- 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
- 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
- <4 days/week and <4 weeks/year.
- >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
- Allergen avoidance
- 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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