Rhinitis overview: Difference between revisions
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{{Rhinitis}} | {{Rhinitis}} | ||
{{CMG}} {{AE}} {{FB}} | {{CMG}} {{AE}} {{FB}} | ||
==Overview== | ==Overview== | ||
Rhinitis is a heterogenous disorder that is often treated with triviality. It is a highly prevalent disease that can have significant impact on the quality of life of affected individuals. It has a huge financial impact on the society, and generates between $1.6-$4.9 billion in direct expenditure in the US. The | Rhinitis is a heterogenous disorder that is often treated with triviality.<ref name="Diseases of the Sinuses">{{cite book |last1=Romeo |first1=Jonathan |last2=Dykewicz |first2=Mark |title=Diseases of the Sinuses |publisher=Springer New York |date=2014 |pages=133-152 |chapter=Chapter 9:Differential Diagnosis of Rhinitis and Rhinosinusitis |isbn=978-1-4939-0265-1}}</ref> It is a highly prevalent, global disease that can have significant impact on the quality of life of affected individuals.<ref name="pmid18662584">{{cite journal| author=Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA et al.| title=The diagnosis and management of rhinitis: an updated practice parameter. | journal=J Allergy Clin Immunol | year= 2008 | volume= 122 | issue= 2 Suppl | pages= S1-84 | pmid=18662584 | doi=10.1016/j.jaci.2008.06.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18662584 }} </ref> Rhinitis is characterized by the presence of one or more nasal symptoms such as sneezing, nasal itching, [[rhinorrhea]](anterior and posterior), and nasal congestion. There can be varying degrees of nasal inflammation.<ref name="pmid24007929">{{cite journal| author=Sacre-Hazouri JA| title=[Chronic rhinosinusitis in children]. | journal=Rev Alerg Mex | year= 2012 | volume= 59 | issue= 1 | pages= 16-24 | pmid=24007929 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24007929 }} </ref> It has a huge financial impact on the society, and generates between $1.6-$4.9 billion in direct expenditure in the US annually.<ref name="pmid25182349">{{cite journal| author=Mims JW| title=Epidemiology of allergic rhinitis. | journal=Int Forum Allergy Rhinol | year= 2014 | volume= 4 Suppl 2 | issue= | pages= S18-20 | pmid=25182349 | doi=10.1002/alr.21385 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25182349 }} </ref> The estimated annual indirect cost from lost productivity in the US ranges between $0.1-$9.7 billion dollars.<ref name="pmid25182349">{{cite journal| author=Mims JW| title=Epidemiology of allergic rhinitis. | journal=Int Forum Allergy Rhinol | year= 2014 | volume= 4 Suppl 2 | issue= | pages= S18-20 | pmid=25182349 | doi=10.1002/alr.21385 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25182349 }} </ref> Chronic rhinitis is one of the most common problems seen by physicians, and allergic rhinitis is the most common type of chronic rhinitis.<ref name="pmid17153005">{{cite journal| author=Settipane RA, Charnock DR| title=Epidemiology of rhinitis: allergic and nonallergic. | journal=Clin Allergy Immunol | year= 2007 | volume= 19 | issue= | pages= 23-34 | pmid=17153005 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17153005 }} </ref><ref name="pmid24007929">{{cite journal| author=Sacre-Hazouri JA| title=[Chronic rhinosinusitis in children]. | journal=Rev Alerg Mex | year= 2012 | volume= 59 | issue= 1 | pages= 16-24 | pmid=24007929 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24007929 }} </ref> The prevalence of allergic rhinitis has been steadily increasing in various countries across the world.<ref name="pmid18331513">{{cite journal| author=Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A et al.| title=Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). | journal=Allergy | year= 2008 | volume= 63 Suppl 86 | issue= | pages= 8-160 | pmid=18331513 | doi=10.1111/j.1398-9995.2007.01620.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18331513 }} </ref><ref name="pmid22092947">{{cite journal| author=Katelaris CH, Lee BW, Potter PC, Maspero JF, Cingi C, Lopatin A et al.| title=Prevalence and diversity of allergic rhinitis in regions of the world beyond Europe and North America. | journal=Clin Exp Allergy | year= 2012 | volume= 42 | issue= 2 | pages= 186-207 | pmid=22092947 | doi=10.1111/j.1365-2222.2011.03891.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22092947 }} </ref> Unfortunately, rhinitis is often overlooked, underdiagnosed, undertreated, and mistreated.<ref name="pmid11449200">{{cite journal| author=Skoner DP| title=Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis. | journal=J Allergy Clin Immunol | year= 2001 | volume= 108 | issue= 1 Suppl | pages= S2-8 | pmid=11449200 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11449200 }} </ref> An understanding of the etiology of the different types of rhinitis and the treatment modalities, would improve the quality of care offered, and ultimately improve the quality of life of those who suffer from chronic rhinitis. | ||
==Historical Perspective== | ==Historical Perspective== | ||
Rhinitis has been in existence since the ancient times. Seasonal allergic rhinitis (hay fever) evolved with the industrialization of westernized countries in the 19th century, and it was a common condition in Europe and North America by the end of the 19th century. Nonallergic Rhinitis with Eosinophilic Syndrome(NARES) was first described in 1981 by Jacobs et al.[ | Rhinitis has been in existence since the ancient times. Seasonal allergic rhinitis ([[hay fever]]) evolved with the industrialization of westernized countries in the 19th century, and it was a common condition in Europe and North America by the end of the 19th century.<ref name="pmid18331513">{{cite journal| author=Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A et al.| title=Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). | journal=Allergy | year= 2008 | volume= 63 Suppl 86 | issue= | pages= 8-160 | pmid=18331513 | doi=10.1111/j.1398-9995.2007.01620.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18331513 }} </ref> Nonallergic Rhinitis with Eosinophilic Syndrome(NARES) was first described in 1981 by Jacobs et al.<ref name="pmid16579871">{{cite journal| author=Ellis AK, Keith PK| title=Nonallergic rhinitis with eosinophilia syndrome. | journal=Curr Allergy Asthma Rep | year= 2006 | volume= 6 | issue= 3 | pages= 215-20 | pmid=16579871 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16579871 }} </ref> [[Atrophic rhinitis|Primary atrophic rhinitis]] has been well known for ages to the ancient Egyptians, Greeks, and Indians, and it was first described by Bernhard Fraenkel in 1876.<ref name="pmid8820180">{{cite journal| author=Shehata MA| title=Atrophic rhinitis. | journal=Am J Otolaryngol | year= 1996 | volume= 17 | issue= 2 | pages= 81-6 | pmid=8820180 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8820180 }} </ref> | ||
==Classification== | ==Classification== | ||
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==Pathophysiology== | ==Pathophysiology== | ||
