Rhinitis – an allergy that causes the inflammation of mucous membrane inside the nose

Dr. Samir Nanawre
Pulmonologist
Global Hospitals
Mumbai

Rhinitis – condition and an allergy that causes the inflammation of mucous membrane inside the nose

Allergic rhinitis is a inflammatory condition involving the mucosa of the nose and the paranasal sinuses. The underlying cause is mostly atopy which is genetic predisposition to develop any forms of allergy such as rhinitis, asthma or skin allergies. It is commonly seen in those having a history of allergy in self or family or due to exposure to environmental allergens. In those who have genetic allergy, extrinsic allergens tend to trigger the nasal allergies.

Allergic rhinitis may present alone or in combination with asthma or skin allergies. Almost 50 percent patients of asthma have concomitant allergic rhinitis.

Symptoms of Allergic Rhinitis :

Clinically allergic rhinitis can present as sneezing, running nose, nasal itching, blocked nose or a combination of these. The symptoms can be perennial, seasonal or sporadic after exposure to the allergens. The allergens can be indoor such as house dust mite or indoor smoke or fumes of biomass fuel or cigarettes either due to active or passive smoking or outdoor allergens such as automobile exhaust, factory smoke, chemicals, smog, and occupational exposure to irritants or organic dust. Viral infections such as influenza or other viruses are also known to trigger nasal allergies.

There is no specific age or sex distribution to develop allergic rhinitis since it’s genetically primed in most of the cases and triggers are extrinsic environmental factors.

Diagnosis of allergic rhinitis:

The diagnosis of allergic rhinitis is made by the typical symptoms with the background of atopy. Additional tests such as blood IgE levels or RAST test and imaging of the paranasal sinuses by X-ray or CT Scan may provide additional information about the severity of atopy and possibility of allergic nasal polyposis.

Treatment :

Treating allergic rhinitis is extremely important as it can abate distressing symptoms thereby improving quality of life and with patients of concomitant asthma it improves asthma control too.ARIA guidelines have discussed allergic rhinitis and its impact on asthma in detail.

The mainstay of treatment involves use of nasal steroids for duration of one to 6 months depending on the response to treatment as it reduces the nasal inflammation which is the main issue. Along with this symptom control can be achieved with nasal antihistamines or oral anti histamines. Oral montelukast can also be given in combination with oral antihistamines for early symptom control which can be subsequently stopped while continuing the nasal steroid.Nasal steroid sprays include fluticasone, mometasone etc either single or in combination with azelastine as the antihistamine. Oral antihistamines include cetirizine, levocetrizine, desloratidine, fexofenadine etc given either alone or in combination with montelukast.

Preventing Allergic Rhinitis

Prevention can be done by reducing exposure to allergens such as house dust mite by wet mopping pillows, curtains, bed sheets etc or reduce outdoor pollutants by stringent regulations on automobile or factory smokes, avoiding smoking etc. Annual influenza viral vaccine can reduce the risk of recurrent viral infection thereby reduces the exacerbation of nasal allergies.

Allergic rhinitis may be quite distressing however with proper diagnosis and prompt treatment it may be easy to manage this condition in most of the patients with good cure and minimum relapse.