Rhinitis

Definition/diagnostic criteria

Rhinitis is characterised by inflammation of the nasal mucosa, leading to symptoms such as nasal congestion, rhinorrhea (runny nose), sneezing, and itching. It can be classified into allergic rhinitis, where symptoms are triggered by allergens, and non-allergic rhinitis, which encompasses a variety of triggers such as infections, changes in the environment, and idiopathic causes.

Epidemiology

Allergic rhinitis is a common condition, affecting up to 20% of the population in the UK. It is more prevalent in children and adolescents but can affect individuals of any age. Non-allergic rhinitis is less well documented but also represents a significant portion of rhinitis cases in the general population.

Diagnosis

Clinical features

The diagnosis of rhinitis is primarily clinical, based on the patient’s history and symptoms. Key symptoms include nasal congestion, sneezing, rhinorrhea, and nasal itching. In allergic rhinitis, symptoms often have a seasonal pattern or are related to exposure to specific allergens. Non-allergic rhinitis may present with similar symptoms but without a clear association with allergens.

Investigations

While the diagnosis of rhinitis is mainly clinical, additional investigations may be warranted in certain cases to differentiate between allergic and non-allergic causes or to identify specific allergens. Skin prick tests or specific IgE blood tests can be used to confirm sensitisation to common allergens. Nasal endoscopy and rhinomanometry may be employed to assess the nasal anatomy and airflow, respectively, especially in cases unresponsive to standard treatment.

Treatment

Management strategies for rhinitis depend on the underlying cause and severity of symptoms. For allergic rhinitis, avoidance of known allergens is fundamental. Pharmacotherapy includes intranasal corticosteroids (eg, fluticasone or mometasone) as the first-line treatment, followed by antihistamines (oral or intranasal) for additional symptom control. For persistent symptoms, a leukotriene receptor antagonist (eg, montelukast) may be considered. Non-allergic rhinitis treatment focuses on symptom management, with intranasal anticholinergics (eg, ipratropium bromide) and saline nasal irrigations also being effective.

Prognosis

The prognosis for patients with rhinitis varies according to the underlying cause and the effectiveness of management strategies. Allergic rhinitis can be effectively managed in most cases with appropriate avoidance measures and pharmacotherapy, leading to a significant improvement in quality of life. The course of non-allergic rhinitis is more variable and may be chronic, requiring ongoing management to control symptoms (ENT UK).