Allergic rhinitis is a multifactorial disease, its development is influenced by an interplay of genetic and environmental factors.<ref ="pmid21364228">{{cite journal| year= 2011 | title=Pathophysiology of allergic and nonallergic rhinitis. | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21364228 | journal=Proc Am Thorac Soc | volume= 8 | issue= 1 | pages= 106-14 | doi=10.1513/pats.201008-057RN | pmc= | pmid=21364228 | author=Sin B, Togias A}} </ref> Aeroallergens in the nasal tissue undergo [[antigen]] processing, eliciting allergen-specific allergic responses and also promoting the development of allergic airway disease.<ref name="pmidPMID: 18331513">{{cite journal| author=Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A et al.| title=Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). | journal=Allergy | year= 2008 | volume= 63 Suppl 86 | issue= | pages= 8-160 | pmid=PMID: 18331513 | doi=10.1111/j.1398-9995.2007.01620.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18331513 }} </ref><ref name="pmid20176255">{{cite journal| author=Dykewicz MS, Hamilos DL| title=Rhinitis and sinusitis. | journal=J Allergy Clin Immunol | year= 2010 | volume= 125 | issue= 2 Suppl 2 | pages= S103-15 | pmid=20176255 | doi=10.1016/j.jaci.2009.12.989 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20176255 }} </ref> Proteins and glycoproteins in indoor and outdoor inhalant allergens such as dust mite fecal particles, cockroach residues, animal danders, molds, and pollens are common aeroallergens causing allergic rhinitis.<ref name="pmidPMID: 18331513">{{cite journal| author=Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A et al.| title=Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). | journal=Allergy | year= 2008 | volume= 63 Suppl 86 | issue= | pages= 8-160 | pmid=PMID: 18331513 | doi=10.1111/j.1398-9995.2007.01620.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18331513 }} </ref><ref name="pmid20176255">{{cite journal| author=Dykewicz MS, Hamilos DL| title=Rhinitis and sinusitis. | journal=J Allergy Clin Immunol | year= 2010 | volume= 125 | issue= 2 Suppl 2 | pages= S103-15 | pmid=20176255 | doi=10.1016/j.jaci.2009.12.989 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20176255 }} </ref> Allergic rhinitis is usually an [[IgE]] mediated disease with varying degrees of nasal [[inflammation]]. Nonallergic rhinitis is a heterogenous group with poorly defined and understood pathophysiology, and it consists of a variety of conditions which require more research and phenotyping.<ref ="pmid21364228">{{cite journal| year= 2011 | title=Pathophysiology of allergic and nonallergic rhinitis. | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21364228 | journal=Proc Am Thorac Soc | volume= 8 | issue= 1 | pages= 106-14 | doi=10.1513/pats.201008-057RN | pmc= | pmid=21364228 | author=Sin B, Togias A}} </ref> | |||
==Causes== | ==Causes== | ||
One of the most common diseases presenting to physicians is chronic rhinitis, and determination of the etiology is crucial to ensure appropriate management.<ref name="pmid17153005">{{cite journal| author=Settipane RA, Charnock DR| title=Epidemiology of rhinitis: allergic and nonallergic. | journal=Clin Allergy Immunol | year= 2007 | volume= 19 | issue= | pages= 23-34 | pmid=17153005 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17153005 }} </ref> Allergic rhinitis is the most common type of chronic rhinitis,<ref name="pmid24007929">{{cite journal| author=Sacre-Hazouri JA| title=[Chronic rhinosinusitis in children]. | journal=Rev Alerg Mex | year= 2012 | volume= 59 | issue= 1 | pages= 16-24 | pmid=24007929 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24007929 }} </ref><ref name="pmid25645524">{{cite journal| author=Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR et al.| title=Clinical practice guideline: allergic rhinitis executive summary. | journal=Otolaryngol Head Neck Surg | year= 2015 | volume= 152 | issue= 2 | pages= 197-206 | pmid=25645524 | doi=10.1177/0194599814562166 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25645524 }} </ref> and it is the fifth most common chronic ailment overall in the U.S.<ref name="pmid25645524">{{cite journal| author=Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR et al.| title=Clinical practice guideline: allergic rhinitis executive summary. | journal=Otolaryngol Head Neck Surg | year= 2015 | volume= 152 | issue= 2 | pages= 197-206 | pmid=25645524 | doi=10.1177/0194599814562166 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25645524 }} </ref> Allergic rhinitis is triggered by the inhalation of indoor and outdoor aeroallergens such as pollens, molds, and animal dander.<ref name="pmid18331513">{{cite journal| author=Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A et al.| title=Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). | journal=Allergy | year= 2008 | volume= 63 Suppl 86 | issue= | pages= 8-160 | pmid=18331513 | doi=10.1111/j.1398-9995.2007.01620.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18331513 }} </ref><ref name="pmid20176255">{{cite journal| author=Dykewicz MS, Hamilos DL| title=Rhinitis and sinusitis. | journal=J Allergy Clin Immunol | year= 2010 | volume= 125 | issue= 2 Suppl 2 | pages= S103-15 | pmid=20176255 | doi=10.1016/j.jaci.2009.12.989 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20176255 }} </ref> Nonallergic rhinitis comprises | One of the most common diseases presenting to physicians is chronic rhinitis, and determination of the etiology is crucial to ensure appropriate management.<ref name="pmid17153005">{{cite journal| author=Settipane RA, Charnock DR| title=Epidemiology of rhinitis: allergic and nonallergic. | journal=Clin Allergy Immunol | year= 2007 | volume= 19 | issue= | pages= 23-34 | pmid=17153005 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17153005 }} </ref> Allergic rhinitis is the most common type of chronic rhinitis,<ref name="pmid24007929">{{cite journal| author=Sacre-Hazouri JA| title=[Chronic rhinosinusitis in children]. | journal=Rev Alerg Mex | year= 2012 | volume= 59 | issue= 1 | pages= 16-24 | pmid=24007929 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24007929 }} </ref><ref name="pmid25645524">{{cite journal| author=Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR et al.| title=Clinical practice guideline: allergic rhinitis executive summary. | journal=Otolaryngol Head Neck Surg | year= 2015 | volume= 152 | issue= 2 | pages= 197-206 | pmid=25645524 | doi=10.1177/0194599814562166 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25645524 }} </ref> and it is the fifth most common chronic ailment overall in the U.S.<ref name="pmid25645524">{{cite journal| author=Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR et al.| title=Clinical practice guideline: allergic rhinitis executive summary. | journal=Otolaryngol Head Neck Surg | year= 2015 | volume= 152 | issue= 2 | pages= 197-206 | pmid=25645524 | doi=10.1177/0194599814562166 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25645524 }} </ref> Allergic rhinitis is triggered by the inhalation of indoor and outdoor aeroallergens such as pollens, molds, and animal dander.<ref name="pmid18331513">{{cite journal| author=Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A et al.| title=Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). | journal=Allergy | year= 2008 | volume= 63 Suppl 86 | issue= | pages= 8-160 | pmid=18331513 | doi=10.1111/j.1398-9995.2007.01620.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18331513 }} </ref><ref name="pmid20176255">{{cite journal| author=Dykewicz MS, Hamilos DL| title=Rhinitis and sinusitis. | journal=J Allergy Clin Immunol | year= 2010 | volume= 125 | issue= 2 Suppl 2 | pages= S103-15 | pmid=20176255 | doi=10.1016/j.jaci.2009.12.989 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20176255 }} </ref> Nonallergic rhinitis comprises a heterogenous group of disorders, some of which are still poorly defined and understood.<ref name="pmid21364228">{{cite journal| author=Sin B, Togias A| title=Pathophysiology of allergic and nonallergic rhinitis. | journal=Proc Am Thorac Soc | year= 2011 | volume= 8 | issue= 1 | pages= 106-14 | pmid=21364228 | doi=10.1513/pats.201008-057RN | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21364228 }} </ref> Nonallergic rhinitis can be induced by non-specific triggers such as exposure to chemical odors, cigarette smoke, spicy food, exercise, and cold air.<ref name="CTOIA" /> | ||
==Differentiating Rhinitis from other Diseases== | ==Differentiating Rhinitis from other Diseases== | ||
