Rhinitis
| ICD-10 |
J00, J30, J31.0 |
| ICD-9 |
472.0, 477 |
| OMIM |
607154 |
| DiseasesDB |
26380 |
| MedlinePlus |
000813 001648 |
| eMedicine |
ent/194 med/104, ped/2560 |
| MeSH |
D012220 |
Rhinitis (pron.: /raɪˈnaɪtɪs/) is a medical term for irritation and inflammation of the mucous membrane inside the nose. Common symptoms of rhinitis are a stuffy nose, runny nose, and post-nasal drip.[1] The most common kind of rhinitis is allergic rhinitis,[2] which is usually triggered by airborne allergens such as pollen and dander.[3] Allergic rhinitis may cause additional symptoms, such as sneezing and nasal itching, coughing, headache,[4] fatigue, malaise, and cognitive impairment.[5][6][7] The allergens may also affect the eyes, causing watery, reddened or itchy eyes and puffiness around the eyes.[4]
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.[8]
In rhinitis, the inflammation of the mucous membrane is caused by viruses, bacteria, irritants or allergens. The inflammation results in the generation of large amounts of mucus, commonly producing a runny nose, as well as a stuffy nose and post-nasal drip. In the case of allergic rhinitis, the inflammation is caused by the degranulation of mast cells in the nose. When mast cells degranulate, they release histamine and other chemicals,[9] starting an inflammatory process that can cause symptoms outside the nose, such as fatigue and malaise.[10]
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Contents
- 1 Types
- 1.1 Infectious
- 1.2 Vasomotor rhinitis
- 1.3 Allergic
- 1.4 Rhinitis medicamentosa
- 1.5 Chronic atrophic rhinitis
- 1.6 Rhinitis sicca
- 1.7 Polypous rhinitis
- 2 Management
- 3 References
- 4 External links
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Types
Rhinitis is categorized into three types: (i) infective rhinitis includes acute and chronic bacterial infections; (ii) nonallergic (vasomotor) rhinitis includes autonomic, hormonal, drug-induced, atrophic, and gustatory rhinitis, as well as rhinitis medicamentosa; (iii) allergic rhinitis, triggered by pollen, mold, animal dander, dust and other similar inhaled allergens.[2]
Infectious
See also: Common cold and Sinusitis
Rhinitis is commonly caused by a viral or bacterial infection, including the common cold, which is caused by Rhinoviruses and Coronaviruses, or bacterial sinusitis. Symptoms of the common cold include rhinorrhea, sore throat (pharyngitis), cough, congestion, and slight headache.[citation needed]
Vasomotor rhinitis
Non-allergic rhinitis refers to runny nose that is not due to allergy. Non-allergic rhinitis can be classified as either non-inflammatory or inflammatory rhinitis. One very common type of non-inflammatory, non-allergic rhinitis that is sometimes confused with allergy is called vasomotor rhinitis,[11] in which certain nonspecific stimuli, including changes in environment (temperature, humidity, barometric pressure, or weather); airborne irritants (odors, fumes); dietary factors (spicy food, alcohol); sexual arousal; and emotional factors.[12] There is still much to be learned about this entity, 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. Vasomotor rhinitis can coexist with allergic rhinitis, and this is called "mixed rhinitis." (Middleton's Allergy Principles and Practice, seventh edition.) The pathology of vasomotor rhinitis appears to involve neurogenic inflammation[13] and is as yet not very well understood. Vasomotor rhinitis appears to be significantly more common in women than men, leading some researchers to believe that hormones play a role. In general, age of onset occurs after 20 years of age, in contrast to allergic rhinitis which can be developed at any age. Individuals suffering from vasomotor rhinitis typically experience symptoms year-round, though symptoms may be exacerbated in the spring and autumn when rapid weather changes are more common.[14] An estimated 17 million United States citizens have vasomotor rhinitis. The antihistamines azelastine and olopatadine, applied as nasal sprays, may both be effective for vasomotor rhinitis.[15][16] Fluticasone propionate or budesonide (both are steroids) in nostril spray form may also be used for symptomatic treatment.
Allergic
Main article: Allergic rhinitis
Pollen grains from a variety of common plants can cause
hay fever.
