Rhinitis
Encyclopedia
Rhinitis commonly known as a stuffy nose, is the medical term describing irritation and inflammation of some internal areas of the nose
. The primary symptom of rhinitis is nasal dripping. It is caused by chronic or acute inflammation
of the mucous membrane
of the nose due to viruses, bacteria
or irritants. The inflammation results in the generating of excessive amounts of mucus
, commonly producing the aforementioned runny nose, as well as nasal congestion
and post-nasal drip
. According to recent studies completed in the United States
, more than 50 million Americans are current sufferers. Rhinitis has also been found to adversely affect more than just the nose, throat, and eyes. It has been associated with sleeping problems, ear conditions, and even learning problems. Rhinitis is caused by an increase in histamine
, which is most often triggered by airborne allergen
s. These allergens may affect an individual's nose, throat, or eyes and cause an increase in fluid production within these areas.
; (iii) allergic rhinitis, the mic reaction triggered by pollen, mold, animal dander
, dust and other similar inhaled allergens.
es and Coronavirus
es, or bacterial sinusitis
. Symptoms of the common cold include rhinorrhea
, sore throat (pharyngitis
), cough
, congestion
, and slight headache
.
PMID 18651116 and is as yet not very well understood. More research is needed. Vasomotor rhinitis appears to be significantly more common in women than men, leading some researchers to believe that hormones play a role. In general, age of onset occurs after 20 years of age, in contrast to allergic rhinitis which can be developed at any age. Individuals suffering from vasomotor rhinitis typically experience symptoms year-round, though symptoms may be exacerbated in the spring and autumn when rapid weather changes are more common. An estimated 17 million United States
citizens have vasomotor rhinitis. The antihistamine azelastine
has been shown to be effective for allergic, mixed, and vasomotor rhinitis. Fluticasone propionate
or budesonide
(both are steroid
s) in nostril spray form may also be used for symptomatic treatment.
Allergic rhinitis or hay fever is when an allergen such as pollen or dust is inhaled by an individual with a sensitized immune system, triggering antibody
production. These antibodies mostly bind to mast cells, which contain histamine
. When the mast cells are stimulated by pollen and dust, histamine (and other chemicals) are released. This causes itching, swelling, and mucus
production. Symptoms vary in severity between individuals. Very sensitive individuals can experience hives or other rash
es. Particulate matter in polluted air and chemicals such as chlorine
and detergents, which can normally be tolerated, can greatly aggravate the condition.
Characteristic physical findings in individuals who have allergic rhinitis include conjunctival swelling and erythema, eyelid swelling, lower eyelid venous stasis, lateral crease on the nose, swollen nasal turbinates, and middle ear effusion.
nasal congestion
brought on by extended use of topical decongestant
s (e.g., oxymetazoline
, phenylephrine
, xylometazoline
, and naphazoline
nasal spray
s) that work by constricting blood vessels in the lining of the nose.
of the mucous membrane and glands.
in the nasal cavity.
has been additionally validated to stimulate the activity of the body's TH1 suppressor T-Cells, which then down-regulates the over-production of the allergen antibody IgE in allergic individuals which could decrease both near and long term manifestations of rhinitis symptomology.
Human nose
The visible part of the human nose is the protruding part of the face that bears the nostrils. The shape of the nose is determined by the ethmoid bone and the nasal septum, which consists mostly of cartilage and which separates the nostrils...
. The primary symptom of rhinitis is nasal dripping. It is caused by chronic or acute inflammation
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
of the mucous membrane
Mucous membrane
The mucous membranes are linings of mostly endodermal origin, covered in epithelium, which are involved in absorption and secretion. They line cavities that are exposed to the external environment and internal organs...
of the nose due to viruses, bacteria
Bacteria
Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...
or irritants. The inflammation results in the generating of excessive amounts of mucus
Mucus
In vertebrates, mucus is a slippery secretion produced by, and covering, mucous membranes. Mucous fluid is typically produced from mucous cells found in mucous glands. Mucous cells secrete products that are rich in glycoproteins and water. Mucous fluid may also originate from mixed glands, which...