It is important to differentiate rhinitis from other conditions micmicking the symptoms of rhinitis such as intranasal foreign bodies, [[cerebrospinal fluid]] rhinorrhea, [[nasal polyps]] and tumors.<ref name="pmid 20176255">{{cite journal| author=Dykewicz MS, Hamilos DL| title=Rhinitis and sinusitis. | journal=J Allergy Clin Immunol | year= 2010 | volume= 125 | issue= 2 Suppl 2 | pages= S103-15 | pmid= 20176255 | doi=10.1016/j.jaci.2009.12.989 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20176255 }} </ref><ref name="pmid24007929">{{cite journal| author=Sacre-Hazouri JA| title=[Chronic rhinosinusitis in children]. | journal=Rev Alerg Mex | year= 2012 | volume= 59 | issue= 1 | pages= 16-24 | pmid=24007929 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24007929 }} </ref><ref name="pmid18331513">{{cite journal| author=Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A et al.| title=Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). | journal=Allergy | year= 2008 | volume= 63 Suppl 86 | issue= | pages= 8-160 | pmid=18331513 | doi=10.1111/j.1398-9995.2007.01620.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18331513 }} </ref><ref name="Allergic rhinitis-an overview of a common disease">{{cite journal |last=Rotiroti |first=Giuseppina |last2=Scadding |first2=Glenis |date=July 2016 |title=Allergic Rhinitis-an overview of a common disease |url=https://www-clinicalkey-com.ezp-prod1.hul.harvard.edu/#!/content/playContent/1-s2.0-S1751722216300063?returnurl=null&referrer=null&scrollTo=%23tbl2|journal=Paediatrics and Child Health |volume= Volume 26 |issue= Issue 7 |pages=298-303 |access-date=January 20, 2017 }} </ref> | |||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
Rhinitis is a very frequent and highly prevalent global disease.<ref name="Diseases of the Sinuses">{{cite book |last1=Romeo |first1=Jonathan |last2=Dykewicz |first2=Mark |title=Diseases of the Sinuses |publisher=Springer New York |date=2014 |pages=133-152 |chapter=Chapter 9:Differential Diagnosis of Rhinitis and Rhinosinusitis |isbn=978-1-4939-0265-1}}</ref> | Rhinitis is a very frequent and highly prevalent global disease.<ref name="Diseases of the Sinuses">{{cite book |last1=Romeo |first1=Jonathan |last2=Dykewicz |first2=Mark |title=Diseases of the Sinuses |publisher=Springer New York |date=2014 |pages=133-152 |chapter=Chapter 9:Differential Diagnosis of Rhinitis and Rhinosinusitis |isbn=978-1-4939-0265-1}}</ref> | ||
Allergic rhinitis is estimated to affect one in every six Americans, and it is the fifth most chronic disease in the U.S.<ref name="pmid25645524">{{cite journal| author=Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR et al.| title=Clinical practice guideline: allergic rhinitis executive summary. | journal=Otolaryngol Head Neck Surg | year= 2015 | volume= 152 | issue= 2 | pages= 197-206 | pmid=25645524 | doi=10.1177/0194599814562166 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25645524 }} </ref> Allergic rhinitis is the most common chronic disease in the pediatric age group in the U.S,<ref name="pmid25645524" /> and it was the most common diagnosis reported in the 2000 Otolaryngology Workforce study.<ref name="pmid25182349">{{cite journal| author=Mims JW| title=Epidemiology of allergic rhinitis. | journal=Int Forum Allergy Rhinol | year= 2014 | volume= 4 Suppl 2 | issue= | pages= S18-20 | pmid=25182349 | doi=10.1002/alr.21385 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25182349 }} </ref> The estimated prevalence of allergic rhinitis ranges from 9-42%.<ref name="pmid17153005">{{cite journal| author=Settipane RA, Charnock DR| title=Epidemiology of rhinitis: allergic and nonallergic. | journal=Clin Allergy Immunol | year= 2007 | volume= 19 | issue= | pages= 23-34 | pmid=17153005 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17153005 }} </ref> Annually, between 30-60 million people in the U.S suffer from allergic rhinitis, 10-30% of these individuals are adults, and up to 40% are children.<ref name="Diseases of the Sinuses" /> The prevalence of allergic rhinitis has been found to be increasing in countries worldwide, and factors such as increased airborne pollution, a rise in the population of dust mite in inadequately ventilated offices/homes with central heating/air conditioning, and sedentary lifestyles, have been suggested to contribute to the rise in its prevalence.<ref name="pmid15025839">{{cite journal| author=Schoenwetter WF, Dupclay L, Appajosyula S, Botteman MF, Pashos CL| title=Economic impact and quality-of-life burden of allergic rhinitis. | journal=Curr Med Res Opin | year= 2004 | volume= 20 | issue= 3 | pages= 305-17 | pmid=15025839 | doi=10.1185/030079903125003053 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15025839 }} </ref><ref name="pmid18331513">{{cite journal| author=Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A et al.| title=Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). | journal=Allergy | year= 2008 | volume= 63 Suppl 86 | issue= | pages= 8-160 | pmid=18331513 | doi=10.1111/j.1398-9995.2007.01620.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18331513 }} </ref><ref name="pmid22092947">{{cite journal| author=Katelaris CH, Lee BW, Potter PC, Maspero JF, Cingi C, Lopatin A et al.| title=Prevalence and diversity of allergic rhinitis in regions of the world beyond Europe and North America. | journal=Clin Exp Allergy | year= 2012 | volume= 42 | issue= 2 | pages= 186-207 | pmid=22092947 | doi=10.1111/j.1365-2222.2011.03891.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22092947 }} </ref> The prevalence of allergic rhinitis has significantly increased during the past 50 years, with over 50% of | Allergic rhinitis is estimated to affect one in every six Americans, and it is the fifth most chronic disease in the U.S.<ref name="pmid25645524">{{cite journal| author=Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR et al.| title=Clinical practice guideline: allergic rhinitis executive summary. | journal=Otolaryngol Head Neck Surg | year= 2015 | volume= 152 | issue= 2 | pages= 197-206 | pmid=25645524 | doi=10.1177/0194599814562166 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25645524 }} </ref> Allergic rhinitis is the most common chronic disease in the pediatric age group in the U.S,<ref name="pmid25645524" /> and it was the most common diagnosis reported in the 2000 Otolaryngology Workforce study.<ref name="pmid25182349">{{cite journal| author=Mims JW| title=Epidemiology of allergic rhinitis. | journal=Int Forum Allergy Rhinol | year= 2014 | volume= 4 Suppl 2 | issue= | pages= S18-20 | pmid=25182349 | doi=10.1002/alr.21385 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25182349 }} </ref> The estimated prevalence of allergic rhinitis ranges from 9-42%.<ref name="pmid17153005">{{cite journal| author=Settipane RA, Charnock DR| title=Epidemiology of rhinitis: allergic and nonallergic. | journal=Clin Allergy Immunol | year= 2007 | volume= 19 | issue= | pages= 23-34 | pmid=17153005 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17153005 }} </ref> Annually, between 30-60 million people in the U.S suffer from allergic rhinitis, 10-30% of these individuals are adults, and up to 40% are children.<ref name="Diseases of the Sinuses" /> The prevalence of allergic rhinitis has been found to be increasing in countries worldwide, and factors such as increased airborne pollution, a rise in the population of dust mite in inadequately ventilated offices/homes with central heating/air conditioning, and sedentary lifestyles, have been suggested to contribute to the rise in its prevalence.<ref name="pmid15025839">{{cite journal| author=Schoenwetter WF, Dupclay L, Appajosyula S, Botteman MF, Pashos CL| title=Economic impact and quality-of-life burden of allergic rhinitis. | journal=Curr Med Res Opin | year= 2004 | volume= 20 | issue= 3 | pages= 305-17 | pmid=15025839 | doi=10.1185/030079903125003053 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15025839 }} </ref><ref name="pmid18331513">{{cite journal| author=Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A et al.| title=Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). | journal=Allergy | year= 2008 | volume= 63 Suppl 86 | issue= | pages= 8-160 | pmid=18331513 | doi=10.1111/j.1398-9995.2007.01620.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18331513 }} </ref><ref name="pmid22092947">{{cite journal| author=Katelaris CH, Lee BW, Potter PC, Maspero JF, Cingi C, Lopatin A et al.| title=Prevalence and diversity of allergic rhinitis in regions of the world beyond Europe and North America. | journal=Clin Exp Allergy | year= 2012 | volume= 42 | issue= 2 | pages= 186-207 | pmid=22092947 | doi=10.1111/j.1365-2222.2011.03891.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22092947 }} </ref> The prevalence of allergic rhinitis has significantly increased during the past 50 years, with over 50% of adolescents in some countries reporting symptoms of allergic rhinitis.<ref name="pmid18331513" /> The prevalence of allergic rhinitis was noticed to have doubled in several countries over the last two decades in studies done in children between the ages 6-14years around the globe.<ref name="pmid22092947">{{cite journal| author=Katelaris CH, Lee BW, Potter PC, Maspero JF, Cingi C, Lopatin A et al.| title=Prevalence and diversity of allergic rhinitis in regions of the world beyond Europe and North America. | journal=Clin Exp Allergy | year= 2012 | volume= 42 | issue= 2 | pages= 186-207 | pmid=22092947 | doi=10.1111/j.1365-2222.2011.03891.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22092947 }} </ref> Nonallergic rhinitis is also very common, and it has been estimated to affect about 19 million people in the U.S.<ref name="pmid17153005" /> "Mixed rhinitis" is estimated to affect about 26 million individuals in the United States.<ref name="pmid17153005" /> | ||