Allergic rhinitis or hay fever may follow when an allergen such as pollen or dust is inhaled by an individual with a sensitized immune system, triggering antibody production. These antibodies mostly bind to mast cells, which contain histamine. When the mast cells are stimulated by pollen and dust, histamine (and other chemicals) are released. This causes itching, swelling, and mucus production. 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 conjunctival swelling and erythema, eyelid swelling, lower eyelid venous stasis, lateral crease on the nose, swollen nasal turbinates, and middle ear effusion.[17]
Even if a person has negative skin-prick, intradermal and blood tests for allergies, they may still have allergic rhinitis, from a local allergy in the nose. This is called local allergic rhinitis.[18] Many people who were previously diagnosed with nonallergic rhinitis may actually have local allergic rhinitis.[19]
Rhinitis medicamentosa
Main article: Rhinitis medicamentosa
It is a condition of rebound nasal congestion brought on by extended use of topical decongestants (e.g., oxymetazoline, phenylephrine, xylometazoline, and naphazoline nasal sprays) that work by constricting blood vessels in the lining of the nose.
Chronic atrophic rhinitis
Main article: Chronic atrophic rhinitis
Chronic rhinitis in form of atrophy of the mucous membrane and glands.
Rhinitis sicca
Chronic form of dryness of the mucous membranes.
Polypous rhinitis
Chronic rhinitis associated with polyps in the nasal cavity.
Management
The management of rhinitis depends on the underlying cause. High-dose administration of Vitamin B12 has been additionally validated to stimulate the activity of the body's TH1 suppressor T-Cells, which then down-regulates the over-production of the allergen antibody IgE in allergic individuals which could decrease both near and long term manifestations of rhinitis symptomology.[20][21]
References
- ^ "Nonallergic rhinitis".
- ^ a b "Allergic rhinitis".
- ^ Sullivan, Jr., John B.; Krieger, Gary R. (2001). Clinical environmental health and toxic exposures. p. 341.
- ^ a b "Allergic rhinitis".
- ^ Quillen, DM; Feller, DB (2006). "Diagnosing rhinitis: Allergic vs. Nonallergic". American family physician 73 (9): 1583–90. PMID 16719251.
- ^ Wilken, Jeffrey A.; Berkowitz, Robert; Kane, Robert (2002). "Decrements in vigilance and cognitive functioning associated with ragweed-induced allergic rhinitis". Annals of Allergy, Asthma & Immunology 89 (4): 372. doi:10.1016/S1081-1206(10)62038-8.
- ^ Marshall, Paul S.; O'Hara, Christine; Steinberg, Paul (2000). "Effects of seasonal allergic rhinitis on selected cognitive abilities". Annals of Allergy, Asthma & Immunology 84 (4): 403. doi:10.1016/S1081-1206(10)62273-9.
- ^ "Economic Impact and Quality-of-Life Burden of Allergic Rhinitis: Prevalence".
- ^ "Inflammatory Nature of Allergic Rhinitis: Pathophysiology".
- ^ "Immunopathogenesis of allergic rhinitis".
- ^ http://www.nlm.nih.gov/medlineplus/ency/article/001648.htm Vasomotor rhinitis Medline Plus
- ^ Adelman, Daniel (2002). Manual of Allergy and Immunology: Diagnosis and Therapy. Lippincott Williams & Wilkins. p. 66. ISBN 9780781730525.
- ^ Knipping, S; Holzhausen, HJ; Riederer, A; Schrom, T (2008). "Ultrastructural changes in allergic rhinitis vs. Idiopathic rhinitis". HNO 56 (8): 799–807. doi:10.1007/s00106-008-1764-4. PMID 18651116.
- ^ Wheeler, PW; Wheeler, SF (2005). "Vasomotor rhinitis". American family physician 72 (6): 1057–62. PMID 16190503.
- ^ Bernstein, Jonathan A. (2007). "Azelastine hydrochloride:a review of pharmacology, pharmacokinetics, clinical efficacy and tolerability". Current Medical Research and Opinion 23 (10): 2441–52. doi:10.1185/030079907X226302. PMID 17723160.
- ^ Lieberman P, Meltzer EO, LaForce CF, Darter AL, Tort MJ. (2011). "Two-week comparison study of olopatadine hydrochloride nasal spray 0.6% versus azelastine hydrochloride nasal spray 0.1% in patients with vasomotor rhinitis". Allergy Asthma Proc. 32 (2): 151–8. PMID 21352639.
- ^ Valet RS, Fahrenholz JM. Allergic rhinitis: update on diagnosis. Consultant. 2009;49:610-613
- ^ Rondón, Carmen; Canto, Gabriela; Blanca, Miguel (2010). "Local allergic rhinitis: A new entity, characterization and further studies". Current Opinion in Allergy and Clinical Immunology 10 (1): 1–7. doi:10.1097/ACI.0b013e328334f5fb. PMID 20010094.
