scholarly journals Rhinitis: differential diagnosis and treatment principles

2020 ◽  
pp. 102-108
Author(s):  
A. L. Guseva ◽  
M. L. Derbeneva
Keyword(s):  
Allergic Rhinitis ◽  
Clinical Symptoms ◽  
Nasal Congestion ◽  
Atrophic Rhinitis ◽  
Vasomotor Rhinitis ◽  
Allergen Specific Immunotherapy ◽  
Acute Viral Infection ◽  
Mixed Rhinitis ◽  
Non Allergic Rhinitis ◽  
Saline Solutions

Rhinitis is inflammation of the mucous membrane inside the nose. The clinical symptoms of this disease include nasal congestion, sneezing, itching of the nose and roof of mouth, rhinorrhea, and mucus draining down the back of the throat. Both allergic and non-allergic factors can play a role in the development of rhinitis. The most commonly used classification of rhinitis includes allergic rhinitis, non-allergic rhinitis, infectious rhinitis, and its specific forms. Allergic rhinitis is classified into the intermittent or persistent types, and may also be classified as mild, moderate and severe according to the severity of symptoms. Treatment of allergic rhinitis includes elimination of contact with allergen, allergen-specific immunotherapy and pharmacotherapy, which is selected depending on the severity of the symptoms. Infectious rhinitis develops in acute viral infection, and rhinitis symptoms are present in acute and chronic rhinosinusitis. Non-allergic rhinitis comprises conditions ranging from vasomotor rhinitis and gustatory rhinitis to non-allergic rhinitis with eosinophilia syndrome. Mixed rhinitis has components of allergic and non-allergic rhinitis. In addition, there are CPAP rhinitis, occupational rhinitis, medication rhinitis, rhinitis in systemic administration of drugs, rhinitis of pregnant women, atrophic rhinitis, rhinitis in systemic diseases. The type of rhinitis is diagnosed based on the patient’s complaints, anamnesis and clinical picture, some cases require laboratory tests and CT scan of the paranasal sinuses to differentiate the diagnosis. Approaches to the treatment of rhinitis depend on its type and include elimination of allergens or provoking factors, administration of saline solutions, intranasal glucocorticosteroids, systemic antihistamines, intranasal cromones, decongestants, antibacterial drugs may be prescribed to treat infectious rhinitis. Rhinitis should be differentiated from structural abnormalities, including congenital features, acquired conditions, neoplasms, gastroesophageal reflux, nasal liquorrhea.

scholarly journals Non-Allergic Rhinitis

2020 ◽  
Author(s):  
Erkan Yıldız
Keyword(s):  
Allergic Rhinitis ◽  
Nasal Congestion ◽  
Seasonal Pattern ◽  
Common Type ◽  
Vasomotor Rhinitis ◽  
Cold Air ◽  
Family Stories ◽  
Runny Nose ◽  
Underlying Factor ◽  
Non Allergic Rhinitis

Non-allergic rhinitis is a term used for situations where no allergen can be detected as the cause of rhinitis. In non-allergic rhinitis; Skin test positivity or specific Ig E response cannot be detected. The pathophysiology of nonallergic rhinitis (NAR) is heterogeneous. The most common type is vasomotor rhinitis, also called idiopathic. In addition, there are many types such as hormonal, gustatory, occupational, atrophic, cold air-induced and systemic diseases. Patients; They present with symptoms such as nasal congestion, runny nose, sneezing, and itching in the nose, the symptoms of the patients do not show a seasonal pattern. There are family stories, but they are not as common as allergic rhinitis (AR). An underlying factor such as infection, sinusitis or polyps cannot be detected in patients. It was determined that the patients showed more neurogenic abnormalities in the pathophysiology. These patients have been shown to be hypersensitive to substances with ingredients such as cold air or capsaicin. The diagnosis is made clinically, the onset of the disease is in adolescence. Oral/nasal antihistamines, steroids, leukotriene antagonists are used in the treatment.

