Rhinitis

Question 1

Define rhinitis

Answer 1

Inflammation of nasal mucosa

Question 2

Symptoms of rhinitis

Answer 2

• nasal blockage
• rhinorrhoea
• itchy
• sneezing

Question 3

What is rhino-conjunctivitis?

Answer 3

Inflammation of nasal mucosa + conjunctivae

Question 4

What is rhinosinusitis?

Answer 4

Inflammation of nasal mucosa + sinus linings

Question 5

Types of rhinitis

Answer 5

Allergic (hayfever)
Infective
Non allergic

Question 6

What is allergic rhinitis also called?

Answer 6

Hay fever

Question 7

What is allergic rhinitis caused by?

Answer 7

Allergens
- hay
- pollen
- dust
- animal hair
- mould species

Question 8

Allergic rhinitis classification

Answer 8

Intermittent
Persistent
Mild
Moderate-severe

Question 9

Compare intermittent + persistent allergic rhinitis symptoms

Answer 9

• intermittent: <4days per week OR <4 consecutive weeks
• persistent: >4days per week AND >4 consecutive weeks

Question 10

Symptoms of mild allergic rhinitis

Answer 10

ALL of following
- normal sleep
- no impairment of daily activities, sport, leisure, work or school
- symptoms present but not troublesome

Question 11

Symptoms of moderate-severe allergic rhinitis

Answer 11

• sleep disturbance
• impairment of daily activities, school or work
• troublesome symptoms

Question 12

Aetiology of allergic rhinitis

Answer 12

• genetic predisposition
• environmental factors
• urban environments
• epigenetic modifications

Question 13

Pathophysiology of allergic rhinitis

Answer 13

• allergen presented to naive CD4+ T cell by APCs
• TH2 > B cells > plasma cells> IgE synthesis
• IgE cause mast cell degranulation > release of mediators:
  -early phase response: histamines, PGs, leukotrienes > mucosal oedema, mucous hyper secretion
  -late phase response: chemokines + cytokines > chronic allergic symptoms
• leads to sneezing, rhinorrhoea, nasal obstruction + itching

Question 14

Associated Comorbidities of allergic rhinitis

Answer 14

• asthma
• conjunctivitis
• anosmia
• otitis media with effusion

Question 15

Diagnosis of allergic rhinitis

Answer 15

Either >2 or >1 on most days of:
- sneezing
- nasal itching
- itching of palate
- rhinorrhoea
- nasal obstruction
- snoring
- sleep problems

Question 16

What is seen when examining a patient with rhinitis?

Answer 16

• Dennie-Morgan lines
• clear, coloured or purulent secretions
• allergic salute and/or horizontal nasal crease across nasal dorsum

Question 17

Investigations of rhinitis

Answer 17

• skin prick test (first line approach)
• serum allergen specific IgE test

Question 18

Treatment of allergic rhinitis

Answer 18

• avoidance
• saline rinses
• antihistamines
• immunotherapy
• ipratropium bromide SAMA
• montelukast
• intranasal steroids
• septoplasty
• turbinate reduction
• nasal decongestants

Question 19

How do nasal decongestants reduce nasal congestion symptoms

Answer 19

Agonists action at a1 + a2 adrenergic receptors on endothelial cells of nasal mucosa > reduced mucosa swelling

Question 20

Nasal drop technique

Answer 20

• blow nose to clear
• shake container
• take approved position
• place drops into nostril
• remain in portion + allow drops to act
• repeat in other nostril

Question 21

Nasal spray technique

Answer 21

• blow nose to tear
• shake bottle well
• close off one nostril + put nozzle in other airings towards outside wall
• tilt head forwards
• squirt once or twice in two directions
• repeat in other side
• do not sniff hard

Question 22

What can overuse of nasal decongestants cause?

Answer 22

Rhinitis medicamentosa
Condition of rebound congestion upon withdrawal of nasal decongestants

Question 23

Treatment of rhinitis medicamentosa

Answer 23

Intranasal corticosteroids

Question 24

What is allergic salute?

Answer 24

Upwards swiping alone tip of nose whilst sniffing

Question 25

What are Dennie-Morgan lines?

Answer 25

Extra creases or folds below the lower eyelid

Question 26

What is horizontal nasal crease due to?

Answer 26

Prolonged allergic salute in rhinitis