==Risk factors== | ==Risk factors== | ||
Risk factors for allergic rhinitis include a history of other atopic diseases such as asthma and [[atopic dermatitis]], and a history of rhinitis in the parent.<ref name="pmid25059756">{{cite journal| author=Baumann LM, Romero KM, Robinson CL, Hansel NN, Gilman RH, Hamilton RG et al.| title=Prevalence and risk factors for allergic rhinitis in two resource-limited settings in Peru with disparate degrees of urbanization. | journal=Clin Exp Allergy | year= 2015 | volume= 45 | issue= 1 | pages= 192-9 | pmid=25059756 | doi=10.1111/cea.12379 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25059756 }} </ref><ref name="pmid24303994">{{cite journal| author=Song N, Shamssain M, Mohammed S, Zhang J, Wu J, Fu C et al.| title=Prevalence, severity and risk factors of asthma, rhinitis and eczema in a large group of Chinese schoolchildren. | journal=J Asthma | year= 2014 | volume= 51 | issue= 3 | pages= 232-42 | pmid=24303994 | doi=10.3109/02770903.2013.867973 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24303994 }} </ref> | |||
Some of the risk factors for infectious rhinitis are daycare attendance, young age, and exposure to air pollutants.<ref name="pmid24415465">{{cite journal| author=Passioti M, Maggina P, Megremis S, Papadopoulos NG| title=The common cold: potential for future prevention or cure. | journal=Curr Allergy Asthma Rep | year= 2014 | volume= 14 | issue= 2 | pages= 413 | pmid=24415465 | doi=10.1007/s11882-013-0413-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24415465 }} </ref> | |||
==Natural History, Complications and Prognosis== | ==Natural History, Complications and Prognosis== | ||
Allergic rhinitis rarely occurs in isolation, it is a product of a genetic predisposition, epigenetic events, and environmental exposures, and it is frequently associated with other forms of atopy such as eczema, asthma, and allergic eye disease(allergic rhinoconjunctivitis).<ref name="pmid27490123">{{cite journal| author=Shaker M, Salcone E| title=An update on ocular allergy. | journal=Curr Opin Allergy Clin Immunol | year= 2016 | volume= 16 | issue= 5 | pages= 505-10 | pmid=27490123 | doi=10.1097/ACI.0000000000000299 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27490123 }} </ref><ref name="pmid16634358">{{cite journal| author=Sacre Hazouri JA| title=[Allergic rhinitis. Coexistent diseases and complications. A review and analysis]. | journal=Rev Alerg Mex | year= 2006 | volume= 53 | issue= 1 | pages= 9-29 | pmid=16634358 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16634358 }} </ref><ref name="pmid25182349">{{cite journal| author=Mims JW| title=Epidemiology of allergic rhinitis. | journal=Int Forum Allergy Rhinol | year= 2014 | volume= 4 Suppl 2 | issue= | pages= S18-20 | pmid=25182349 | doi=10.1002/alr.21385 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25182349 }} </ref> The vast majority of individuals with asthma have rhinitis, and allergic eye disease has been reported to affect almost all patients with allergic rhinitis.<ref name="pmid27490123">{{cite journal| author=Shaker M, Salcone E| title=An update on ocular allergy. | journal=Curr Opin Allergy Clin Immunol | year= 2016 | volume= 16 | issue= 5 | pages= 505-10 | pmid=27490123 | doi=10.1097/ACI.0000000000000299 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27490123 }} </ref><ref name="pmid18331513">{{cite journal| author=Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A et al.| title=Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). | journal=Allergy | year= 2008 | volume= 63 Suppl 86 | issue= | pages= 8-160 | pmid=18331513 | doi=10.1111/j.1398-9995.2007.01620.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18331513 }} </ref> Nonallergic rhinitis is also associated with asthma.<ref name="pmid22056609">{{cite journal| author=Westman M, Stjärne P, Asarnoj A, Kull I, van Hage M, Wickman M et al.| title=Natural course and comorbidities of allergic and nonallergic rhinitis in children. | journal=J Allergy Clin Immunol | year= 2012 | volume= 129 | issue= 2 | pages= 403-8 | pmid=22056609 | doi=10.1016/j.jaci.2011.09.036 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22056609 }} </ref><ref name="pmid18331513">{{cite journal| author=Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A et al.| title=Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). | journal=Allergy | year= 2008 | volume= 63 Suppl 86 | issue= | pages= 8-160 | pmid=18331513 | doi=10.1111/j.1398-9995.2007.01620.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18331513 }} </ref> Frequent extension of rhinitis (especially infectious rhinitis) into the sinuses also occur, resulting in [[rhinosinusitis]].<ref name="pmid20176255">{{cite journal| author=Dykewicz MS, Hamilos DL| title=Rhinitis and sinusitis. | journal=J Allergy Clin Immunol | year= 2010 | volume= 125 | issue= 2 Suppl 2 | pages= S103-15 | pmid=20176255 | doi=10.1016/j.jaci.2009.12.989 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20176255 }} </ref><ref name= "Diseases of the Sinuses"></ref> Children with nonallergic rhinitis have a higher likelihood of undergoing remission, compared with those with allergic rhinitis, who tend to have a more persistent disease.<ref name="pmid22056609">{{cite journal| author=Westman M, Stjärne P, Asarnoj A, Kull I, van Hage M, Wickman M et al.| title=Natural course and comorbidities of allergic and nonallergic rhinitis in children. | journal=J Allergy Clin Immunol | year= 2012 | volume= 129 | issue= 2 | pages= 403-8 | pmid=22056609 | doi=10.1016/j.jaci.2011.09.036 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22056609 }} </ref> Remission occurs in up to 73% of four year old children with nonallergic rhinitis by the age of eight years.<ref name="pmid22056609">{{cite journal| author=Westman M, Stjärne P, Asarnoj A, Kull I, van Hage M, Wickman M et al.| title=Natural course and comorbidities of allergic and nonallergic rhinitis in children. | journal=J Allergy Clin Immunol | year= 2012 | volume= 129 | issue= 2 | pages= 403-8 | pmid=22056609 | doi=10.1016/j.jaci.2011.09.036 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22056609 }} </ref> Rhinitis is a significant cause of lost school and work days, and it constitutes a huge financial burden to the society.<ref name="pmid15025839">{{cite journal| author=Schoenwetter WF, Dupclay L, Appajosyula S, Botteman MF, Pashos CL| title=Economic impact and quality-of-life burden of allergic rhinitis. | journal=Curr Med Res Opin | year= 2004 | volume= 20 | issue= 3 | pages= 305-17 | pmid=15025839 | doi=10.1185/030079903125003053 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15025839 }} </ref><ref name="pmid18662584">{{cite journal| author=Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA et al.| title=The diagnosis and management of rhinitis: an updated practice parameter. | journal=J Allergy Clin Immunol | year= 2008 | volume= 122 | issue= 2 Suppl | pages= S1-84 | pmid=18662584 | doi=10.1016/j.jaci.2008.06.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18662584 }} </ref> Untreated/poorly treated chronic rhinitis is associated with a diminished quality of life, disordered sleep, impaired work performance, and several other comorbidities.