- ^ Rondón, C; Fernandez, J; Canto, G; Blanca, M (2010). "Local allergic rhinitis: Concept, clinical manifestations, and diagnostic approach". Journal of investigational allergology & clinical immunology 20 (5): 364–71; quiz 2 p following 371. PMID 20945601.
- ^ O'Conner, Richard D. M.D. (1990). FDA Investigative New Drug IND No. 30,488. [verification needed]
- ^ Mansfield, Lyndon E. M.D. (1992). [verification needed]
External links
- Rhinitis at Centers for Chronic Nasal and Sinus Dysfunction
- Sinus Infection And Allergic Rhinitis
- Specialist Library for ENT and Audiology Hay fever resources – online library of high quality research on hay fever and other ENT disorders
- Daily Pollen Count in the USA
- Information on hay fever and children from Seattle Children's Hospital
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Inflammation
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| Acute |
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Plasma derived mediators
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Bradykinin · complement (C3, C5a, MAC) · coagulation (Factor XII, Plasmin, Thrombin)
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Cell derived mediators
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preformed: Lysosome granules · vasoactive amines (Histamine, Serotonin)
synthesized on demand: cytokines (IFN-γ, IL-8, TNF-α, IL-1) · eicosanoids (Leukotriene B4, Prostaglandins) · Nitric oxide · Kinins
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| Chronic |
Macrophage · Epithelioid cell · Giant cell · Granuloma
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| Processes |
Traditional: Rubor · Calor · Tumor · Dolor (pain) · Functio laesa
Modern: Acute-phase reaction/Fever · Vasodilation · Increased vascular permeability · Exudate · Leukocyte extravasation · Chemotaxis
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| Specific locations |
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Nervous
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CNS (Encephalitis, Myelitis) · Meningitis (Arachnoiditis) · PNS (Neuritis) · eye (Dacryoadenitis, Scleritis, Episcleritis, Keratitis, Choroiditis, Retinitis, Chorioretinitis, Blepharitis, Conjunctivitis, Uveitis) · ear (Otitis, Labyrinthitis, Mastoiditis)
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Cardiovascular
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Carditis (Endocarditis, Myocarditis, Pericarditis) · Vasculitis (Arteritis, Phlebitis, Capillaritis)
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Respiratory
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upper (Sinusitis, Rhinitis, Pharyngitis, Laryngitis) · lower (Tracheitis, Bronchitis, Bronchiolitis, Pneumonitis, Pleuritis) · Mediastinitis
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Digestive
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mouth (Stomatitis, Gingivitis, Gingivostomatitis, Glossitis, Tonsillitis, Sialadenitis/Parotitis, Cheilitis, Pulpitis, Gnathitis) · tract (Esophagitis, Gastritis, Gastroenteritis, Enteritis, Colitis, Enterocolitis, Duodenitis, Ileitis, Caecitis, Appendicitis, Proctitis) · accessory (Hepatitis, Cholangitis, Cholecystitis, Pancreatitis) · Peritonitis
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Integumentary
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Dermatitis (Folliculitis) · Cellulitis · Hidradenitis
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Musculoskeletal
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Arthritis · Dermatomyositis · soft tissue (Myositis, Synovitis/Tenosynovitis, Bursitis, Enthesitis, Fasciitis, Capsulitis, Epicondylitis, Tendinitis, Panniculitis)
Osteochondritis: Osteitis (Spondylitis, Periostitis) · Chondritis
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Urinary
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Nephritis (Glomerulonephritis, Pyelonephritis) · Ureteritis · Cystitis · Urethritis
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Reproductive
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female: Oophoritis · Salpingitis · Endometritis · Parametritis · Cervicitis · Vaginitis · Vulvitis · Mastitis
male: Orchitis · Epididymitis · Prostatitis · Balanitis · Balanoposthitis
pregnancy/newborn: Chorioamnionitis · Omphalitis
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Endocrine
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Insulitis · Hypophysitis · Thyroiditis · Parathyroiditis · Adrenalitis
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Lymphatic
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Lymphangitis · Lymphadenitis
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Pathology of respiratory system (J, 460–519), respiratory diseases
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Upper RT
(including URTIs,
Common cold) |
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Head
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- sinuses
- Sinusitis
- nose
- Rhinitis
- Vasomotor rhinitis
- Atrophic rhinitis
- Hay fever
- Nasal polyp
- Rhinorrhea
- nasal septum
- Nasal septum deviation
