| Tips
to Remember: Rhinitis
Do
you have a runny or stuffy nose that doesn't seem
to go away? If so, you may have rhinitis, which
is an inflammation of the mucous membranes of the
nose.
Rhinitis
is one of the most common allergic conditions in
the United States, affecting about 40 million people.
It often coexists with other allergic disorders,
such as asthma. It is important to treat rhinitis
because it can contribute to other conditions such
as sleep disorders, fatigue and learning problems.
There
are two general types of rhinitis:
Allergic
rhinitis
Allergic rhinitis is caused by substances called
allergens. Allergens are often common, usually harmless
substances that can cause an allergic reaction in
some people.
Causes
 |
ragweed
pollen |
When
allergic rhinitis is caused by common outdoor allergens,
such as airborne tree, grass and weed pollens or
mold, it is called seasonal allergic rhinitis, or
"hay fever."
Allergic
rhinitis is also triggered by common indoor allergens,
such as animal dander (dried skin flakes and saliva),
indoor mold or droppings from cockroaches or dust
mites. This is called perennial allergic rhinitis.
Symptoms
Sneezing
Congestion
Runny nose
Itchiness in the nose, roof of the mouth, throat,
eyes and ears
Diagnosis
If you have symptoms of allergic rhinitis, an allergist/immunologist
can help determine which specific allergens are
triggering your reaction. He or she will take a
thorough health history, and then test you to determine
if you have allergies. Skin tests or Blood (RAST)
tests are the most common methods for determining
your allergic triggers.
Treatment
Once your allergic triggers are determined, your
physician or nurse will work with you to develop
a plan to avoid the allergens that trigger your
symptoms. For example, if you are allergic to dust
mites or indoor mold, you will want to take steps
to reduce these allergens in your house as much
as possible. The Tips brochures on Indoor Allergens
and Outdoor Allergens provide helpful advice in
this area.
Your
physician might prescribe medication to decrease
your allergic rhinitis symptoms.
Oral
and Nasal Antihistamines block histamine, one of
the most important mediators of the allergic response.
The release of histamine leads to many allergy symptoms,
including itching of the eyes and nose, runny nose,
and sneezing.
Nasal
inhaled corticosteroids reduce and control the impact
of all or most of the mediators that can cause inflammation
in the nose. It improves the nasal symptoms of allergic
rhinitis, including itching, runny nose, and congestion.
Decongestants
are important in the care of allergic rhinitis because
congestion is, for the majority of patients with
allergic rhinitis, the most troublesome symptom.
Leukotriene
modifiers block the action of leukotrienes, a mediator
of allergy symptoms and of inflammation. They block
both the early response to allergic triggers (itching
and sneezing) as well as the delayed response to
allergic triggers (congestion).
Allergen
immunotherapy, also known as "allergy shots,"
may be considered if your symptoms persist. This
treatment involves receiving injections periodically-as
determined by your allergist/immunologist-over a
period of three to five years. This helps your immune
system to become more and more resistant to specific
allergens, and lessens the need for future medications.
Types
of non-allergic rhinitis
- Non-allergic
rhinitis usually afflicts adults and causes year-round
symptoms, especially nasal congestion or "stuffiness"
and headaches. These kinds of reactions differ
from allergic rhinitis because they do not produce
a reaction in an individual's immune systems.
Generally, this is called irritant rhinitis, and
is triggered by strong smells, pollution, particulate
matter in the air, smoke or other irritants.
- If
the rhinitis also has a runny nose, it is referred
to as vasomotor rhinitis. Although medication
cannot completely relieve symptoms, your doctor
might prescribe decongestants or a steroid nose
spray to reduce symptoms. Interestingly, regular
exercise can also be helpful.
- Symptoms
of non-allergic rhinitis may also occur as a result
of pregnancy, thyroid disorders or as a side effect
of certain medications. When the symptoms are
traced to a deficiency of thyroid hormone, thyroid
medication can help.
- Infectious
rhinitis is usually caused by a virus. Symptoms
include discolored nasal secretions and a low
grade fever can be present.
- Another
type of non-allergic rhinitis, called eosinophilic
non-allergic rhinitis, is named after the blood
cell - the eosinophil - which distinguishes it
from the other forms of non-allergic rhinitis.
This type of rhinitis behaves like allergic rhinitis
in that it causes frequent, recurrent bouts of
sneezing and a runny nose. This disorder, which
may seem to appear from out of the blue, can be
provoked by changes in the environment such as
air pressure variations or weather shifts. Allergy
skin tests are negative with this type of rhinitis,
and growths in the nose, called nasal polyps,
are a common complication. Medications such as
antihistamines, decongestants and topical cromolyn
may be beneficial, but topical nasal corticosteroids
provide the best relief for many patients.
- Rhinitis
medicamentosa occurs when non-prescription topical
decongestants (over-the-counter nose sprays) are
used in excess, often for more than three consecutive
days. This form of rhinitis causes severe nasal
congestion and is best treated by stopping use
of the offending nasal spray. This often leads
to temporary severe congestion, which can be helped
by topical or oral corticosteroids.
- Neutrophilic
rhinosinusitis is usually triggered by a sinus
or related infection. It may also be associated
with viral infections such as a cold or flu. This
form of rhinitis causes symptoms such as post-nasal
drip and sinus pain, which may be treated with
decongestants and nasal saline solution. Antibiotics
are prescribed when the sinuses are infected,
but not for simple colds.
- Structural
rhinitis is caused by structural abnormalities
in the nasal septum. These abnormalities can be
the result of an injury, such as a broken nose,
or something that the person was born with, such
as small or crooked nasal passages. Structural
rhinitis may produce year-round congestion that
usually affects one side of the nose more than
the other. Surgery can aid in correcting this
abnormality.
- Symptoms
of rhinitis can also be caused by nasal polyps
- growths on the mucus membrane of the nose that
can cause congestion and loss of sense of smell.
They provoke symptoms year-round and usually begin
between the ages of 20 and 40. Nasal polyps may
be associated with aspirin sensitivity and asthma,
and may cause recurrent sinusitis. Decongestants
or corticosteroid nasal sprays or pills may provide
temporary relief. Nasal polyps can be surgically
removed, but they have a tendency to recur. By
learning about the causes and symptoms of various
forms of rhinitis, you will be better able to
identify your symptoms and triggers. Your allergist/immunologist
can assist by making an accurate diagnosis and
developing an effective treatment plan for you.
- Your
allergist/immunologist can provide you with more
information on allergic and non-allergic rhinitis.
Tips
to Remember are created by the Public Education
Committee of the American Academy of Allergy, Asthma
and Immunology. This brochure was updated in 2003.
The
content of this brochure is for informational purposes
only. It is not intended to replace evaluation by
a physician. If you have questions or medical concerns,
please contact your allergist/immunologist.
American
Academy of Allergy,
Asthma and Immunology
611 East Wells Street
Milwaukee, WI 53202
AAAAI
Physician Referral and
Information Line
1-800-822-2762
AAAAI
Web site
www.aaaai.org
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