<ref name="Diseases of the Sinuses"></ref><ref name="pmid16634358">{{cite journal| author=Sacre Hazouri JA| title=[Allergic rhinitis. Coexistent diseases and complications. A review and analysis]. | journal=Rev Alerg Mex | year= 2006 | volume= 53 | issue= 1 | pages= 9-29 | pmid=16634358 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16634358 }} </ref> | Allergic rhinitis rarely occurs in isolation, it is a product of a genetic predisposition, epigenetic events, and environmental exposures, and it is frequently associated with other forms of [[atopy]] such as [[eczema]], [[asthma]], and allergic eye disease(allergic rhinoconjunctivitis).<ref name="pmid27490123">{{cite journal| author=Shaker M, Salcone E| title=An update on ocular allergy. | journal=Curr Opin Allergy Clin Immunol | year= 2016 | volume= 16 | issue= 5 | pages= 505-10 | pmid=27490123 | doi=10.1097/ACI.0000000000000299 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27490123 }} </ref><ref name="pmid16634358">{{cite journal| author=Sacre Hazouri JA| title=[Allergic rhinitis. Coexistent diseases and complications. A review and analysis]. | journal=Rev Alerg Mex | year= 2006 | volume= 53 | issue= 1 | pages= 9-29 | pmid=16634358 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16634358 }} </ref><ref name="pmid25182349">{{cite journal| author=Mims JW| title=Epidemiology of allergic rhinitis. | journal=Int Forum Allergy Rhinol | year= 2014 | volume= 4 Suppl 2 | issue= | pages= S18-20 | pmid=25182349 | doi=10.1002/alr.21385 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25182349 }} </ref> The vast majority of individuals with [[asthma]] have rhinitis, and allergic eye disease has been reported to affect almost all patients with allergic rhinitis.<ref name="pmid27490123">{{cite journal| author=Shaker M, Salcone E| title=An update on ocular allergy. | journal=Curr Opin Allergy Clin Immunol | year= 2016 | volume= 16 | issue= 5 | pages= 505-10 | pmid=27490123 | doi=10.1097/ACI.0000000000000299 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27490123 }} </ref><ref name="pmid18331513">{{cite journal| author=Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A et al.| title=Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). | journal=Allergy | year= 2008 | volume= 63 Suppl 86 | issue= | pages= 8-160 | pmid=18331513 | doi=10.1111/j.1398-9995.2007.01620.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18331513 }} </ref> Nonallergic rhinitis is also associated with [[asthma]].<ref name="pmid22056609">{{cite journal| author=Westman M, Stjärne P, Asarnoj A, Kull I, van Hage M, Wickman M et al.| title=Natural course and comorbidities of allergic and nonallergic rhinitis in children. | journal=J Allergy Clin Immunol | year= 2012 | volume= 129 | issue= 2 | pages= 403-8 | pmid=22056609 | doi=10.1016/j.jaci.2011.09.036 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22056609 }} </ref><ref name="pmid18331513">{{cite journal| author=Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A et al.| title=Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). | journal=Allergy | year= 2008 | volume= 63 Suppl 86 | issue= | pages= 8-160 | pmid=18331513 | doi=10.1111/j.1398-9995.2007.01620.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18331513 }} </ref> Frequent extension of rhinitis (especially infectious rhinitis) into the [[Paranasal sinus|sinuses]] also occur, resulting in [[rhinosinusitis]].<ref name="pmid20176255">{{cite journal| author=Dykewicz MS, Hamilos DL| title=Rhinitis and sinusitis. | journal=J Allergy Clin Immunol | year= 2010 | volume= 125 | issue= 2 Suppl 2 | pages= S103-15 | pmid=20176255 | doi=10.1016/j.jaci.2009.12.989 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20176255 }} </ref><ref name= "Diseases of the Sinuses"></ref> Children with nonallergic rhinitis have a higher likelihood of undergoing remission, compared with those with allergic rhinitis, who tend to have a more persistent disease.<ref name="pmid22056609">{{cite journal| author=Westman M, Stjärne P, Asarnoj A, Kull I, van Hage M, Wickman M et al.| title=Natural course and comorbidities of allergic and nonallergic rhinitis in children. | journal=J Allergy Clin Immunol | year= 2012 | volume= 129 | issue= 2 | pages= 403-8 | pmid=22056609 | doi=10.1016/j.jaci.2011.09.036 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22056609 }} </ref> Remission occurs in up to 73% of four year old children with nonallergic rhinitis by the age of eight years.<ref name="pmid22056609">{{cite journal| author=Westman M, Stjärne P, Asarnoj A, Kull I, van Hage M, Wickman M et al.| title=Natural course and comorbidities of allergic and nonallergic rhinitis in children. | journal=J Allergy Clin Immunol | year= 2012 | volume= 129 | issue= 2 | pages= 403-8 | pmid=22056609 | doi=10.1016/j.jaci.2011.09.036 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22056609 }} </ref> Rhinitis is a significant cause of lost school and work days, and it constitutes a huge financial burden to the society.<ref name="pmid15025839">{{cite journal| author=Schoenwetter WF, Dupclay L, Appajosyula S, Botteman MF, Pashos CL| title=Economic impact and quality-of-life burden of allergic rhinitis. | journal=Curr Med Res Opin | year= 2004 | volume= 20 | issue= 3 | pages= 305-17 | pmid=15025839 | doi=10.1185/030079903125003053 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15025839 }} </ref><ref name="pmid18662584">{{cite journal| author=Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA et al.| title=The diagnosis and management of rhinitis: an updated practice parameter. | journal=J Allergy Clin Immunol | year= 2008 | volume= 122 | issue= 2 Suppl | pages= S1-84 | pmid=18662584 | doi=10.1016/j.jaci.2008.06.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18662584 }} </ref> Untreated/poorly treated chronic rhinitis is associated with a diminished quality of life, disordered sleep, impaired work performance, and several other comorbidities.<ref name="Diseases of the Sinuses"></ref><ref name="pmid16634358">{{cite journal| author=Sacre Hazouri JA| title=[Allergic rhinitis. Coexistent diseases and complications. A review and analysis]. | journal=Rev Alerg Mex | year= 2006 | volume= 53 | issue= 1 | pages= 9-29 | pmid=16634358 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16634358 }} </ref> | ||
==History and Symptoms== | ==History and Symptoms== | ||
It is pertinent to obtain the symptoms of rhinitis, and the symptoms that are | It is pertinent to obtain the history of the symptoms of rhinitis, and also ask about the symptoms that are most bothersome to the patient. The pattern of the symptoms, precipitating factors, environmental history, coexisting conditions, family history, and previous response to medications, should all be obtained.<ref name="Allergic rhinitis-an overview of a common disease">{{cite journal |last=Rotiroti |first=Giuseppina |last2=Scadding |first2=Glenis |date=July 2016 |title=Allergic Rhinitis-an overview of a common disease |url=https://www-clinicalkey-com.ezp-prod1.hul.harvard.edu/#!/content/playContent/1-s2.0-S1751722216300063?returnurl=null&referrer=null&scrollTo=%23tbl2|journal=Paediatrics and Child Health |volume= Volume 26 |issue= Issue 7 |pages=298-303 |access-date=January 20, 2017 }} </ref><ref name="pmid18331513" /><ref name="pmid20176255">{{cite journal| author=Dykewicz MS, Hamilos DL| title=Rhinitis and sinusitis. | journal=J Allergy Clin Immunol | year= 2010 | volume= 125 | issue= 2 Suppl 2 | pages= S103-15 | pmid=20176255 | doi=10.1016/j.jaci.2009.12.989 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20176255 }} </ref><ref name="pmid18662584">{{cite journal| author=Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA et al.| title=The diagnosis and management of rhinitis: an updated practice parameter. | journal=J Allergy Clin Immunol | year= 2008 | volume= 122 | issue= 2 Suppl | pages= S1-84 | pmid=18662584 | doi=10.1016/j.jaci.2008.06.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18662584 }} </ref> | ||
==Physical Examination== | ==Physical Examination== | ||
