Generality
Chronic rhinitis is an irritative and inflammatory process affecting the nasal mucosa, whose symptoms appear gradually, last several months and are of moderate severity.
Chronic rhinitis can be allergic or non-allergic (or vasomotor).
Chronic allergic rhinitis arises following an allergy to substances such as pollen, dust, animal hair or the so-called Balsamo of Peru.
Chronic non-allergic rhinitis, on the other hand, appears due to an excessive dilation of the blood vessels of the nasal mucosa, which leads to an accumulation of blood and fluids in the nasal cavities.
The treatment of chronic rhinitis depends on the triggering causes. Therefore, correct diagnosis is essential.
Medical meaning of Rhinitis
Rhinitis is the medical term for any irritative and inflammatory process affecting the nasal mucosa.
Main functions of the nasal mucosa:- Heats and humidifies the air that enters the nose;
- It traps harmful (or in any case foreign) substances that could be found in the air that enters the nose;
- It supports the sense of smell, as it has connections with the first cranial nerve (or olfactory nerve).
Highly vascularized, the nasal mucosa is the mucus-secreting epithelium, which coats and moistens the nasal cavities.
What is chronic rhinitis?
A chronic rhinitis is a form of rhinitis whose symptoms appear gradually, last several months and are of moderate severity.
According to a more specialized definition, coined by doctors, rhinitis is chronic when its clinical manifestations last at least an hour a day, for about a year.
It is important to underline that what has just been stated is valid in most cases, not for everyone (there may therefore be variations).
DIFFERENCES COMPARED TO ACUTE RHINITIS
A rhinitis is acute when the symptoms that characterize it appear quickly, last a few days and are very severe.
Causes
There are two types of chronic rhinitis: chronic allergic rhinitis and chronic vasomotor rhinitis (or non-allergic).
These two types of rhinitis differ in their causes.
CAUSES OF CHRONIC ALLERGIC RINITE
The causes of chronic allergic rhinitis are the same as those of generic allergic rhinitis .
Allergic rhinitis is the result of an allergic response (so it is an allergy) to substances, such as pollen, dust, the so-called Balsamo of Peru or animal hair.
From the physiopathological point of view, in the presence of an allergic rhinitis it happens that the allergens (ie the substances mentioned above) induce the mast cells present at the nasal level to become protagonists of an abnormal and massive degranulation, from which they derive large quantities of inflammatory substances. A substance deriving from degranulation, particularly active in causing the inflammatory processes that characterize allergic rhinitis, is histamine.
What is an allergy?
An allergy can be defined as an exaggerated, inappropriate and harmful antibody response, triggered by the immune system towards substances (the so-called allergens) which, for most people, are completely harmless.
CAUSES OF CHRONIC VASOMOTOR RHINITE
Vasomotor chronic rhinitis arises in the same way as a generic vasomotor rhinitis (or non-allergic rhinitis ).
According to the most accredited medical theories, to initiate the inflammatory process that characterizes non-allergic rhinitis would be an excessive dilation of the blood vessels of the nasal mucosa and the consequent accumulation, in the nasal cavities covered by the latter (ie the nasal mucosa), of large amounts of blood and fluids.
On the basis of various scientific studies, some of the main factors that would seem to be able to favor the aforementioned vasodilation process in circumstances that are still difficult to understand are:
- High temperature, sudden changes in temperature, high humidity, exposure to toxic fumes (eg cigarette smoke), spicy foods, foods that are too hot, stress, alcohol, intense aromas, etc. All these factors are labeled with the term environmental factors;
- Hormonal imbalances, which characterize particular moments in the life of a human being, such as pregnancy (exclusively for women) or puberty;
- Hormonal therapies or hormonal contraceptives;
- Special pharmacological substances, including: some NSAIDs (eg: ibuprofen or aspirin), beta-blockers, ACE inhibitors (or angiotensin-converting enzyme inhibitors), nasal decongestants in the form of sprays (in these situations, we talk about medicated rhinitis), drugs for the treatment of erectile dysfunction and some tranquilizers (eg: benzodiazepines);
- The presence of damage to the turbinates or the absence of the latter, due for example to surgery removal surgery. The turbinates are specific areas of the nasal cavities, consisting of tissues that have the task of humidifying the inside of the nose and preventing the entry into the body of bacterial agents and other potentially dangerous microorganisms.
Vasomotor rhinitis, which depends on turbinate damage or absence, is also called atrophic rhinitis ;
- Intense physical exercise;
- Strong emotions;
- Sexual arousal.
It is important to point out that, in some cases, vasomotor rhinitis appears without the occurrence of any of the above circumstances; in other words, it appears for inexplicable reasons. In these situations, the doctors describe the inflammatory condition as an idiopathic disorder ( idiopathic vasomotor rhinitis ).
Epidemiology
Chronic rhinitis is quite common.
