Rhinitis
Rhinitis | |
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Other names | Coryza |
Pollen grains from a variety of common plants can cause hay fever. | |
Pronunciation |
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Infectious disease, allergy and immunology |
Rhinitis, also known as coryza,
The inflammation is caused by
Rhinitis is very common. Allergic rhinitis is more common in some countries than others; in the United States, about 10–30% of adults are affected annually.[12] Mixed rhinitis (MR) refers to patients with nonallergic rhinitis and allergic rhinitis. MR is a specific rhinitis subtype. It may represent between 50 and 70% of all AR patients. However, true prevalence of MR has not been confirmed yet.[13]
Types
Rhinitis is categorized into three types (although infectious rhinitis is typically regarded as a separate clinical entity due to its transient nature): (i) infectious rhinitis includes acute and chronic
Infectious
Rhinitis is commonly caused by a
Nonallergic rhinitis
Nonallergic rhinitis refers to rhinitis that is not due to an allergy. The category was formerly referred to as vasomotor rhinitis, as the first cause discovered was vasodilation due to an overactive parasympathetic nerve response. As additional causes were identified, additional types of nonallergic rhinitis were recognized. Vasomotor rhinitis is now included among these under the more general classification of nonallergic rhinitis.[17] The diagnosis is made upon excluding allergic causes.[18] It is an umbrella term of rhinitis of multiple causes, such as occupational (chemical), smoking, gustatory, hormonal, senile (rhinitis of the elderly), atrophic, medication-induced (including rhinitis medicamentosa), local allergic rhinitis, non-allergic rhinitis with eosinophilia syndrome (NARES) and idiopathic (vasomotor or non-allergic, non-infectious perennial allergic rhinitis (NANIPER), or non-infectious non-allergic rhinitis (NINAR).[19]
In vasomotor rhinitis, There is still much to be learned about this, 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.
Non-allergic rhinitis can co-exist with allergic rhinitis, and is referred to as "mixed rhinitis".[24] The pathology of vasomotor rhinitis appears to involve neurogenic inflammation[25] and is as yet not very well understood. The role of transient receptor potential ion channels on the non-neuronal nasal epithelial cells has also been suggested. Overexpression of these receptors have influence the nasal airway hyper-responsiveness to non-allergic irritant environmental stimuli (e.g., extremes of temperature, changes in osmotic or barometric pressure).[26] Vasomotor rhinitis appears to be significantly more common in women than men, leading some researchers to believe that hormone imbalance plays a role.[27][28] In general, age of onset occurs after 20 years of age, in contrast to allergic rhinitis which can be developed at any age. Individuals with vasomotor rhinitis typically experience symptoms year-round, though symptoms may be exacerbated in the spring and autumn when rapid weather changes are more common.[17] An estimated 17 million United States citizens have vasomotor rhinitis.[17]
Drinking alcohol may cause rhinitis as well as worsen asthma (see alcohol-induced respiratory reactions). In certain populations, particularly those of East Asian countries such as Japan, these reactions have a nonallergic basis.[29] In other populations, particularly those of European descent, a genetic variant in the gene that metabolizes ethanol to acetaldehyde, ADH1B, is associated with alcohol-induced rhinitis. It is suggested that this variant metabolizes ethanol to acetaldehyde too quickly for further processing by ALDH2 and thereby leads to the accumulation of acetaldehyde and rhinitis symptoms.[30] In these cases, alcohol-induced rhinitis may be of the mixed rhinitis type and, it seems likely, most cases of alcohol-induced rhinitis in non-Asian populations reflect true allergic response to the non-ethanol and/or contaminants in alcoholic beverages, particularly when these beverages are wines or beers.[29] Alcohol-exacerbated rhinitis is more frequent in individuals with a history of rhinitis exacerbated by aspirin.[31]
Aspirin and other
The antihistamine
A systematic review on non-allergic rhinitis reports improvement of overall function after treatment with capsaicin (the active component of chili peppers). The quality of evidence is low, however.[35]
Allergic
Allergic rhinitis or hay fever may follow when an allergen such as
Symptoms vary in severity between individuals. Very sensitive individuals can experience hives or other rashes. Particulate matter in polluted air and chemicals such as chlorine and detergents, which can normally be tolerated, can greatly aggravate the condition.[citation needed]
Characteristic physical findings in individuals who have allergic rhinitis include
Even if a person has negative
A patch test may be used to determine if a particular substance is causing the rhinitis.