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==Laboratory Findings== | ==Laboratory Findings== | ||
Allergic rhinitis can be confirmed by recording specific IgE reactivity to relevant aeroallergens in the patient's history, via skin testing(skin-prick/intradermal test) or serum specific IgE testing known as the radioallergosorbent test(RAST). | Allergic rhinitis can be confirmed by recording specific [[IgE]] reactivity to relevant aeroallergens in the patient's history, via [[Skin allergy testing|skin testing]](skin-prick/intradermal test) or serum specific [[IgE]] testing known as the [[radioallergosorbent test]]([[RAST blood test|RAST]]).<ref name="Allergic rhinitis-an overview of a common disease" /><ref name="pmid25644617">{{cite journal| author=Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR et al.| title=Clinical practice guideline: Allergic rhinitis. | journal=Otolaryngol Head Neck Surg | year= 2015 | volume= 152 | issue= 1 Suppl | pages= S1-43 | pmid=25644617 | doi=10.1177/0194599814561600 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25644617 }} </ref><ref name="pmid27340637">{{cite journal| author=K Maru Y, Gupta Y| title=Nasal Endoscopy Versus Other Diagnostic Tools in Sinonasal Diseases. | journal=Indian J Otolaryngol Head Neck Surg | year= 2016 | volume= 68 | issue= 2 | pages= 202-6 | pmid=27340637 | doi=10.1007/s12070-014-0762-y | pmc=4899354 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27340637 }} </ref><ref name="pmid20176255">{{cite journal| author=Dykewicz MS, Hamilos DL| title=Rhinitis and sinusitis. | journal=J Allergy Clin Immunol | year= 2010 | volume= 125 | issue= 2 Suppl 2 | pages= S103-15 | pmid=20176255 | doi=10.1016/j.jaci.2009.12.989 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20176255 }} </ref> | ||
==X ray== | ==X ray== | ||
Chest x-ray is of no clinical importance in the diagnosis of rhinitis, unless it is necessary for the evaluation of some associated comorbid conditions. | |||
==CT== | ==CT== | ||
Imaging studies such as CT scan are not routinely required for the diagnosis of rhinitis. However, a CT scan may be required when further evaluation is needed, such as in cases of complicated rhinosinusitis or when other pathological conditions are suspected. CT scans are also usually indicated for the evaluation of atrophic rhinitis. | Imaging studies such as [[CT scan]] are not routinely required for the diagnosis of rhinitis. However, a [[CT scan]] may be required when further evaluation is needed, such as in cases of complicated [[rhinosinusitis]] or when other pathological conditions are suspected. [[CT scans]] are also usually indicated for the evaluation of [[atrophic rhinitis]]. | ||
==Other Diagnostic Studies== | ==Other Diagnostic Studies== | ||
Nasal endoscopy is a very good technique for detecting sinonasal pathologies as well as anatomical variations that are not accessible on anterior rhinoscopy, and it should be considered in the early diagnosis of various sinonasal diseases to ensure a complete examination of the nose and sinuses.<ref name="pmid27340637">{{cite journal| author=K Maru Y, Gupta Y| title=Nasal Endoscopy Versus Other Diagnostic Tools in Sinonasal Diseases. | journal=Indian J Otolaryngol Head Neck Surg | year= 2016 | volume= 68 | issue= 2 | pages= 202-6 | pmid=27340637 | doi=10.1007/s12070-014-0762-y | pmc=4899354 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27340637 }} </ref> | Nasal endoscopy is a very good technique for detecting sinonasal pathologies as well as anatomical variations that are not accessible on anterior [[rhinoscopy]], and it should be considered in the early diagnosis of various sinonasal diseases to ensure a complete examination of the nose and [[sinuses]].<ref name="pmid27340637">{{cite journal| author=K Maru Y, Gupta Y| title=Nasal Endoscopy Versus Other Diagnostic Tools in Sinonasal Diseases. | journal=Indian J Otolaryngol Head Neck Surg | year= 2016 | volume= 68 | issue= 2 | pages= 202-6 | pmid=27340637 | doi=10.1007/s12070-014-0762-y | pmc=4899354 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27340637 }} </ref> | ||
==Medical Therapy== | ==Medical Therapy== | ||
The etiology of rhinitis often determines the type of medical therapy offered. The commonly used medications are antihistamines and corticosteroids. Avoidance of triggers when possible, and saline irrigation of the nose also has clear benefits. | The etiology and severity of rhinitis often determines the type of medical therapy offered. The commonly used medications are [[antihistamines]] and [[corticosteroids]]. Avoidance of triggers when possible, and [[Nasal irrigation|saline irrigation]] of the nose also has clear benefits. [[Allergen immunotherapy|Allergen-specific immunotherapy]] is also indicated for the treatment of allergic rhinitis in appropriately selected patients.<ref name="pmid21122901">{{cite journal| author=Cox L, Nelson H, Lockey R, Calabria C, Chacko T, Finegold I et al.| title=Allergen immunotherapy: a practice parameter third update. | journal=J Allergy Clin Immunol | year= 2011 | volume= 127 | issue= 1 Suppl | pages= S1-55 | pmid=21122901 | doi=10.1016/j.jaci.2010.09.034 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21122901 }} </ref> | ||
==Surgery== | ==Surgery== | ||
Surgery is not commonly required for the management of rhinitis. Surgical procedures are however sometimes indicated in the management of structural/mechanical problems, or coexisting comorbid conditions.<ref name="pmid24007929">{{cite journal| author=Sacre-Hazouri JA| title=[Chronic rhinosinusitis in children]. | journal=Rev Alerg Mex | year= 2012 | volume= 59 | issue= 1 | pages= 16-24 | pmid=24007929 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24007929 }} </ref> | Surgery is not commonly required for the management of rhinitis. Surgical procedures are however, sometimes indicated in the management of structural/mechanical problems, or coexisting comorbid conditions.<ref name="pmid24007929">{{cite journal| author=Sacre-Hazouri JA| title=[Chronic rhinosinusitis in children]. | journal=Rev Alerg Mex | year= 2012 | volume= 59 | issue= 1 | pages= 16-24 | pmid=24007929 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24007929 }} </ref> | ||
==References== | ==References== | ||
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{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | |||
[[Category:Otolaryngology]] | |||
[[Category:Immunology]] | |||
Latest revision as of 00:00, 30 July 2020
| https://https://www.youtube.com/watch?v=vmsLvgAr_xA%7C350}} |
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Rhinitis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Rhinitis overview On the Web |
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American Roentgen Ray Society Images of Rhinitis overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fatimo Biobaku M.B.B.S [2]
Overview
Rhinitis is a heterogenous disorder that is often treated with triviality.[1] It is a highly prevalent, global disease that can have significant impact on the quality of life of affected individuals.[2] Rhinitis is characterized by the presence of one or more nasal symptoms such as sneezing, nasal itching, rhinorrhea(anterior and posterior), and nasal congestion. There can be varying degrees of nasal inflammation.[3] It has a huge financial impact on the society, and generates between $1.6-$4.9 billion in direct expenditure in the US annually.[4] The estimated annual indirect cost from lost productivity in the US ranges between $0.1-$9.7 billion dollars.[4] Chronic rhinitis is one of the most common problems seen by physicians, and allergic rhinitis is the most common type of chronic rhinitis.[5][3] The prevalence of allergic rhinitis has been steadily increasing in various countries across the world.[6][7] Unfortunately, rhinitis is often overlooked, underdiagnosed, undertreated, and mistreated.[8] An understanding of the etiology of the different types of rhinitis and the treatment modalities, would improve the quality of care offered, and ultimately improve the quality of life of those who suffer from chronic rhinitis.