, commonly producing the aforementioned runny nose, as well as nasal congestion
Nasal congestion
Nasal congestion is the blockage of the nasal passages usually due to membranes lining the nose becoming swollen from inflamed blood vessels. It is also known as nasal blockage, nasal obstruction, blocked nose, stuffy nose, or stuffed up nose.Nasal congestion has many causes and can range from a...
and post-nasal drip
Post-nasal drip
Post-nasal drip , also known as Upper Airway Cough Syndrome , occurs when excessive mucus is produced by the nasal mucosa. The excess mucus accumulates in the throat or back of the nose...
. According to recent studies completed in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, more than 50 million Americans are current sufferers. Rhinitis has also been found to adversely affect more than just the nose, throat, and eyes. It has been associated with sleeping problems, ear conditions, and even learning problems. Rhinitis is caused by an increase in histamine
Histamine
Histamine is an organic nitrogen compound involved in local immune responses as well as regulating physiological function in the gut and acting as a neurotransmitter. Histamine triggers the inflammatory response. As part of an immune response to foreign pathogens, histamine is produced by...
, which is most often triggered by airborne allergen
Allergen
An allergen is any substance that can cause an allergy. In technical terms, an allergen is a non-parasitic antigen capable of stimulating a type-I hypersensitivity reaction in atopic individuals....
s. These allergens may affect an individual's nose, throat, or eyes and cause an increase in fluid production within these areas.
Types
Rhinitis is categorized into three types: (i) infective rhinitis includes acute and chronic bacterial infections; (ii) nonallergic (vasomotor) rhinitis includes autonomic, hormonal, drug-induced, atrophic, and gustatory rhinitis, as well as rhinitis medicamentosaRhinitis medicamentosa
Rhinitis medicamentosa is a condition of rebound nasal congestion brought on by extended use of topical decongestants that work by constricting blood vessels in the lining of the nose.-Presentation:This condition typically occurs after 5 to 7 days of use of such medications...
; (iii) allergic rhinitis, the mic reaction triggered by pollen, mold, animal dander
Dander
Dander is an informal term for a material shed from the body of various animals, similar to dandruff. It may contain scales of dried skin and hair, or feathers. It is a cause of allergies in humans....
, dust and other similar inhaled allergens.
Infectious
Rhinitis is commonly caused by a viral or bacterial infection, including the common cold, which is caused by RhinovirusRhinovirus
Human rhinoviruses are the most common viral infective agents in humans and are the predominant cause of the common cold. Rhinovirus infection proliferates in temperatures between 33–35 °C , and this may be why it occurs primarily in the nose...
es and Coronavirus
Coronavirus
Coronaviruses are species in the genera of virus belonging to the subfamily Coronavirinae in the family Coronaviridae. Coronaviruses are enveloped viruses with a positive-sense single-stranded RNA genome and a helical symmetry. The genomic size of coronaviruses ranges from approximately 16 to 31...
es, or bacterial sinusitis
Sinusitis
Sinusitis is inflammation of the paranasal sinuses, which may be due to infection, allergy, or autoimmune issues. Most cases are due to a viral infection and resolve over the course of 10 days...
. Symptoms of the common cold include rhinorrhea
Rhinorrhea
Rhinorrhea or rhinorrhoea is a condition where the nasal cavity is filled with a significant amount of mucous fluid. The condition, commonly known as "runny nose", occurs relatively frequently and is not usually considered dangerous. Rhinorrhea is a common symptom of allergies or certain diseases,...
, sore throat (pharyngitis
Pharyngitis
Pharyngitis is an inflammation of the throat or pharynx. In most cases it is quite painful, and is the most common cause of a sore throat.Like many types of inflammation, pharyngitis can be acute – characterized by a rapid onset and typically a relatively short course – or chronic....
), cough
Cough
A cough is a sudden and often repetitively occurring reflex which helps to clear the large breathing passages from secretions, irritants, foreign particles and microbes...
, congestion
Congestion
Congestion generally means excessive crowding.Congestion may refer to:* congestion in heart failure, a term to describe low cardiac output seen in heart failure.* Nasal congestion, the blockage of nasal passages due to swollen membranes...
