Rhinitis
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 .
KEY TERMS
Allergen —A foreign substance that provokes an immune reaction or allergic response in some sensitive people but not in most others.
Interferon —A potent immune-defense protein produced by virus-infected cells; used as an anti-cancer and anti-viral drug.
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: <www.aaaai.org>.
Tish Davidson, A.M. Rebecca J. Frey, PhD
Rhinitis
Rhinitis
Definition
Rhinitis is inflammation of the mucous lining of the nose.
Description
Rhinitis is a nonspecific term that covers nasal congestion due to infections, allergies , and other disorders. In rhinitis, the mucous membranes of the nose become infected or irritated, producing a discharge, congestion, and swelling of the tissues.
The most widespread form of infectious rhinitis is the common cold . The common cold is the most frequent viral infection in the general population. Colds are self-limited, lasting about three to 10 days, although they are sometimes followed by a bacterial infection.
Causes & symptoms
Colds can be caused by as many as 200 different viruses which are transmitted by sneezing and coughing, by contact with soiled tissues or handkerchiefs, or by close contact with an infected person.
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. The inflammation spreads from the nasal passages to the throat and upper airway, producing a dry cough, headache , and watery eyes. After several days, the nasal tissues become less inflamed and the watery discharge is replaced by a thick, sticky mucus. This change in the appearance of the nasal discharge helps to distinguish rhinitis caused by a viral infection from allergic rhinitis.
Allergies are another frequent cause of rhinitis which is called allergic rhinitis. Allergies occur when a person's immune system overreacts to a substance called an allergen. Airborne allergens can be just about anything but are commonly mold, pollen, dust mites, and pet dander. Symptoms of allergy include watery eyes, nasal discharge, sneezing, and headache.
Diagnosis
Viral rhinitis is diagnosed based on symptoms. Symptoms that last longer than a week may require further testing to rule out a secondary bacterial infection, or an allergy. Allergies can be evaluated by blood tests, skin testing for specific substances, or nasal smears.
Treatment
The many alternative treatments for colds and allergies will not be addressed here. Treatments specifically for rhinitis, regardless of the cause, are described.
Herbal remedies
Flavonoids have anti-inflammatory activities and can be found in many plants including licorice, parsley , legumes (beans), onions, garlic , berries, and citrus fruits. Herbals which may help lessen the symptoms of rhinitis include:
- astragalus (Astragalus membranaceous ) root
- baical skullcap (Scutellaria baicalensis ) decoction
- echinacea (Echinacea spp.)
- elderflower (Sambucus nigra ) tea
- garlic, which contains anti-inflammatory compounds
- goldenseal (Hydrastis canadensis )
- horehound (Marrubium vulgare ) tea relieves congestion
- licorice (Glycyrrhiza glabra ) has anti-inflammatory activity
- mullein (Verbascum thapsus ) is a decongestant and soothes mucous membranes
- nettle (Urtica dioica ) tea stops nasal discharge
- onion, which contains anti-inflammatory compounds
- thyme (Thymus vulgaris ) tea, which is anti-inflammatory and soothes sore nasal tissues
- walnut (Juglans nigra or regia ) leaf tea, which stops nasal discharge
Other remedies
Other natural remedies for rhinitis include those from traditional Chinese medicine . Chronic rhinitis is treated with acupuncture , ear acupuncture, and herbals taken internally or used externally. The most common rhinitis remedy is Bi Yan Pian (Bi is for nose.) There are many others, depending on the specific pattern of the patient. Magnolia flower and xanthium are commonly used herbs for rhinitis.
Less common Chinese remedies include Huo Dan Wan (Agastache and Pig's Gall Bladder Pill) taken three times daily. A decoction of Yu Xing Cao (Herba houttuyniae ) may be taken internally. The patient can apply 30% Huang Lian Shui (Coptis Fluid), Huang Bai Shui (Phellodendron Fluid), Yu Xing Cao (Herba houttuyniae ) juice, E Bu Shi Cao (Herba centipedae ) decoction, or 1% ephedrine solution directly to the nose.
Colored light therapy is based upon the theory that an unhealthy body is lacking a specific color frequency. Green colored light therapy may relieve chronic rhinitis.
Homeopathic physicians prescribe any of 10 different remedies, depending on the appearance of the nasal discharge, the patient's emotional state, and the stage of infection.
Vitamin C is a natural antihistamine. Vitamin A and zinc may also be helpful.
Allopathic treatment
There is no cure for the common cold; 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. Antibiotics are ineffective against viral infections. Allergies are treated with anti-histamines (Benadryl).
Expected results
Most colds resolve 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. Allergies may resolve or may be lifelong.