Historical Perspective
Rhinitis has been in existence since the ancient times. Seasonal allergic rhinitis (hay fever) evolved with the industrialization of westernized countries in the 19th century, and it was a common condition in Europe and North America by the end of the 19th century.[6] Nonallergic Rhinitis with Eosinophilic Syndrome(NARES) was first described in 1981 by Jacobs et al.[9] Primary atrophic rhinitis has been well known for ages to the ancient Egyptians, Greeks, and Indians, and it was first described by Bernhard Fraenkel in 1876.[10]
Classification
Rhinitis can be broadly classified into allergic and nonallergic rhinitis.[11] Some forms of rhinitis are not easily classified as either allergic or nonallergic,[11] and sometimes, there also appear to be an overlap of both allergic and nonallergic rhinitis (sometimes referred to as 'mixed' rhinitis).[5] The classification and diagnosis of nonallergic rhinitis is challenging due to its diverse etiology, and it is also not well understood compared to the allergic type.[12]
Pathophysiology
Allergic rhinitis is a multifactorial disease, its development is influenced by an interplay of genetic and environmental factors.[13] Aeroallergens in the nasal tissue undergo antigen processing, eliciting allergen-specific allergic responses and also promoting the development of allergic airway disease.[14][15] Proteins and glycoproteins in indoor and outdoor inhalant allergens such as dust mite fecal particles, cockroach residues, animal danders, molds, and pollens are common aeroallergens causing allergic rhinitis.[14][15] Allergic rhinitis is usually an IgE mediated disease with varying degrees of nasal inflammation. Nonallergic rhinitis is a heterogenous group with poorly defined and understood pathophysiology, and it consists of a variety of conditions which require more research and phenotyping.[16]
Causes
One of the most common diseases presenting to physicians is chronic rhinitis, and determination of the etiology is crucial to ensure appropriate management.[5] Allergic rhinitis is the most common type of chronic rhinitis,[3][17] and it is the fifth most common chronic ailment overall in the U.S.[17] Allergic rhinitis is triggered by the inhalation of indoor and outdoor aeroallergens such as pollens, molds, and animal dander.[6][15] Nonallergic rhinitis comprises a heterogenous group of disorders, some of which are still poorly defined and understood.[18] Nonallergic rhinitis can be induced by non-specific triggers such as exposure to chemical odors, cigarette smoke, spicy food, exercise, and cold air.[12]
Differentiating Rhinitis from other Diseases
It is important to differentiate rhinitis from other conditions micmicking the symptoms of rhinitis such as intranasal foreign bodies, cerebrospinal fluid rhinorrhea, nasal polyps and tumors.[19][3][6][20]
Epidemiology and Demographics
Rhinitis is a very frequent and highly prevalent global disease.[1] Allergic rhinitis is estimated to affect one in every six Americans, and it is the fifth most chronic disease in the U.S.[17] Allergic rhinitis is the most common chronic disease in the pediatric age group in the U.S,[17] and it was the most common diagnosis reported in the 2000 Otolaryngology Workforce study.[4] The estimated prevalence of allergic rhinitis ranges from 9-42%.[5] Annually, between 30-60 million people in the U.S suffer from allergic rhinitis, 10-30% of these individuals are adults, and up to 40% are children.[1] The prevalence of allergic rhinitis has been found to be increasing in countries worldwide, and factors such as increased airborne pollution, a rise in the population of dust mite in inadequately ventilated offices/homes with central heating/air conditioning, and sedentary lifestyles, have been suggested to contribute to the rise in its prevalence.[21][6][7] The prevalence of allergic rhinitis has significantly increased during the past 50 years, with over 50% of adolescents in some countries reporting symptoms of allergic rhinitis.[6] The prevalence of allergic rhinitis was noticed to have doubled in several countries over the last two decades in studies done in children between the ages 6-14years around the globe.[7] Nonallergic rhinitis is also very common, and it has been estimated to affect about 19 million people in the U.S.[5] "Mixed rhinitis" is estimated to affect about 26 million individuals in the United States.[5]
Risk factors
Risk factors for allergic rhinitis include a history of other atopic diseases such as asthma and atopic dermatitis, and a history of rhinitis in the parent.[22][23] Some of the risk factors for infectious rhinitis are daycare attendance, young age, and exposure to air pollutants.[24]
Natural History, Complications and Prognosis
Allergic rhinitis rarely occurs in isolation, it is a product of a genetic predisposition, epigenetic events, and environmental exposures, and it is frequently associated with other forms of atopy such as eczema, asthma, and allergic eye disease(allergic rhinoconjunctivitis).[25][26][4] The vast majority of individuals with asthma have rhinitis, and allergic eye disease has been reported to affect almost all patients with allergic rhinitis.[25][6] Nonallergic rhinitis is also associated with asthma.[27][6] Frequent extension of rhinitis (especially infectious rhinitis) into the sinuses also occur, resulting in rhinosinusitis.[15][1] Children with nonallergic rhinitis have a higher likelihood of undergoing remission, compared with those with allergic rhinitis, who tend to have a more persistent disease.[27] Remission occurs in up to 73% of four year old children with nonallergic rhinitis by the age of eight years.[27] Rhinitis is a significant cause of lost school and work days, and it constitutes a huge financial burden to the society.[21][2] Untreated/poorly treated chronic rhinitis is associated with a diminished quality of life, disordered sleep, impaired work performance, and several other comorbidities.[1][26]
History and Symptoms
It is pertinent to obtain the history of the symptoms of rhinitis, and also ask about the symptoms that are most bothersome to the patient. The pattern of the symptoms, precipitating factors, environmental history, coexisting conditions, family history, and previous response to medications, should all be obtained.[20][6][15][2]
Physical Examination
A careful history and physical examination is essential for accurate diagnosis, treatment, and prevention of the potential complications associated with chronic rhinitis.[8][5] It is essential to examine all the organ systems that are potentially affected by allergies.[2] A detailed examination of the upper respiratory tract should be done in all patients presenting with rhinitis.[2]
Laboratory Findings
Allergic rhinitis can be confirmed by recording specific IgE reactivity to relevant aeroallergens in the patient's history, via skin testing(skin-prick/intradermal test) or serum specific IgE testing known as the radioallergosorbent test(RAST).[20][28][29][15]
X ray
Chest x-ray is of no clinical importance in the diagnosis of rhinitis, unless it is necessary for the evaluation of some associated comorbid conditions.