Rhinitis medicamentosa
Rhinitis medicamentosa is a form of drug-induced nonallergic rhinitis which is associated with
Chronic atrophic rhinitis
Chronic rhinitis is a form of atrophy of the mucous membrane and glands of the nose.
Rhinitis sicca
Chronic form of dryness of the mucous membranes.
Polypous rhinitis
Chronic rhinitis associated with polyps in the nasal cavity.
Pathophysiology
Most prominent pathological changes observed are nasal airway epithelial metaplasia in which goblet cells replace ciliated columnar epithelial cells in the nasal mucous membrane.[26] This results in mucin hypersecretion by goblet cells and decreased mucociliary activity. Nasal secretion are not adequately cleared with clinical manifestation of nasal congestion, sinus pressure, post-nasal dripping, and headache. Over-expression of transient receptor potential (TRP) ion channels, such as TRPA1 and TRPV1, may be involved in the pathogenesis of non-allergic rhinitis.[41]
Association between rhinitis and asthma
Neurogenic inflammation produced by neuropeptides released from sensory nerve endings to the airways is a proposed common mechanism of association between both allergic and non-allergic rhinitis with asthma. This may explain higher association of rhinitis with asthma developing later in life.[42] Environmental irritants acts as modulators of airway inflammation in these contiguous airways. Development of occupational asthma is often preceded by occupational rhinitis. Among the causative agents are flours, enzymes used in processing food, latex, isocyanates, welding fumes, epoxy resins, and formaldehyde. Accordingly, prognosis of occupational asthma is contingent on early diagnosis and the adoption of protective measures for rhinitis.[43]
Diagnosis
The different forms of rhinitis are essentially diagnosed clinically.[clarification needed] Vasomotor rhinitis is differentiated from viral and bacterial infections by the lack of purulent exudate and crusting. It can be differentiated from allergic rhinitis because of the absence of an identifiable allergen.[44]
Evidence has been published from a few health apps for mobile devices that show potential to assist in the diagnosis of rhinitis and rhinosinusitis and to evaluate management and treatment adherence. While this shows promise for clinical management, as of 2022[update] few had been validated in the scientific literature, and even fewer included considerations for multimorbidity.[45][46]
Prevention
In the case of infectious rhinitis, vaccination against
Management
The management of rhinitis depends on the underlying cause.
For allergic rhinitis, intranasal corticosteroids are recommended.[47] For severe symptoms intranasal antihistamines may be added.[47]
Pronunciation and etymology
Rhinitis is pronounced /raɪˈnaɪtɪs/,[48] while coryza is pronounced /kəˈraɪzə/.[49]
Rhinitis comes from the
References
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- ^ "Immunopathogenesis of allergic rhinitis" (PDF). Archived from the original (PDF) on 2017-08-09. Retrieved 2012-01-11.
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- ^ Valet RS, Fahrenholz JM (2009). "Allergic rhinitis: update on diagnosis". Consultant. 49: 610–613. Archived from the original on 2010-01-14. Retrieved 2010-02-22.
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- ^ "Nonallergic Rhinitis - Ear, Nose, and Throat Disorders". MSD Manual Professional Edition. Retrieved 2019-03-07.
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- ^ May, Brandon (6 December 2022). "Study Finds 7 Apps for Rhinitis and Rhinosinusitis With Evidence". Medscape.
- ^ PMID 29181536.
- ^ "rhinitis | Definition, meaning & more | Collins Dictionary". www.collinsdictionary.com. Retrieved 4 January 2017.
- ^ "coryza | Definition, meaning & more | Collins Dictionary". www.collinsdictionary.com. Retrieved 4 January 2017.
- ^ Beekes RS (2009). Etymological Dictionary of Greek. Brill. p. 756.
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