Tip #16

Rhinitis, or inflammation of the mucous membranes of the nose, is often classified simply as allergic or nonallergic rhinitis. Though all types of rhinitis fall into one of these two categories, there are many variations of the nonallergic form.

Allergic Rhinitis
Allergic rhinitis is caused by allergens such as pollen, dust, mites, mold, or animal dander. It may produce sneezing, congestion, a runny nose and itchiness in the nose, throat, eyes and ears.

Allergic rhinitis may be seasonal, occurring during pollen seasons in the spring, summer and fall. Indoor dust, mites, molds, and animal dander may cause allergic rhinitis year round. It will usually appear before the age of 20 but may be diagnosed in the first year of life, particularly if there is a history of maternal allergy, if solid foods are introduced into the diet early, and if the mother is a heavy cigarette smoker.

Allergy skin testing will identify inhalant or food causes of allergic rhinitis and guide the physician in treatment. Environmental control such as the use of air conditioning, particularly in the bedroom, for pollen-sensitive patients, and dust, mite and pet avoidance measures for indoor allergens are important. Oral medications, such as antihistamines (particularly the new non-sedating types) and decongestants, are often useful. Inhaled medications, such as topical cromolyn or corticosteroids, may be prescribed as well.

Allergic rhinitis also may be treated with immunotherapy. If no relief is realized with the above measures, and if the patient has symptoms for many months of the year, allergy injection treatment may greatly lessen the need for medications.

Nonallergic Rhinitis
Vasomotor rhinitis, or irritant rhinitis, is a condition of unknown origin which seems to be aggravated by fumes, odors, temperature and atmospheric changes, smoke, and other irritants. This form of rhinitis, which usually afflicts adults, causes year-round symptoms that include congestion and headache. Decongestants and topical steroids are usually prescribed for this illness, although no known medications can give complete relief from symptoms.

Eosinophilic, nonallergic rhinitis, is named after the blood cell which distinguishes itself from other forms of nonallergic rhinitis -- the eosinophil. This type of rhinitis behaves like allergic rhinitis in that it causes frequent, recurrent bouts of sneezing and 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 changes or weather shifts. Allergy skin tests are negative with this type of rhinitis, and nasal polyps are a common complication. Antihistamines, decongestants and topical cromolyn are seldom beneficial, although topical steroids provide relief for some patients.

Rhinitis medicamentosa occurs when topical decongestants (nasal sprays) are used to excess. In these cases, patients have used over-the-counter nasal sprays for more than three days. This form of rhinitis causes severe nasal congestion. It is best treated by going "cold turkey" and discontinuing the offending nasal spray. Topical or oral corticosteroids can be used to help end nasal spray dependency. The patient may be advised to use cromolyn sodium or corticosteroid nasal sprays as alternatives.

Neutrophilic rhinosinusitis is usually precipitated by a sinus or related infection, but may also be associated with colds and flu. It causes post-nasal drip, sinus pain and pus-filled secretions which may be treated with decongestants, nasal saline solution and antibiotics.

Structural rhinitis is caused by structural abnormalities in the nasal septum normally resulting from an injury or congenital abnormality. This type of rhinitis may produce perennial, or year-round congestion that usually affects one side of the nose more than the other. Surgery may aid in correcting this abnormality.

Nasal polyps are growths on the mucus membrane which 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 asthma and aspirin sensitivity and may cause recurrent sinusitis. Decongestants, topical corticosteroids and surgical removal may provide temporary relief.

Primary vasomotor instability usually occurs as a result of pregnancy, thyroid disorders or as a response to certain medications. With this condition, the vessels in the nasal passages overreact, causing congestion. This type of rhinitis may be treated with decongestants, nasal saline solutions and topical corticosteroids. When it is traced to a deficiency of thyroid hormone, thyroid medication can help.

By learning about the various forms of rhinitis and what their causes and symptoms are, you will be better able to identify your symptoms and help your physician make an accurate diagnosis and effective treatment plan for you.

Your allergist can provide you with more information on allergic and non-allergic rhinitis.

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