Rhinitis

Definition

Rhinitis is inflammation of the mucous lining of the nose.

Description

Rhinitis is a nonspecific term that covers infections, allergies , and other disorders whose common feature is the location of their symptoms. In rhinitis, the mucous membranes become infected or irritated, producing a discharge, congestion, and swelling of the tissues. The most widespread form of infectious rhinitis is the common cold . Doctors sometimes designate two different forms of rhinitis. These are allergic rhinitis and nonallergic rhinitis. Allergic rhinitis is cause by allergies, and nonallergic rhinitis is caused by other conditions such as the common cold.

Transmission

Nonallergic rhinitis is generally transmitted in the same ways as the common cold. It is transmitted from person to person. The sick person touches his or her nose and then another person's hands. If that person then touches his nose, mouth, or eyes, the infection is transmitted. Infection can also be transmitted through sharing of cups, silverware, or eating utensils, or by coughing or sneezing. Allergic rhinitis cannot be transmitted from person to person.

Demographics

The most frequent cause of nonallergic rhinitis is the common cold. The common cold is the most frequent viral infection in the general population, causing more absenteeism from school or work than any other illness. Colds are self-limited, lasting about three to 10 days, although they are sometimes followed by a bacterial infection. Children are more susceptible than adults; teenage boys more susceptible than teenage girls; and adult women more susceptible than adult men. In the United States, colds are most frequent during the late fall and winter. Allergic rhinitis is less common that nonallergic rhinitis. Allergic rhinitis affects between 20 and 40 million people in the United States. Children are more at risk for allergic rhinitis if one or both parents has allergies.

Causes and symptoms

The onset of a cold is usually sudden. The virus causes the lining of the nose to become inflamed and produce large quantities of thin, watery mucus. Children sometimes develop a fever with a cold. The inflammation spreads from the nasal passages to the throat and upper airway, producing a dry cough , headache , and watery eyes. Some people develop muscle or joint aches and feel generally tired or weak. After several days, the nose becomes less inflamed and a thick, sticky mucus replaces the watery discharge. This change in the appearance of the nasal discharge helps to distinguish rhinitis caused by a viral infection from rhinitis caused by an allergy.

Allergic rhinitis is caused by allergens such as pollen, animal dander, dust mites, or grass. The symptoms of allergic rhinitis are similar to those of nonallergic rhinitis, except that they are usually much longer lasting and are rarely accompanied by a fever. These symptoms often occur at specific times of year if they are not constant.

When to call the doctor

If the symptoms of rhinitis persist for more than a week, or it they frequently occur in specific situations or during specific times of year, a doctor should be consulted. The doctor can then do tests to determine if the rhinitis is viral, bacterial, or caused by allergies and treat it accordingly.

Diagnosis

There is no specific test for viral rhinitis. The diagnosis is based on the symptoms. In children, the doctor will examine the child's throat and glands to rule out other childhood illnesses that have similar early symptoms. If the symptoms last for more than a week, the child may be tested further to rule out bacterial infections or allergies. Allergies can be evaluated by blood tests, skin testing for specific substances, or nasal smears.

Treatment

There is no cure for viral nonallergic rhinitis; treatment is given for symptom relief. Medications include aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) for headache and muscle pain , and decongestants to relieve stuffiness or runny nose. Patients should be warned against overusing decongestants, because they can cause a rebound effect. Over-the-counter (OTC) antihistamines are also available; however, most anti-histamines carry warnings of drowsiness and the inability to do some tasks while medicated. Claritin is a prescription-strength OTC non-drowsy antihistamine that helps relieve symptoms of rhinitis. Antibiotics are not given for viral nonallergic rhinitis because they do not kill viruses. Supportive care includes bed rest and drinking plenty of fluid. Treatments under investigation, as of 2004, included the use of ultraviolet light and injections of interferon. If the nonallergic rhinitis has a bacterial cause at its root, antibiotics can be given; however, bacterial causes of rhinitis are not very common.

Allergic rhinitis is treated in a number of ways, including seasonal allergy medication, nasal sprays, and decongestants. If the cause of the allergies is determined to be an indoor allergen such as dust mites or pet dander, steps can be taken to rid the home of some of the allergens. Injections, or allergy shots , are also sometimes used to treat allergic rhinitis. A small amount of the allergen is injected at first, with tolerance built up over weeks or months. The shots are given frequently at first, but when a maintenance level of the allergen is reached, they are given less frequently. After a few years, they are no longer given at all. These shots have been found to be very effective in some cases, but there are often problems with compliance. Children may also find the experience of regular injections over such a long period to be distressing.

Alternative treatment

Homeopaths might prescribe any of 10 different remedies, depending on the appearance of the nasal discharge, the patients emotional state, and the stage of infection. Naturopaths may recommend vitamin A and zinc supplements, together with botanical preparations made from echinacea (Echinacea spp.), goldenseal ( Hydrastis canadensis ), licorice ( Glycyrrhiza glabra ), or astragalus ( Astragalus membraneceus ) root.

Prognosis

Most rhinitis caused by a cold resolves completely in about a week. Complications are unusual but may include sinusitis (inflammation of the nasal sinuses), bacterial infections, or infections of the middle ear. Allergic rhinitis can usually be treated very effectively. Bacterial causes of rhinitis can usually be resolved fairly quickly with the use of antibiotics.

Prevention

There is no known way to successfully prevent allergic rhinitis. The only way to prevent viral and bacterial nonallergic rhinitis is to take the steps which prevent transmission of the common cold. These include:

• washing hands often, especially before touching the face
• minimizing contact with people already infected
• not sharing hand towels, eating utensils, or water glasses

Parental concerns

Rhinitis causes symptoms such as runny nose, itching , and sneezing that may be uncomfortable for the child. Nonallergic rhinitis is not thought to have any significant long-term consequences. Children who have allergic rhinitis may be at increased risk for developing asthma .

See also Allergic rhinitis ; Allergies ; Common cold .

Resources

BOOKS

Busse, William W., and Holgate, Stephan T. eds. Asthma and Rhinitis. Malden, MA: Blackwell Science, 2000.

Long, Aidan, et al. Management of Allergic and Nonallergic Rhinitis. Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality, 2002.

PERIODICALS

Hopkinson, Kate, and Pauline Powell. "Management of Allergic Rhinitis." Primary Health Care 14, n0. 4 (May 2004): 43.

Wachter, Kerri. "Allergy Is Not Always Behind Rhinitis Symptoms: Separating Allergic from Nonallergic." Family Practice News 33, i.23 (December 1, 2003): 20.

ORGANIZATIONS

American Academy of Allergy, Asthma, Immunology. 555 East Wells Street, Suite 1100, Milwaukee, WI 53202-3823. Web site: http://www.aaaai.org.

Tish Davidson, A.M. Rebecca J. Frey, PhD