Prevention
There is no vaccine effective against colds, and infection does not prevent one from getting colds. Prevention depends on washing hands often, minimizing contact with persons already infected, and not sharing hand towels, eating utensils, or water glasses. In 2002, researchers discovered a new antiseptic skin cleanser that may prevent hand-to-hand transmission of the rhinovirus that causes colds. The cleaner's active ingredient is salicylic or pyroglutamic acid, and each showed promising results for killing the virus on subject's hands.
Allergies may be prevented by avoiding the cause of the allergy, although this is not always possible or practical. Patients may become desensitized to the offending allergen by receiving a series of injections. In 2002, Australian researchers discovered a new potential vaccine that might boost immune response to allergens without the risk of side effects that come with some desensitizing vaccines available today.
Resources
BOOKS
Berman, Stephen, and Ken Chan. "Ear, Nose, & Throat." Current Pediatric Diagnosis & Treatment. Edited by William W. Hay, Jr., et al. Stamford, CT: Appleton & Lange, 1997.
Jackler, Robert K., and Michael J. Kaplan. "Ear, Nose, & Throat." In Current Medical Diagnosis & Treatment 1998, edited by Lawrence M. Tierney Jr., et al. Stamford, CT: Appleton & Lange, 1997.
King, Hueston C., and Richard L. Mabry. "Rhinitis." In Current Diagnosis 9, edited by Rex B. Conn, et al. Philadelphia: W. B. Saunders Company, 1997.
Ying, Zhou Zhong, and Jin Hui De. "Common Diseases of the Nose." Clinical Manual of Chinese Herbal Medicine and Acupuncture. New York: Churchill Livingston, 1997.
PERIODICALS
"Antispetic Skin Cleansers May Prevent Rhinovirus Transmission." Clinical Infectious Diseases (February 1, 2002): ii.
Cocilovo, Anna. "Colored Light Therapy: Overview of its History, Theory, Recent Developments and Clinical Applications Combined with Acupuncture." American Journal of Acupuncture 27 (1999): 71–83.
"Potential Vaccine Boosts Hope for Pollen Relief." Immunotherapy Weekly (March 6, 2002): 3.
Rebecca Frey
Belinda Rowland
Teresa G. Odle
Rhinitis
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.
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 3-10 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.
Causes and symptoms
Colds can be caused by as many as 200 different viruses. The viruses are transmitted by sneezing and coughing, by contact with soiled tissues or handkerchiefs, or by close contact with an infected person. Colds are easily spread in schools, offices, or any place where people live or work in groups. The incubation period ranges between 24 and 72 hours.
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 run 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 the watery discharge is replaced by a thick, sticky mucus. This change in the appearance of the nasal discharge helps to distinguish rhinitis caused by a viral infection from rhinitis caused by an allergy.
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 measles and other childhood illnesses that have similar early symptoms. Adults whose symptoms last longer than a week may require further testing to rule out a secondary bacterial infection, or an allergy. Bacterial infections can usually be identified from a laboratory culture of the patient's nasal discharge. Allergies can be evaluated by blood tests, skin testing for specific substances, or nasal smears.
Treatment
There is no cure for the common cold; 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 antihistamines 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 colds because they do not kill viruses.
Supportive care includes bed rest and drinking plenty of fluid.
Treatments under investigation include the use of ultraviolet light and injections of interferon.
Many prescription and over-the-counter drugs are available to help control the symptoms of allergic rhinitis. The most common class is antihistamines.
Alternative treatment
Homeopaths might prescribe any of 10 different remedies, depending on the appearance of the nasal discharge, the patient's emotional state, and the stage of infection. Naturopaths would recommend vitamin A and zinc supplements, together with botanical preparations made from goldenseal (Hydrastis canadensis ), licorice (Glycyrrhiza glabra ), or astragalus (Astragalus membraneceus ) root.
At one time, the herb (Echinacea spp.) was touted as a remedy to relieve cold and rhinitis symptoms. However, a study published in 2004 reported that the herb failed to relieve cold symptoms in 400 children taking it and caused skin rashes in some children.
Prognosis
Most colds resolve 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.
Prevention
There is no vaccine effective against colds, and infection does not confer immunity. Prevention depends on:
- washing hands often, especially before touching the face
- minimizing contact with people already infected
- not sharing hand towels, eating utensils, or water glasses.
Resources
PERIODICALS
"Study: Echinacea Is Ineffective." Chain Drug Review February 16, 2004: 25.
KEY TERMS
Interferon— A protein produced by cells infected by a virus that stimulates the body's resistance to the virus.
rhinitis
rhi·ni·tis / rīˈnītis/ • n. Med. inflammation of the mucous membrane of the nose, caused by a virus infection (e.g., the common cold) or by an allergic reaction (e.g., hay fever).