Comparison of efficacy and tolerability of oral desloratadine, rupatadine and ketotifen in seasonal allergic rhinitis

2021 ◽  
Vol 4 (3) ◽  
pp. 106-114
Author(s):  
Syed Khadeer ◽  
B Jagannath
Keyword(s):  
Allergic Rhinitis ◽  
Adverse Events ◽  
Nasal Congestion ◽  
Primary Outcome Measure ◽  
Nasal Symptom ◽  
Secondary Outcome ◽  
Open Label ◽  
Non Allergic Rhinitis ◽  
The Individual ◽  
Change In Mean

Rhinitis is inflammation of nasal mucosa which characteristically presents as running nose, blocked nose, itching on nose or sneezing. Allergic rhinitis is more common than non-allergic rhinitis. Anti-histamines are the mainstay of SAR treatment. Desloratadine, rupatadine and ketotifen are the commonly prescribed anti histamines in our region. In this study, we have compared efficacy and tolerability of desloratadine, rupatadine and ketotifen in SAR. This was a prospective, randomized, three arm, open label comparative study of desloratadine, rupatadine and ketotifen in SAR, conducted at Department of ENT, Kempegowda Institute of Medical Sciences, Bangalore; between January 2014 and December 2014. Patients’ severity of SAR symptoms were assessed by TNSS, QoL was measured using Medical Outcomes Study questionnaire (SF-12). SF-12 was administered at the start of study and then at the end of study. Adverse effects were monitored during clinical examination at each visit. Study subjects were systemically randomized into three groups – desloratadine (DES), rupatadine (RUP) and ketotifen (KET). Based on the assigned group; desloratadine was given orally in dose of 10mg OD, rupatadine orally 10 mg OD and ketotifen orally 1mg BD. All medications were given for 4 weeks. Follow up was done for all patients every week during treatment period of 4 weeks. The primary outcome measure was change in mean TNSS from baseline; secondary outcome measures were changes in the individual nasal symptom scores, change in the quality of life and tolerability to the study medications. Total 150 patients were recruited for this study, divided into 3 groups. DES and RUP were equally effective but significantly better than KET in improving rhinorrhea, nasal congestion, TNSS and AEC. (p=0.05). All the drugs were equally effective with no statistically significant intergroup difference in improving sneezing, nasal itching and QoL. RUP appeared to have better tolerability as the total number of adverse events were marginally less. DES and RUP are comparatively more effective and faster acting than KET. All the study medications were well tolerated with few mild, self-limiting, transient adverse events requiring no intervention.

scholarly journals Immunotherapy in Allergic Rhinitis: It’s Effect on the Immune System and Clinical Symptoms

2018 ◽  
Vol 6 (7) ◽  
pp. 1248-1252 ◽  
Author(s):  
Samaneh Kouzegaran ◽  
Mohammad Ali Zamani ◽  
Reza Faridhosseini ◽  
Houshang Rafatpanah ◽  
Abdolrahim Rezaee ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Clinical Symptoms ◽  
Nasal Congestion ◽  
Subcutaneous Immunotherapy ◽  
Positive Skin Prick Test ◽  
Tgf Beta ◽  
Positive Skin ◽  
Ifn Gamma ◽  
Clinical Criteria ◽  
Prick Test

BACKGROUND: Allergic rhinitis is one of the most common allergic diseases and characterised by sneezing, rhinorrhea, nasal congestion and nasopharyngeal itching. Subcutaneous immunotherapy (SCIT) for specific allergens is an effective treatment and induces the inhibitory effect of T regulatory lymphocytes and decreases clinical symptoms in allergic rhinitis.AIM: In this study effect of subcutaneous immunotherapy with specific allergens on clinical symptoms and T regulatory and T Helper cells cytokines, in patients with allergic rhinitis are evaluated.METHODS: In this study, 30 patients with moderate to severe allergic rhinitis according to clinical criteria and positive skin prick test for aeroallergens were selected and treated by SCIT. Clinical symptoms and T cells cytokines IL4, IL17, IFN gamma, TGF beta, GITR, FOXP3 and IL-10 (by RT-PCR) were evaluated before and one year after initiation of treatment.RESULTS: Thirty (30) patients with allergic rhinitis at age range 15-45 years old were treated by SCIT, and 23 (14 female, 9 male) patients continued the study, and 7 patients did not continue treatment. After immunotherapy, clinical symptoms decreased significantly. The specific cytokines TGF beta and IL10 levels increased and changes were statistically significant. (Respectively P = 0.013 and P = 0.05) The IL17 level was also increased, but not statistically significant. (P = 0.8) IFN gamma, IL4, GITR, FOXP3, all decreased, but the changes were not statistically significant (P > 0.05).CONCLUSION: Subcutaneous Immunotherapy for specific allergens decreases clinical symptoms in patients with allergic rhinitis and induces tolerance in T lymphocytes, especially by increasing T regulatory cells cytokines, TGF beta and IL10.