It can affect individuals of all ages, however it has a particular predilection for adults.
In most cases, chronic rhinitis episodes are allergic.
Symptoms and Complications
The classic symptoms of chronic rhinitis are the typical symptoms of a generic rhinitis, namely: stuffy nose, runny nose, repeated sneezing, postnasal drip (or drain) and nasal voice.
If chronic rhinitis is allergic, the following disorders may be added:
- Nasal itching;
- Cough;
- Headache;
- Sense of fatigue;
- Malaise;
- Itchy throat;
- Conjunctivitis;
- Tearing;
- Palpebral swelling (or swollen eyelids);
If chronic rhinitis is vasomotor, they can complete the classic symptomatology:
- Moderate irritation and a sense of discomfort in and around the nose;
- A reduced sense of smell (anosmia);
- The formation of one or more scabs inside the nasal cavities. These scabs can be responsible for a bad smell coming out of the nose and bleeding (if you try to remove them);
- The tendency to snoring and halitosis.
INTENSITY AND PERIODICITY OF SYMPTOMS
The intensity of the symptoms of chronic rhinitis varies from patient to patient, with some of them suffering more than others.
However, the symptomatological severity is always lower than that observed with acute rhinitis.
In general, those who suffer from chronic rhinitis alternate periods in which the symptomatology is particularly evident with periods in which the clinical manifestations are barely mentioned; in some situations, this alternation can take place during the same day and within a few hours.
COMPLICATIONS
A chronic rhinitis characterized by particularly intense symptoms can greatly affect the quality of life of the patient, affecting work activity, interpersonal relationships, academic performance, etc.
In the specific case of chronic vasomotor rhinitis, this, if not properly treated, can lead to the onset of sinusitis, nasal polyps and / or otitis.
Diagnosis
To diagnose chronic rhinitis and understand its triggers (so if it is allergic or vasomotor), the following are necessary: physical examination, medical history and a series of allergy tests (skin tests and blood tests).
A positive response to allergy tests is indicative of chronic allergic rhinitis; a negative response, on the other hand, indicates a chronic vasomotor rhinitis.
Knowledge of the precise causes of chronic rhinitis is essential for planning the most appropriate therapy.
Treatment
The treatment of chronic rhinitis depends mainly on the triggering causes. In fact, chronic allergic rhinitis requires a therapy that, for various aspects, is different from the therapy envisaged in the case of chronic vasomotor rhinitis.
CHRONIC ALLERGIC RINITE
The most adopted therapy in case of allergic chronic rhinitis includes:
- A series of precautions aimed at avoiding exposure to the allergens triggering the symptoms;
- The administration of antihistamines in spray, tablets or liquid solution. Antihistamine drugs are used to block the release of histamine, which, as readers will remember, is the substance responsible for allergic inflammatory processes;
- The use of decongestants administered by spray or by mouth. Decongestants are useful for clearing the stuffy nose.
They are contraindicated in cases of hypertension and genitourinary diseases. They must not be used for long periods of time;
- Use of eye drops and spray saline solutions. Eye drops serve to relieve itchy eyes; spray saline solutions, on the other hand, serve to rid the nose of excess mucus;
- Immunotherapy. Allergies are exaggerated responses of the immune system. Immunotherapy is intended to reduce the power of the immune system, so that the probability of an exaggerated response by the immune system to some type of allergen is less.
CHRONIC VASOMOTOR RHINITE
The treatment of non-allergic rhinitis includes:
- A series of attentions aimed at avoiding exposure to those factors that seem to induce dilation of the blood vessels of the nasal mucosa and the consequent inflammatory process. This is possible, of course, in all those cases in which vasomotor rhinitis is not idiopathic;
- Nasal washings with saline solutions. They serve to cleanse the nasal cavities from excess mucus and irritants. In addition to reducing the inflammatory state, they are a source of relief;
- The use of nasal sprays based on corticosteroids. Corticosteroids are powerful anti-inflammatory drugs, which are medicines that reduce inflammation. Their prolonged use can lead to different side effects, therefore it is good to take them only after prescription;
- The use of anticholinergic nasal sprays. They limit the production of mucus inside the nasal cavities, thus relieving the symptom known as a runny nose;
- The use of decongestant nasal sprays. Reduce excessive dilation of blood vessels in the nasal mucosa.
DURATION OF TREATMENTS
Chronic rhinitis is a long-term condition, so it is likely that treatments will have to last for long periods of time.
Generally, doctors advise to stop treatments after a few months for at least two reasons:
- Because some of the aforementioned therapies, if applied for long periods of time, can have serious side effects;
- To see if the condition has resolved or if, on the other hand, if the therapy ceases, it reappears.
Prognosis
In general, if patients avoid exposing themselves to the triggers of the symptoms, they have a fair probability of recovering from chronic rhinitis or, at least, limiting the resulting disorders.
