Rhinitis and Rhinorrhoea

Question 1

What is rhinitis

Answer 1

Rhintiis is a common disease causing acute and chronic inflammation of nasal mucosa

Question 2

Symptoms of rhinitis

Answer 2

Rhinorrhoea - Runny nose, watery mucous accumulation in nasal cavity
Sneezing, itching, nasal congestion and obstruction

Question 3

What causes nasal congestion and obstruction

Answer 3

Swelling of nasal mucosa largely due to dilated blood vessels

Question 4

Types of rhinitis

Answer 4

Allergic, non-allergic and mixed

Question 5

What is rhinitis also known as

Answer 5

Coryza

Question 6

Types of allergic rhinitis

Answer 6

Seasonal, perennial and episodic

Question 7

Pathology of allergic rhinitis

Answer 7

Inhalation of allergen increases specific levels of IgE. This IgE binds to mast cells and basophils. Re-exposure to allergen causes mast cell and basophil degranulation. This causes release of mediators including histamine, cysLT, tryptase,prostaglandins causing acute sneezing, itching, rhinorrhea and nasal congestion

Question 8

What is non-allergic rhinitis

Answer 8

Any rhinitis that doesn’t involve IgE dependant events

Question 9

Causes of non-allergic rhinitis

Answer 9

Infectious, hormonal, vasomotor disturbance or idiopathic, drug induced, nonallergic rhinitis with eosinophillic syndrome (NARES)

Question 10

Occupational rhintis

Answer 10

Rhinitis may involve allergic and non-allergic rhinitis

Question 11

Target of rhinitis and rhiorrhoea

Answer 11

Anti-inflammatory (glucocorticoids), mediator receptor blockade (H1 receptor antagonist/CysLT1 receptor antagonist), nasal blood flow (vasoconstriction) and anti-allergic (sodium cromoglicate)

Question 12

Mainstay therapy of seasonal and perineal allergic rhinitis

Answer 12

Glucocorticoids

Question 13

What are NARES

Answer 13

Nonallergic rhinitis with eosinophilic syndrome

Question 14

Mechanism of glucocorticoids in rhinitis

Answer 14

Reduce vascular permeability, recruitment and activity of inflammatory cells and release of cytokines and mediators

Question 15

What drugs are effective in seasonal, perinneal and episodic rhinitis but less in non-allergic

Answer 15

H1 receptor antagonist (H1 receptor)

Ex: Cetrizine, loratidine, fexofenadine

Question 16

What symptoms do glucocorticoids reduce in rhinitis

Answer 16

All over several weeks

Question 17

What symptoms do anti-histamine relieve

Answer 17

Less effect upon congestion than other symptoms

Question 18

Mechanism of muscarinic receptor antagonist

Answer 18

ACh release from post-ganglionic parasympathetic fibres activates muscarinic receptors on nasal glands causing watery secretion that contributes to rhinorrhea. Ex: Ipratropium

Question 19

What symptoms do muscarinic receptor antagonists relieve

Answer 19

Rhinorrhoea in seasonal and perinneal allergic rhinitis but none other

Question 20

Mechanism of sodium cromoglicate in rhinitis

Answer 20

Mast cell stabilization

Question 21

What is sodium cromoglicate used for

Answer 21

Maintenance treatment of allergic rhinitis

Question 22

Mechanism of Cysteinyl Leukotriene receptor antagonist

Answer 22

Reduce effect of CysLT on nasal mucosa

Question 23

Drug choice for patients with allergic rhinitis and asthma

Answer 23

CysLT’s receptor antagonist ex: Montelukast

Question 24

Effectiveness of treating H1 receptor vs CysLT 1 receptor antagonist in seasonal and perennial alllergic rhinitis

Answer 24

Both have the same efficacy with which their effect maybe additive

Question 25

Mechanism of vasoconstrictors

Answer 25

Act directly or indirectly to mimic effect of adrenaline. Produce vasoconstriction via activation of alpha1-adrenoceptors in vascular mucosa. Ex: Oxymetazoline

Question 26

Why shouldn’t Oxymetazoline be used for more than a few days

Answer 26

Rhinitis medicamentosa - Condition of rebound nasal congestion bought on by extended use of topical decongestants. This can lead to increase nasal congestion upon discontinuation