Mast cell stabilizers

1992 ◽  
Vol 107 (6_part_2) ◽  
pp. 841-844 ◽  
Author(s):  
Hueston C. King
Keyword(s):  
Allergic Rhinitis ◽  
Mast Cell ◽  
Cell Membrane ◽  
Nasal Mucosa ◽  
Nasal Polyps ◽  
Nasal Congestion ◽  
Correct Diagnosis ◽  
Vasomotor Rhinitis ◽  
Ige Mediated ◽  
Exercise Induced

The precise mode of action of the well-studied cromolyn sodium and the newer nedocromil sodium has not been completely elucidated. Because the drugs do not pass the cell membrane and enter the cell, they are virtually not metabolized, do not exert a systemic action, and therefore are associated with only minimal systemic toxicity. To be effective either drug must be applied topically and directly to the nasal mucosa. Proper contact with the nasal mucosa is essential for efficacy; in patients with nasal congestion and secretions, vasoconstrictors or saline lavages are indicated before cromolyn or nedocromil use. Both products are highly effective in patients who have IgE-mediated allergic rhinitis but must be administered prophylactically before exposure to an allergen to prevent development of the allergic event. Neither drug is effective in vasomotor rhinitis, exercise-induced rhinitis, or in the management of nasal polyps. Correct diagnosis is essential before therapy.

Nasal Responses to Metabisulfite (MBS) Solution in Non-Atopic Subjects and Patients with Atopic Rhinitis

1994 ◽  
Vol 8 (5) ◽  
pp. 231-236 ◽  
Author(s):  
Mariola Śliwińska-Kowalska ◽  
Marek L. Kowalski ◽  
Wiestaw Sutkowski ◽  
Wiktor Wesotowski ◽  
Melvyn R. Danzig
Keyword(s):  
Allergic Rhinitis ◽  
Total Protein ◽  
Clinical Symptoms ◽  
Nasal Congestion ◽  
Absolute Amount ◽  
Protein Ratio ◽  
Nasal Symptoms ◽  
Before And After ◽  
Nasal Secretions ◽  
Dose Dependent Increase

In order to characterize the effect of metabisulfite (MBS) on human nasal mucosa, in 10 healthy, non-atopic subjects and in six patients with atopic rhinitis, 50 mg/mL and 100 mg/mL solutions of MBS were sprayed into both nostrils. Clinical symptoms and Nasal Peak Flow (NPF) were recorded. Nasal lavages were performed before and after MBS challenges. MBS challenge induced similar burning/itching sensation in both groups, but rhinorrhea was significantly more intense (P < 0.02) in atopic patients. There was no nasal congestion and no change in NPF after the challenge. Only in atopic patients were nasal symptoms accompanied by a dose-dependent increase in the concentration of total protein and glandular protein lysozyme in nasal washes (P < 0.05). No statistically significant changes were seen in the absolute amount of plasma protein albumin and albumin to total protein ratio (Albumin %) in nasal secretions. This study demonstrates that MBS induces nasal symptoms both in healthy, non-atopic subjects and in patients with allergic rhinitis; but secretory glandular responses are detected only in patients with allergic rhinitis.

scholarly journals Role of inflammation in non-allergic rhinitis

2014 ◽  
Vol 52 (2) ◽  
pp. 142-149
Author(s):  
E. de Corso ◽  
M. Battista ◽  
M. Pandolfini ◽  
L. Liberati ◽  
S. Baroni ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Clinical Symptoms ◽  
Diagnostic Algorithm ◽  
Inflammatory Cell Infiltrate ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Significant Difference ◽  
Nasal Cytology ◽  
Non Allergic Rhinitis

Objective: To investigate the role of inflammation in non-allergic rhinitis (NAR) patients in a large series to establish the prevalence of different NAR-subtypes, clinical features and the role of nasal cytology in the diagnostic algorithm. Methodology: Patients were selected out of 3650 individuals who spontaneously presented at our institution. We consecutively enrolled 519 NAR-patients in an analytical cross-sectional study between November 2007 and June 2013 (level of evidence: 3b). All patients underwent rhinological evaluation including symptoms questionnaire, endoscopy, CT scan, allergy tests and nasal cytology. Results: The inflammatory cell infiltrate affects the severity of symptoms differently, allowing for identification of different phenotypes of NAR. We distinguished two groups: “NAR without inflammation”(NAR-) and “NAR with inflammation”(NAR+), in addition to different NAR-subtypes with inflammation. A significant difference was observed in terms of clinical symptoms and association with comorbidities (previously diagnosed asthma and aspirin intolerance) between NAR–, NAR+ and between different NAR+ subtypes. Conclusion: Our data suggest that NAR- and NAR with neutrophils behave similarly, showing lower symptom score values and a lower risk of association with comorbidities compared to NAR with eosinophils and mast cells (singularly or mixed). In our belief it is very important to establish the presence and type of inflammation in non-allergic rhinitis patients and nasal cytology is a very useful test in correct differential diagnosis.