, and slight headache
Headache
A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...
.
Vasomotor rhinitis
Non-allergic rhinitis refers to runny nose that is not due to allergy. Non-allergic rhinitis can be classified as either non-inflammatory or inflammatory rhinitis. One very common type of non-inflammatory, non-allergic rhinitis that is sometimes confused with allergy is called vasomotor rhinitis, in which certain non-allergic triggers such as smells, fumes, smoke, dusts, and temperature changes, cause rhinitis. There is still much to be learned about this entity, but it is thought that these non-allergic triggers cause dilation of the blood vessels in the lining of the nose, which results in swelling, and drainage. Vasomotor rhinitis can coexist with allergic rhinitis, and this is called "mixed rhinitis." (Middleton's Allergy Principles and Practice, seventh edition.) The pathology of vasomotor rhinitis appears to involve neurogenic inflammationNeurogenic inflammation
Neurogenic inflammation is inflammation arising from the local release from afferent neurons of inflammatory mediators such as Substance P and Calcitonin Gene-Related Peptide ....
PMID 18651116 and is as yet not very well understood. More research is needed. Vasomotor rhinitis appears to be significantly more common in women than men, leading some researchers to believe that hormones play a role. In general, age of onset occurs after 20 years of age, in contrast to allergic rhinitis which can be developed at any age. Individuals suffering from vasomotor rhinitis typically experience symptoms year-round, though symptoms may be exacerbated in the spring and autumn when rapid weather changes are more common. An estimated 17 million United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
citizens have vasomotor rhinitis. The antihistamine azelastine
Azelastine
Azelastine is a potent, second-generation, selective, histamine antagonist manufactured by MedaPharma. According to the Allergic Rhinitis and its Impact on Asthma treatment guidelines, intranasal anti-histamines are recommended for the first line therapy of mild intermittent, moderate/severe...
has been shown to be effective for allergic, mixed, and vasomotor rhinitis. Fluticasone propionate
Fluticasone propionate
Fluticasone propionate is a synthetic corticosteroid derived from fluticasone used to treat asthma and allergic rhinitis . It is also used to treat eosinophilic esophagitis....
or budesonide
Budesonide
Budesonide is a glucocorticoid steroid for the treatment of asthma and non-infectious rhinitis , and for treatment and prevention of nasal polyposis...
(both are steroid
Steroid
A steroid is a type of organic compound that contains a characteristic arrangement of four cycloalkane rings that are joined to each other. Examples of steroids include the dietary fat cholesterol, the sex hormones estradiol and testosterone, and the anti-inflammatory drug dexamethasone.The core...
s) in nostril spray form may also be used for symptomatic treatment.
Allergic
Antibody
An antibody, also known as an immunoglobulin, is a large Y-shaped protein used by the immune system to identify and neutralize foreign objects such as bacteria and viruses. The antibody recognizes a unique part of the foreign target, termed an antigen...
production. These antibodies mostly bind to mast cells, which contain histamine
Histamine
Histamine is an organic nitrogen compound involved in local immune responses as well as regulating physiological function in the gut and acting as a neurotransmitter. Histamine triggers the inflammatory response. As part of an immune response to foreign pathogens, histamine is produced by...
. When the mast cells are stimulated by pollen and dust, histamine (and other chemicals) are released. This causes itching, swelling, and mucus
Mucus
In vertebrates, mucus is a slippery secretion produced by, and covering, mucous membranes. Mucous fluid is typically produced from mucous cells found in mucous glands. Mucous cells secrete products that are rich in glycoproteins and water. Mucous fluid may also originate from mixed glands, which...
production. Symptoms vary in severity between individuals. Very sensitive individuals can experience hives or other rash
Rash
A rash is a change of the skin which affects its color, appearance or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cracked or blistered, swell and may be painful. The causes, and...
es. Particulate matter in polluted air and chemicals such as chlorine
Chlorine
Chlorine is the chemical element with atomic number 17 and symbol Cl. It is the second lightest halogen, found in the periodic table in group 17. The element forms diatomic molecules under standard conditions, called dichlorine...
and detergents, which can normally be tolerated, can greatly aggravate the condition.