- Nasal septum perforation
- Nasal septal hematoma
- tonsil
- Tonsillitis
- Adenoid hypertrophy
- Peritonsillar abscess
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Neck
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- pharynx
- Pharyngitis
- Strep throat
- Laryngopharyngeal reflux (LPR)
- Retropharyngeal abscess
- larynx
- Croup
- Laryngitis
- Laryngopharyngeal reflux (LPR)
- Laryngospasm
- vocal folds
- Laryngopharyngeal reflux (LPR)
- Vocal fold nodule
- Vocal cord paresis
- Vocal cord dysfunction
- epiglottis
- Epiglottitis
- trachea
- Tracheitis
- Tracheal stenosis
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Lower RT/lung disease
(including LRTIs) |
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Bronchial/
obstructive
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- acute
- Acute bronchitis
- chronic
- COPD
- Chronic bronchitis
- Acute exacerbations of chronic bronchitis
- Acute exacerbation of COPD
- Emphysema)
- Asthma (Status asthmaticus
- Aspirin-induced
- Exercise-induced
- Bronchiectasis
- unspecified
- Bronchitis
- Bronchiolitis
- Bronchiolitis obliterans
- Diffuse panbronchiolitis
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Interstitial/
restrictive
(fibrosis) |
External agents/
occupational
lung disease |
- Pneumoconiosis
- Asbestosis
- Baritosis
- Bauxite fibrosis
- Berylliosis
- Caplan's syndrome
- Chalicosis
- Coalworker's pneumoconiosis
- Siderosis
- Silicosis
- Talcosis
- Byssinosis
- Hypersensitivity pneumonitis
- Bagassosis
- Bird fancier's lung
- Farmer's lung
- Lycoperdonosis
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Other
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- ARDS
- Pulmonary edema
- Löffler's syndrome/Eosinophilic pneumonia
- Respiratory hypersensitivity
- Allergic bronchopulmonary aspergillosis
- Hamman-Rich syndrome
- Idiopathic pulmonary fibrosis
- Sarcoidosis
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Obstructive or
restrictive
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Pneumonia/
pneumonitis
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By pathogen
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- Viral
- Bacterial
- Atypical bacterial
- Mycoplasma
- Legionnaires' disease
- Chlamydiae
- Fungal
- Parasitic
- noninfectious
- Chemical/Mendelson's syndrome
- Aspiration/Lipid
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By vector/route
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- Community-acquired
- Healthcare-associated
- Hospital-acquired
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By distribution
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IIP
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Other
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- Atelectasis
- circulatory
- Pulmonary hypertension
- Pulmonary embolism
- Lung abscess
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Pleural cavity/
mediastinum |
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Pleural disease
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- Pneumothorax/Hemopneumothorax
- Pleural effusion
- Hemothorax
- Hydrothorax
- Chylothorax
- Empyema/pyothorax
- Malignant
- Fibrothorax
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Mediastinal disease
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- Mediastinitis
- Mediastinal emphysema
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| Other/general |
- Respiratory failure
- Influenza
- SARS
- Idiopathic pulmonary haemosiderosis
- Pulmonary alveolar proteinosis
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anat (n, x, l, c)/phys/devp
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noco (c, p)/cong/tumr, sysi/epon, injr
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proc, drug (R1/2/3/5/6/7)
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Health science – Medicine – Allergic conditions
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| Respiratory system |
- Allergic rhinitis
- Asthma
- Hypersensitivity pneumonitis
- Eosinophilic pneumonia
- Churg-Strauss syndrome
- Allergic bronchopulmonary aspergillosis
- Farmer's lung
- Laboratory animal allergy
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| Skin |
- Angioedema
- Urticaria
- Atopic dermatitis
- Allergic contact dermatitis
- Hypersensitivity vasculitis
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| Blood and immune system |
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| Circulatory system |
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| Digestive system |
- Coeliac disease
- Eosinophilic gastroenteritis
- Eosinophilic esophagitis
- Food allergy
- Milk intolerance
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| Nervous system |
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| Genitourinary system |
- Acute interstitial nephritis
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| Other conditions |
- Drug allergy
- Allergic conjunctivitis
- Latex allergy
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cell/phys/auag/auab/comp, igrc
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