scholarly journals RINITIS ALERGI DI POLIKLINIK THT-KL BLU RSU PROF. DR. R. D. KANDOU MANADO PERIODE JANUARI 2010 – DESEMBER 2012

e-CliniC ◽  
2013 ◽  
Vol 1 (2) ◽  
Author(s):  
Elia Reinhard ◽  
O. I. Palandeng ◽  
O. C. P. Pelealu
Keyword(s):  
Allergic Rhinitis ◽  
Clinical Symptoms ◽  
Nasal Congestion ◽  
Neck Surgery ◽  
Age Group ◽  
Number Of Patients ◽  
Atopic Condition ◽  
Antihistamine Drug ◽  
Surgery Department ◽  
Nose And Throat

ABSTRACT: Allergic Rhinitis is an atopic condition which most often occurred. The incidence of allergic rhinitis is estimated at about 10% of the general population. This study aims to know the profile of allergic rhinitis patients in Ear, Nose and Throat – Head and Neck Surgery Department at Prof. Dr. R. D. Kandou General Hospital, Manado period January 2010 – December 2012 by using descriptive retrospective study method. The overall number of objects in this study are 209 patients. The result, distribution by year obtained the highest number of patients in the year 2011 as many as 80 patients of 4.295 visitors (1,86%), age group 21-30 years old had the highest percentage (23,92%). Percentage of patients with allergic rhinitis was higher in woman (56,48%) than men (43,54%), jobs of patients which employees have highest percentage (34,93%), sneezing clinical symptom has highest percentage (39,40%), antihistamine treatment has highest percentage (42.70%). Conclusion, Age group 21-30 years is the most frequent suffer from allergic rhinitis. Woman is more frequent suffer from allergic rhinitis than in men. The job of patients which most frequent to get allergic rhinitis is an employee. Clinical symptoms which are most frequent complained are sneezing, rhinorrhea and nasal congestion. Treatment which most frequent given is antihistamine drug. Keywords: Allergic rhinitis   ABSTRAK: Rinitis alergi merupakan keadaan atopi yang paling sering dijumpai. Insiden rinitis alergi diperkirakan menyerang sekitar 10% dari populasi umum. Penelitian ini dilakukan untuk mengetahui profil penderita rinitis alergi di poliklinik THT-KL BLU RSU Prof. Dr. R. D Kandou Periode Januari 2010 – Desember 2012 dengan menggunakan metode retrospektif deskriptif. Keseluruhan jumlah objek penelitian adalah 209 penderita. Hasil penelitian, distribusi menurut tahun didapatkan jumlah penderita tertinggi pada tahun 2011 yaitu sebanyak 80 penderita dari 4.295 pengunjung (1,86%),  golongan umur 21-30 tahun memiliki presentase tertinggi (23,92%). Rinitis alergi tinggi pada perempuan (56,48%) dari pada laki-laki (43,54%), pekerjaan terbanyak adalah pegawai (34,93%), gejala klinik bersin sebesar 39,40%,  penanganan antihistamin memiliki presentase tertinggi sebesar 42.70%.Kesimpulan, golongan umur 21-30 tahun ialah yang paling sering menderita rinitis alergi. Perempuan lebih sering menderita rinitis alergi daripada laki-laki. Jenis pekerjaan yang paling sering terkena rinitis alergi ialah pegawai. Gejala klinik yang paling sering dikeluhkan yaitu bersin-bersin, rinore dan hidung tersumbat. Penanganan yang paling sering diberikan ialah obat golongan antihistamin. Kata Kunci: Rinitis alergi

scholarly journals CLINICAL SYMPTOMS AND ETIOLOGIC FACTORS OF ALLERGIC RHINITIS OR VASOMOTOR RHINITIS

1967 ◽  
Vol 70 (6) ◽  
pp. 1067-1076
Author(s):  
AKIRA TERAO ◽  
YASUO SATO ◽  
DAIJI IDE ◽  
ICHIRO KIRIKAE
Keyword(s):  
Allergic Rhinitis ◽  
Clinical Symptoms ◽  
Vasomotor Rhinitis