Characteristic physical findings in individuals who have allergic rhinitis include conjunctival swelling and erythema, eyelid swelling, lower eyelid venous stasis, lateral crease on the nose, swollen nasal turbinates, and middle ear effusion.
Rhinitis medicamentosa
It is a condition of reboundRebound effect
The rebound effect, or rebound phenomenon, is the tendency of some medications, when discontinued suddenly, to cause a return of the symptoms it relieved, and that, to a degree stronger than they were before treatment first began...
nasal congestion
Nasal congestion
Nasal congestion is the blockage of the nasal passages usually due to membranes lining the nose becoming swollen from inflamed blood vessels. It is also known as nasal blockage, nasal obstruction, blocked nose, stuffy nose, or stuffed up nose.Nasal congestion has many causes and can range from a...
brought on by extended use of topical decongestant
Topical decongestant
Topical decongestants are decongestants applied directly to the nasal cavity. By applying them directly to the site of action, topical decongestants relieve nasal congestion while reducing the side effects associated with systemically-acting decongestants, such as high blood pressure...
s (e.g., oxymetazoline
Oxymetazoline
Oxymetazoline is a selective alpha-1 agonist and partial alpha-2 agonist topical decongestant, used in the form of Oxymetazoline hydrochloride, in products such as Afrin, Dristan, Nasivin, Logicin, Vicks Sinex, Visine L.R., Sudafed OM, and Zicam. It was developed from Xylometazoline at E.Merck...
, phenylephrine
Phenylephrine
Phenylephrine is a selective α1-adrenergic receptor agonist used primarily as a decongestant, as an agent to dilate the pupil, and to increase blood pressure...
, xylometazoline
Xylometazoline
Xylometazoline is a drug which is used as a topical nasal decongestant. It is applied directly into the nose, either as a spray or as drops....
, and naphazoline
Naphazoline
Naphazoline is the common name for 2--2-imidazoline hydrochloride. It is a sympathomimetic agent with marked alpha adrenergic activity. It is a vasoconstrictor with a rapid action in reducing swelling when applied to mucous membrane...
nasal spray
Nasal spray
Nasal sprays come in a variety of forms. Medicated such as Astelin, Afrin and Nasonex and natural such as Sinusoothe and Sterimar. Although delivery methods vary, most nasal sprays function by instilling a fine mist into the nostril by action of a hand-operated pump mechanism.-Antihistamine nasal...
s) that work by constricting blood vessels in the lining of the nose.
Chronic atrophic rhinitis
Chronic rhinitis in form of atrophyAtrophy
Atrophy is the partial or complete wasting away of a part of the body. Causes of atrophy include mutations , poor nourishment, poor circulation, loss of hormonal support, loss of nerve supply to the target organ, disuse or lack of exercise or disease intrinsic to the tissue itself...
of the mucous membrane and glands.
Polypous rhinitis
Chronic rhinitis associated with polypsPolyp (medicine)
A polyp is an abnormal growth of tissue projecting from a mucous membrane. If it is attached to the surface by a narrow elongated stalk, it is said to be pedunculated. If no stalk is present, it is said to be sessile. Polyps are commonly found in the colon, stomach, nose, sinus, urinary bladder...
in the nasal cavity.
Management
The management of rhinitis depends on the underlying cause. High-dose administration of Vitamin B12Vitamin B12
Vitamin B12, vitamin B12 or vitamin B-12, also called cobalamin, is a water-soluble vitamin with a key role in the normal functioning of the brain and nervous system, and for the formation of blood. It is one of the eight B vitamins...
has been additionally validated to stimulate the activity of the body's TH1 suppressor T-Cells, which then down-regulates the over-production of the allergen antibody IgE in allergic individuals which could decrease both near and long term manifestations of rhinitis symptomology.
External links
- Rhinitis at Centers for Chronic Nasal and Sinus Dysfunction
- Sinus Infection And Allergic Rhinitis
- Specialist Library for ENT and Audiology Hay fever resources – online library of high quality research on hay fever and other ENT disorders
- Daily Pollen Count in the USA
- Information on hay fever and children from Seattle Children's Hospital