Rhinitis

What it is

Rhinitis is recognised by one or more of sneezing, rhinorrhea whether anterior or posterior, nasal congestion or stuffiness, nasal itching, and cough. It divides into allergic rhinitis and non-allergic rhinitis, and the non-allergic group divides again into infectious and non-infectious.

Causes and risk

• Allergic rhinitis is an IgE-mediated hypersensitivity to foreign allergens. The seasonal form answers to pollens from trees; the perennial form to inhaled house dust, wool, feathers, foods, tobacco, hair and mould, or to ingested wheat, eggs, milk and nuts.
• Vasomotor rhinitis is due to the parasympathetic system, the vidian nerve, acting on the mucosal blood vessels, and is described in emotional females. Its triggers are hormonal changes with hypothyroidism, pregnancy or menopause, stress, alcohol, dust, smoke, chemical irritants, and changes in weather or humidity.
• Rhinitis medicamentosa is rebound congestion from vasodilation after excessive or prolonged use, beyond 5 days, of the intranasal vasoconstrictors xylo/oxymetazoline.
• Infective rhinitis is viral, with rhinoviruses, RSV, parainfluenza, influenza and adenoviruses, or bacterial, with Strep. pneumoniae, H. influenzae, M. catarrhalis and S. aureus; Candida, Chlamydia and Mycoplasma are also named.
• The causative agent of atrophic rhinitis is klebsiella ozaenae, with replacement of the pseudostratified columnar epithelium by a metaplastic squamous epithelium. It is described in the young female of poor socioeconomic status, with multivitamin and iron deficiency.