Allergic and nonallergic rhinitis

2019 ◽  
Vol 40 (6) ◽  
pp. 376-379 ◽  
Author(s):  
Neha T. Agnihotri ◽  
Kris G. McGrath
Keyword(s):  
Allergic Rhinitis ◽  
Nasal Cavity ◽  
Immunoglobulin E ◽  
Nasal Congestion ◽  
Skin Testing ◽  
Systemic Disease ◽  
Symptomatic Relief ◽  
Vasomotor Rhinitis ◽  
Nonallergic Rhinitis ◽  
Intranasal Corticosteroids

Rhinitis is characterized by nasal congestion, rhinorrhea, sneezing, and/or posterior nasal drainage. It affects a significant portion of the population and presents a large burden economically and on quality of life. Rhinitis is broadly characterized as allergic and nonallergic, of which nonallergic rhinitis may be divided into inflammatory and noninflammatory etiologies. The inflammatory causes include nonallergic rhinitis with eosinophilia, postinfectious, and rhinitis associated with nasal polyps. The noninflammatory causes include idiopathic nonallergic (vasomotor) rhinitis, medication-induced rhinitis, hormone related (e.g., pregnancy), and systemic disease related. Allergic rhinitis is classified as intermittent or persistent and mild versus moderate-severe. The nasal mucosa is extremely vascular; parasympathetic stimulation promotes an increase in nasal cavity resistance and nasal gland secretion, whereas sympathetic stimulation leads to vasoconstriction. The diagnosis of rhinitis begins with a directed history, particularly noting pattern, chronicity, and triggers of symptoms. Examination of the nasal cavity with attention to appearance of the septum and inferior turbinates is recommended. Skin testing for aeroallergens is helpful in demonstrating the presence or absence of immunoglobulin E antibodies and to differentiate nonallergic from allergic rhinitis. Treatment includes patient education, irritant or allergen avoidance, and pharmacotherapy. Medications used for the treatment of rhinitis include intranasal corticosteroids, oral and intranasal antihistamines, intranasal anticholinergic agents, oral decongestants, and leukotriene receptor antagonists. When used in combination, an intranasal antihistamine spray and nasal steroid provide greater symptomatic relief than monotherapy. Allergen immunotherapy is the only disease-modifying intervention available for allergic rhinitis.

scholarly journals Analysis of the dynamics of clinical indicators in patients with allergic rhinitis with sensitization to pollen and household allergens using combined allergen-specific immunotherapy

2021 ◽  
Vol 26 (4) ◽  
pp. 87-93
Author(s):  
S.V. Biletska ◽  
E.M. Dytyatkovska ◽  
M.A. Nikolaychuk
Keyword(s):  
Allergic Rhinitis ◽  
Specific Immunotherapy ◽  
High Efficiency ◽  
Comparison Group ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
House Dust Mites ◽  
Skin Tests ◽  
Pollen Allergens ◽  
Allergen Specific Immunotherapy

The aim of this study was to evaluate the clinical efficacy of combined allergen-specific immunotherapy (ASIT) in patients with allergic rhinitis (AR) with combined sensitization to pollen and household allergens. To achieve this goal, 49 patients with AR of working age were examined – 35.5±1.5 years with clinical manifestations of seasonal rhinoconjunctival syndrome with a long period of 9.2±1.1 years, among which there were 25 (51.0%) males and 24 (49%) females. All patients were divided into 2 homogeneous groups by age, sex, duration of the disease, the average number of etiologically significant allergens: the main one – 31 patients who received combined ASIT with solutions of pollen and household allergens and a comparison group – 18 patients for whom only pollen allergens were used. Allergological examination included anamnesis, skin tests with pollen allergens (wormwood, ragweed, quinoa, corn, etc.) and household (house dust, mites, epidermal agents) and / or molecular research methods using the ALEX technology. The quantitative integral assessment of the intensity of AR clinical symptoms was calculated as a total score for the main symptoms. The maximum score for the severity of nasal symptoms – 12, eye - 6, total – 18. The results obtained and their analysis indicate that under the influence of ASIT pollen and household allergens in patients there is a significant and reliable decrease in the intensity of clinical manifestations of seasonal rhinoconjunctive syndrome: nasal manifestations – by 52,2%, conjunctival – by 60%, integral – by 54.3% and an increase of 2.2 times in the percentage of patients in the main group with the disappearance or minimization of clinical symptoms of the disease after treatment compared with patients from the comparison group, which convincingly proves and confirms high efficiency of the selected type of therapy in patients with AR in combination with sensitization to pollen and household allergens.

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