from mast cells attract other inflammatory cells such as eosinophils and neutrophils into the nasal mucosa causing further inflammation.

Non-Allergic Rhinitis:

Non-allergic rhinitis encompasses several subtypes including infectious rhinitis (viral or bacterial infections), hormonal rhinitis (associated with pregnancy or menstrual cycle), occupational rhinitis (exposure to certain irritants at work), drug-induced rhinitis (medication side effects), gustatory rhinitis (triggered by eating spicy foods), etc. Each subtype has its own unique pathophysiological mechanisms. For example, viral rhinitis involves direct invasion of the nasal mucosa by viruses leading to inflammation and increased mucus production.

Neurogenic Rhinitis:

Neurogenic rhinitis is characterized by excessive nasal secretions due to dysfunction in neural control mechanisms. It can be caused by various factors such as autonomic nervous system imbalances, hormonal changes, or certain medications affecting neural pathways that regulate nasal gland secretion.

Structural Abnormalities:

In some cases, structural abnormalities like deviated septum or nasal polyps can contribute to chronic rhinitis symptoms. These physical obstructions impede normal airflow and drainage within the nasal passages, leading to congestion and inflammation.

Environmental Triggers:

Exposure to environmental irritants such as cigarette smoke, air pollutants (including particulate matter), strong odors/fragrances, or cold air can induce acute or chronic rhinitis symptoms through direct irritation of the nasal mucosa.

Diagnostic Investigations

• History taking
• Physical examination
• CT scan
• Nasal endoscopy
• Skin test
• Blood test to measures the amount of immunoglobulin E (IgE) antibodies

Treatment Measures of Rhinitis

Treatment options for allergic rhinitis include

• Immunotherapy
• saline nasal irrigation
• Sympathomimetic decongestants such as Phenylephrine, pseudoephedrine, which activates alpha-1 receptors causing vasoconstriction, thereby reduces swelling
• Intranasal glucocorticoids such as beclomethasone, budesonide, triamcinolone, ciclesonide, fluticasone, to reduce the release of inflammatory mediators
• Antihistamines such as diphenhydramine, fexofenadine, loratadine, cetirizine, intranasal azelastine, which blocks histamine receptors from responding to trigger
• Leukotriene receptor antagonists (LTRAs) such as Pranlukast, montelukast
• Intranasal corticosteroids such as triamcinolone acetonide, fluticasone propionate, mometasone furoate and fluticasone furoate
• Oral antihistamines

Non-allergic treatment

Often, medications are used to control symptoms and include:

• Intranasal saline spray or nasal glucocorticoids, such as budesonide, fluticasone, or triamcinolone to relieve symptoms.
• Antihistamines (oral or intranasal), azelastine (Astelin) and olopatadine (Patanase) can relieve symptoms of postnasal drip, congestion, and sneezing
• Decongestants. Oral decongestant medications -- such as pseudoephedrine -- may help relieve congestion.
• Corticosteroids (usually applied as an intranasal spray)
• Ipratropium bromide intranasal spray
• Immunotherapy (allergic shots) are not used to treat nonallergic rhinitis.

To avoid rebound congestion, nasal decongestants sprays containing oxymetazoline and phenylephrine should not be used for more than 2 to 3 days at a time.

Nursing Care of Rhinitis

The following are the measures to put in place in the care of a hospitalized person recieving treatment

• Encourage the patient to increase fluid intake to help thin mucus secretions.
• Instruct the patient on proper blowing techniques to clear the nasal passages.
• Administer nasal saline irrigation or sprays to moisturize and flush out allergens from the nasal cavity.
• Educate the patient on avoiding allergen exposure and the use of protective measures such as wearing masks or using air purifiers.
• Teach the patient relaxation techniques and deep breathing exercises to help alleviate anxiety and improve breathing patterns.
• Encourage the patient to practice diaphragmatic breathing to maximize airflow.
• Provide a calm and quiet environment to minimize triggers and reduce stress.
• Administer prescribed bronchodilators or nasal decongestants as indicated to relieve nasal congestion and improve breathing.
• Monitor the patient`s vital signs and temperature regularly to detect early signs of infection.
• Encourage good hand hygiene practices and educate the patient on infection prevention measures.
• Instruct the patient to avoid rubbing or touching the eyes and nose to prevent the spread of infection.
• Encourage the patient to avoid allergen exposure, such as staying indoors during high pollen count periods.
• Administer prescribed medications, such as antihistamines or intranasal corticosteroids, as directed to alleviate symptoms.
• Encourage the patient to perform regular nasal irrigation using saline solutions to promote mucus clearance.
• Teach effective coughing and deep breathing techniques to help clear mucus from the airways.
• Monitor respiratory status closely, including lung sounds and oxygen saturation levels, to detect any signs of respiratory distress.
• Provide education to the patient and their caregivers about allergic rhinitis, including its causes, common triggers, and management strategies.
• Teach the patient how to identify and avoid allergen triggers, such as pollen, dust mites, or pet dander.
• Instruct the patient on proper medication use, including dosage, timing, and potential side effects of prescribed medications.

Preventions of Rhinitis

• Preventive measures depend on what triggers your rhinitis. These can include:
• Staying away from areas where there is heavy dust, mites, or molds
• Avoiding contact with allergic agents or what triggers your rhinitis
• Controls in your environment, such as air conditioning during pollen season
• Staying away from fumes from smoking
• Staying away from strong odors and irritants when possible
• Using nasal sprays for the prescribed periods