Generality
The term rhinitis indicates a generic irritation and inflammation of the nasal mucosa.
There are three main types of rhinitis: infectious rhinitis, allergic rhinitis and non-allergic rhinitis (or vasomotor rhinitis).
The classic symptoms of rhinitis are: stuffy nose, runny nose, repeated sneezing, postnasal drip (or drain) and nasal voice.
For a correct diagnosis, a physical examination, anamnesis, a series of allergy tests and a nasal swab are necessary.
The treatment of rhinitis varies according to the triggering causes.
What is Rhinitis?
Rhinitis is the medical term for any irritative and inflammatory process affecting the nasal mucosa.
According to the most widespread classification, which takes into account the triggering causes, there are three types of rhinitis: infectious rhinitis, non-allergic rhinitis (or vasomotor rhinitis ) and allergic rhinitis .
The episodes of rhinitis represent a fairly common problem.
WHAT IS NASAL MUCOSA?
Highly vascularized, the nasal mucosa is the particular epithelium that covers the nasal cavities and makes them moist, through the secretion of mucus . It has at least three functions:
- It helps to heat and humidify 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).
OTHER RINITE CLASSIFICATION: ACUTE FORMS AND CHRONIC FORMS
Depending on the rapidity of onset of symptoms and their severity, rhinitis can be defined as acute or chronic (NB: a synonym of chronic is permanent).
A rhinitis is acute, when the symptoms that characterize it appear quickly, last a few days and are very severe.
A rhinitis is chronic, however, when the clinical manifestations that characterize it appear gradually, last several weeks and are not particularly intense. To learn more, read: Chronic Rhinitis.
Causes
The three types of rhinitis mentioned above have different causes, therefore they deserve a case-by-case discussion.
ALLERGIC RHINITIS
Allergic rhinitis is the result of an allergic response 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 .
According to some statistical surveys, which refer to the inhabitants of the United States, allergic rhinitis would affect 10-30% of adults each year.
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
NON-ALLERGIC RHINITIS
At the moment there is little clarity on what are the precise causes of non-allergic rhinitis.
According to the most reliable medical hypotheses, to initiate the inflammatory process that characterizes vasomotor 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, of huge quantities of blood and fluids.
According to various scientific studies, some of the factors that would seem to be able to favor, in still unclear circumstances, the aforementioned vasodilation process 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.
Non-allergic rhinitis, which depends on turbinate damage or absence, is also called atrophic rhinitis ;
- Intense physical exercise;
- Sexual arousal.
According to some interesting research conducted in the United States, non-allergic rhinitis would affect about 17 million inhabitants and would affect the twenties in particular.
Sometimes non-allergic rhinitis can occur in association with allergic rhinitis. To identify these particular circumstances, doctors have adopted the term " mixed rhinitis ".
INFECTIOUS RHINITIS
Infectious rhinitis is so called because it arises due to viral infections - that is, triggered by viruses - or bacterial - that is induced by bacteria.
Among the viruses capable of causing rhinitis, are:
- Rhinoviruses ;
- The Coronaviruses ;
- Influenza viruses;
- Adenoviruses ;
- Human parainfluenza viruses;
- The Syncytial Respiratory Virus;
- Enteroviruses ;
- Metapneumoviruses ;
- The measles virus.
Among the bacteria capable of causing rhinitis, they deserve a mention:
- Streptococcus pneumoniae ;
- Haemophilus influenzae ;
- Moraxella catarrhalis .
Symptoms, signs and complications
The classic symptoms of rhinitis are: stuffy nose, runny nose, repeated sneezing, postnasal drip (or drain) and nasal voice.
The presence of other disorders depends on the type of rhinitis.
Therefore, it can be concluded that the symptomatology of a rhinitis includes a series of generic clinical manifestations, independent of the type of rhinitis, and a series of specific clinical manifestations, depending on the triggering causes.
SYMPTOMS OF ALLERGIC RHINITIS
The specific symptoms of allergic rhinitis are:
- Nasal itching;
- Cough;
- Headache;
- Sense of fatigue;
- Malaise;
- Itchy throat;
- Conjunctivitis;
- Tearing;
- Palpebral swelling (or swollen eyelids);
SYMPTOMS OF NON-ALLERGIC RHINITIS
The specific symptoms of non-allergic rhinitis consist of:
- Moderate irritation and a sense of discomfort in and around the nose;
- Reduced sense of smell (anosmia);
- 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);
- Snoring;
- Halitosis.
If particularly severe or if not treated adequately, non-allergic rhinitis can give rise to various complications, including: sleep disturbances, daytime sleepiness, irritability, concentration problems, nasal polyps, sinusitis and dependent infections middle ear.
SYMPTOMS OF INFECTIVE RHINITIS
The specific symptoms of infectious rhinitis are:
- Temperature;
- Cough;
- Halitosis;
- Fatigue;
- Malaise.
Failure to treat infectious rhinitis can cause the bacterium or virus responsible for the infection to reach the bronchi and / or lungs and cause pneumonia. Thus, episodes of bacterial or viral pneumonia are among the possible complications of infectious rhinitis.
Diagnosis
In general, to diagnose rhinitis and understand its precise type, a physical examination, a history of allergies (skin tests and blood tests) and a nasal swab are necessary.
A positive response to allergy tests is indicative of allergic rhinitis; a negative response, on the other hand, is indicative of non-allergic or infectious rhinitis.
A positive response to the nasal swab is proof that rhinitis is due to an infection; nasal swabs are tests that allow those who perform them to trace the causative pathogen.
Knowledge of the precise causes of rhinitis is essential for planning the most appropriate therapy.
Treatment
The treatment of a rhinitis depends, first of all, on the triggering causes (therefore on the type of rhinitis) and, secondly, on the severity of the symptomatology.
ALLERGIC RHINITIS
The most adopted therapy for allergic 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.
NON-ALLERGIC RHINITIS
The treatment of non-allergic rhinitis includes:
- A series of attentions aimed at avoiding the direct contact of those factors that seem to induce the inflammatory process on the nasal mucosa;
- 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.
INFECTIOUS RHINITIS
The treatment of infectious rhinitis depends on which pathogen is.
If a bacterium is the cause of rhinitis, doctors prescribe ad hoc antibiotic therapy, associated with a period of rest and the administration of anti - inflammatories against fever .
If a virus is the cause of rhinitis, doctors almost always avoid prescribing antiviral drugs and only recommend a period of rest and the administration of anti-inflammatories against the fever.
Prognosis
The prognosis in case of rhinitis depends on several factors, including:
- The curability of the triggering causes. A rhinitis with treatable causes will, for obvious reasons, have a better prognosis than a rhinitis that is difficult to treat;
- The severity of symptoms. A rhinitis that has given rise to complications will have a more frequent negative prognosis;
- The attention that the patient places on avoiding certain agents triggering the symptomatology. This point is particularly valid in case of allergic rhinitis and non-allergic rhinitis.
Prevention
The only type of truly preventable rhinitis is infectious rhinitis.
To prevent the latter, doctors believe two countermeasures to be fundamental: to keep away from people with infectious rhinitis and to be vaccinated against the viruses and bacteria responsible for infectious rhinitis.
