Rhinitis

 Rhinitis is an inflammation and irritation of the mucous membranes of the nose. It may be classified as allergic or non-allergic.

Rhinitis may be an acute or chronic condition.

The signs and symptoms of rhinitis include:

• Rhinorrhea (excessive nasal drainage, runny nose), 
• Nasal congestion, 
• Nasal discharge (purulent with bacterial rhinitis), 
• Nasal itchiness, and sneezing. 
• Headache may occur, particularly if sinusitis is also present.

The Allergic Appearance:

• in chronic nasal congestion Mouth breathing and a gaping mouth
• Nasal itching causes repeated wiggling of the nose (bunny nose), or wiping and pushing of the nose 

Complication

• Sinusitis which is inflammation or swelling of the tissue that lines the sinuses
• Eustachian tube dysfunction. Eustachian tubes connect the middle ears to the back of the throat
• Chronic ear infection, known as otitis media 
• Loss of smell or anosmia
• Asthma 
• Obstractive sleep apnea

Pathophysiology of Allergic Rhinitis

It occurs when the body’s immune system over-responds to specific, non-infectious particles such as plant pollens, dust mites, animal hair, industrial chemicals (including tobacco smoke).

During an allergic attack, antibodies, primarily immunoglobin E (IgE), attach to mast cells (cells that release histamine) in the lungs, skin, and mucous membranes.

Once IgE connects with the mast cells, a number of chemicals are released. One of the chemicals, histamine, opens the blood vessels and causes skin redness and swollen membranes.

Pathophysiology of Non-Allergic Rhinitis

The symptoms can be initiated by cigarette smoke, strong odors, alcoholic beverages and changes in temperature or humidity, or foods.

These agents do not act through immune mediated systems, but are an irritant to the nasal mucosa and cause hyper responsive reactions. They trigger both the Olfactory nerve and the Trigeminal nerve that senses burning and irritation by airborne. 

Other causes may include: 

• Blockages in the nose 
• a deviated septum 
• Infections 
• Drug-induced rhinitis is associated with use of antihypertensive agents and oral contraceptives and chronic use of nasal decongestants (Ephedrine), NSAIDs nonsteroidal antiinflammatory drugs such as aspirin and ibuprofen

Medical Therapy

• Medication therapy for allergic and non- allergic rhinitis focuses on symptom relief.
• Antihistamines are administered for sneezing, itching, and rhinorrhea. 
• Oral decongestant agents are used for nasal obstruction. 
• Intranasal corticosteroids may be used for severe congestion. 
• Ophthalmic agents are used to relieve irritation, itching, and redness of the eyes.