Can be seasonal (hayfever or seasonal allergic rhinitis), throughout the year (perennial rhinitis) or linked to an allergen at work (occupational).
Epidemiology of rhinitis
Very common – prevalence up to 20%
Adults more commonly have perennial rhinitis and children more commonly have seasonal rhinitis.
Aetiology of rhinitis
Seasonal rhinitis
Common allergens are pollens from trees (spring), grass (late spring/early summer), weeds (spring to autumn)
Perennial rhinitis
House-dust mite, domestic pets
Sensitivity to substances like smoke, perfumes can aggravate rhinitis
Vasomotor rhinitis (perennial symptoms, but without the eosinophilic granulocytosis seen in nasal secretions – unlike perennial or seasonal allergic disease).
Thought to be due to autonomic system imbalance
Rhinitis often co-exists with asthma
May have personal or family history of atopy
Symptoms of rhinitis
Sneezing
Nasal discharge/Nasal blockage
Ask about discharge colour – usually clear in allergic rhinitis.
Itching/red eyes
Seasonal attacks of asthma
Ask about timing of symptoms and irritant exposure.
Think about classifications
Mild: Normal sleep/activities/work/school
Moderate-severe: These all affected
Intermittent
<4 days/week and <4 weeks/year.
Persistent
>4 days/week and 4 weeks/year.
Treatment of rhinitis
All patients
Allergen avoidance
Skin prick testing/RAST is helpful to find what allergens are implicated.
Removal of pets, enclosure of industrial processes, avoid being outside in later afternoon (pollen count highest), keep bedroom window shut etc.
Nasal douching with saline
Mild intermittent:
Oral route preferred or age 2-5 or conjunctivitis a problem use oral antihistamines e.g. cetirizine or loratidine (non-sedating) else use spray e.g. azelastine.
Mild persistent:
Use nasal steroid spray e.g. Flixonase, Avamys. Consider also oral/topical anthihistamine.
Moderate-severe intermittent:
Use nasal steroid drops e.g. Flixonase nasules.
Consider mast cell stabiliser e.g. sodium cromoglycate spray
Moderate-severe persistent
A short course of oral steroids can be helpful followed by above treatment (e.g. 40mg prednisolone 7 days in adults).
Montelukast can also be used especially if asthmatic.
If struggling, refer to medical rhinologist/ENT.
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