Allergy/Asthma Information Association

Rhinitis: The Facts

By Liliane Gendreau-Reid, MD, Victoria, BC

Q. What is rhinitis?
A. Rhinitis is an inflammation of the tissues inside the nose. It causes sneezing, runny nose and stuffy nose. It is often accompanied by conjunctivitis (itchy, watery eyes). Most often it is caused by an allergy or an infection.

Q. It is not dangerous, so why worry about it?
A. The itching, incessant sneezing, loss of sleep from nasal congestion, etc. can cause difficulty concentrating at school or at work. Older sedating antihistamines can hamper productivity and make driving dangerous, as can incessant sneezing. Moreover, rhinitis can lead to asthma. Treating rhinitis helps to treat and even prevent asthma.

Q. How can I tell if it is an allergy?
A. Most people know when they have an allergy to pets or pollens. They react with itchy eyes or sneezing after petting a cat or when outside during the pollen season. Allergy to dust mite causes rhinitis symptoms mostly around older upholstered furniture, bedding and carpets. It is worse inside, at home, and in the colder months.

Q. So what are the symptoms if the cause is infectious?
A. The common cold is a rhinitis triggered by a viral infection. The symptoms also include sneezing, runny nose and nasal congestion and can be mistaken for an allergy at first. Cloudy discharge, cough and/or sore throat suggest an infectious cause. This usually resolves in 7-10 days. Treatment is symptomatic with steaming, an anti-inflammatory, decongestants and antihistamines for sneezing and runny nose.

If symptoms of colored/thick discharge, sinus headaches or coughing, gagging, choking on post nasal drip last more than 10 days after a viral illness or allergic rhinitis reaction episode, it has developed into acute rhinosinusitis. This is a bacterial infection and needs treatment with 14 days of wide spectrum antibiotics and nasal steroids until there is no nasal symptom for at least one week.

If not treated at all or long enough, this can lead to chronic rhinosinusitis with the same symptoms lasting for weeks to months. The treatment entails 3-6 weeks of oral antibiotics, saline washes, nasal steroids and/or sinus surgery.

Q. Is all sinusitis infectious?
A. No, patients with nasal polyps get sinusitis (as found on X-rays). They have difficulty breathing through their nose and have no sense of smell. Their sinusitis does not respond to antibiotics but is treated with a nasal or oral steroid and often requires sinus surgery.

Q. How do I treat the allergic causes?
A. The best treatment for allergy is prevention by identifying the triggers and avoiding them. Dust mite can be avoided by using impermeable covers on the bed and pillow, for example. Other measures to avoid other allergens are available on the AAIA website or from your allergist.

Q. What medication helps for rhinitis?
A. Antihistamines are used as prevention about 20 minutes or more before being exposed to an allergen, such as before going to visit a friend who owns a dog. Otherwise they are used as needed for relief of sneezing, itchy or runny nose. When they are needed more than 4 times a week or do not provide enough relief especially for nasal congestion, the next recommended step is to use a nasal steroid daily.

Q. What to do if these measures fail?
A. When avoidance, antihistamines and a nasal steroid are not sufficient to relieve the symptoms, your family physician will usually recommend a consultation with an allergist. After pertinent history, examination and testing, immunotherapy might be prescribed. It is a five year program of injections with some of the allergens the patient reacts to clinically and on allergy tests. It has an 80 % success rate for most environmental allergens during treatment and lasts for many years after the treatment is finished.

Q. I still sneeze and have a runny nose but all allergy tests are negative…
A. This is most likely vasomotor rhinitis. This occurs in allergic and non allergic patients. The triggers can be perfumes, strong smells, dust, cold air or smoke. Avoidance is best, otherwise Ipratropium nasal spray may provide relief if antihistamines are inefficient.

As with other rhinitis, daily nasal steroid can help if antihistamines fail. If it does not help enough, see the allergist to rule out allergies or mild hidden sinusitis.

Q. What do nasal steroids do?
A. Antihistamines block the histamine receptor on nasal tissues and prevent sneezing and runny nose. They will work best when used preventatively before exposure to an allergen, i.e. before histamine is liberated (if possible). They last up to 24 hours.
The nasal steroid decreases the damage done by inflammatory cells brought to the nasal lining by the allergic reaction or the infection. The lining of the nose is gradually repaired. The nasal symptoms improve on a daily basis and are easier to treat or control.

Q. What is new about rhinitis treatment?
A. Sublingual immunotherapy is being tested and used in Europe and is more user friendly, especially for children and safer overall since there is a risk of anaphylaxis from subcutaneous injections. Its long term effects are not known.

from Allergy & Asthma News, Issue 2 2006

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