CT
Imaging studies such as CT scan are not routinely required for the diagnosis of rhinitis. However, a CT scan may be required when further evaluation is needed, such as in cases of complicated rhinosinusitis or when other pathological conditions are suspected. CT scans are also usually indicated for the evaluation of atrophic rhinitis.
Other Diagnostic Studies
Nasal endoscopy is a very good technique for detecting sinonasal pathologies as well as anatomical variations that are not accessible on anterior rhinoscopy, and it should be considered in the early diagnosis of various sinonasal diseases to ensure a complete examination of the nose and sinuses.[29]
Medical Therapy
The etiology and severity of rhinitis often determines the type of medical therapy offered. The commonly used medications are antihistamines and corticosteroids. Avoidance of triggers when possible, and saline irrigation of the nose also has clear benefits. Allergen-specific immunotherapy is also indicated for the treatment of allergic rhinitis in appropriately selected patients.[30]
Surgery
Surgery is not commonly required for the management of rhinitis. Surgical procedures are however, sometimes indicated in the management of structural/mechanical problems, or coexisting comorbid conditions.[3]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Romeo, Jonathan; Dykewicz, Mark (2014). "Chapter 9:Differential Diagnosis of Rhinitis and Rhinosinusitis". Diseases of the Sinuses. Springer New York. pp. 133–152. ISBN 978-1-4939-0265-1.
- ↑ 2.0 2.1 2.2 2.3 2.4 Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA; et al. (2008). "The diagnosis and management of rhinitis: an updated practice parameter". J Allergy Clin Immunol. 122 (2 Suppl): S1–84. doi:10.1016/j.jaci.2008.06.003. PMID 18662584.
- ↑ 3.0 3.1 3.2 3.3 3.4 Sacre-Hazouri JA (2012). "[Chronic rhinosinusitis in children]". Rev Alerg Mex. 59 (1): 16–24. PMID 24007929.
- ↑ 4.0 4.1 4.2 4.3 Mims JW (2014). "Epidemiology of allergic rhinitis". Int Forum Allergy Rhinol. 4 Suppl 2: S18–20. doi:10.1002/alr.21385. PMID 25182349.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 Settipane RA, Charnock DR (2007). "Epidemiology of rhinitis: allergic and nonallergic". Clin Allergy Immunol. 19: 23–34. PMID 17153005.
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A; et al. (2008). "Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen)". Allergy. 63 Suppl 86: 8–160. doi:10.1111/j.1398-9995.2007.01620.x. PMID 18331513.
- ↑ 7.0 7.1 7.2 Katelaris CH, Lee BW, Potter PC, Maspero JF, Cingi C, Lopatin A; et al. (2012). "Prevalence and diversity of allergic rhinitis in regions of the world beyond Europe and North America". Clin Exp Allergy. 42 (2): 186–207. doi:10.1111/j.1365-2222.2011.03891.x. PMID 22092947.
- ↑ 8.0 8.1 Skoner DP (2001). "Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis". J Allergy Clin Immunol. 108 (1 Suppl): S2–8. PMID 11449200.
- ↑ Ellis AK, Keith PK (2006). "Nonallergic rhinitis with eosinophilia syndrome". Curr Allergy Asthma Rep. 6 (3): 215–20. PMID 16579871.
- ↑ Shehata MA (1996). "Atrophic rhinitis". Am J Otolaryngol. 17 (2): 81–6. PMID 8820180.
- ↑ 11.0 11.1 Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA; et al. (2008). "The diagnosis and management of rhinitis: an updated practice parameter". J Allergy Clin Immunol. 122 (2 Suppl): S1–84. doi:10.1016/j.jaci.2008.06.003. PMID PMID:18662584 Check
|pmid=value (help). - ↑ 12.0 12.1 Paraskevopoulos, Giannis; Kalogiros, Lampros (March 2016). "Non-Allergic Rhinitis". Current Treatment Options in Allergy. Volume 3 (Issue 1): 45–68. doi:10.1007/s40521-016-0072-6. Retrieved January 5, 2017.
- ↑ Sin B, Togias A (2011). "Pathophysiology of allergic and nonallergic rhinitis". Proc Am Thorac Soc. 8 (1): 106–14. doi:10.1513/pats.201008-057RN. PMID 21364228.
- ↑ 14.0 14.1 Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A; et al. (2008). "Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen)". Allergy. 63 Suppl 86: 8–160. doi:10.1111/j.1398-9995.2007.01620.x. PMID 18331513 PMID: 18331513 Check
|pmid=value (help). - ↑ 15.0 15.1 15.2 15.3 15.4 15.5 Dykewicz MS, Hamilos DL (2010). "Rhinitis and sinusitis". J Allergy Clin Immunol. 125 (2 Suppl 2): S103–15. doi:10.1016/j.jaci.2009.12.989. PMID 20176255.
- ↑ Sin B, Togias A (2011). "Pathophysiology of allergic and nonallergic rhinitis". Proc Am Thorac Soc. 8 (1): 106–14. doi:10.1513/pats.201008-057RN. PMID 21364228.
- ↑ 17.0 17.1 17.2 17.3 Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR; et al. (2015). "Clinical practice guideline: allergic rhinitis executive summary". Otolaryngol Head Neck Surg. 152 (2): 197–206. doi:10.1177/0194599814562166. PMID 25645524.
- ↑ Sin B, Togias A (2011). "Pathophysiology of allergic and nonallergic rhinitis". Proc Am Thorac Soc. 8 (1): 106–14. doi:10.1513/pats.201008-057RN. PMID 21364228.
- ↑ Dykewicz MS, Hamilos DL (2010). "Rhinitis and sinusitis". J Allergy Clin Immunol. 125 (2 Suppl 2): S103–15. doi:10.1016/j.jaci.2009.12.989. PMID 20176255 20176255 Check
|pmid=value (help). - ↑ 20.0 20.1 20.2 Rotiroti, Giuseppina; Scadding, Glenis (July 2016). "Allergic Rhinitis-an overview of a common disease". Paediatrics and Child Health. Volume 26 (Issue 7): 298–303. Retrieved January 20, 2017.
- ↑ 21.0 21.1 Schoenwetter WF, Dupclay L, Appajosyula S, Botteman MF, Pashos CL (2004). "Economic impact and quality-of-life burden of allergic rhinitis". Curr Med Res Opin. 20 (3): 305–17. doi:10.1185/030079903125003053. PMID 15025839.
- ↑ Baumann LM, Romero KM, Robinson CL, Hansel NN, Gilman RH, Hamilton RG; et al. (2015). "Prevalence and risk factors for allergic rhinitis in two resource-limited settings in Peru with disparate degrees of urbanization". Clin Exp Allergy. 45 (1): 192–9. doi:10.1111/cea.12379. PMID 25059756.
- ↑ Song N, Shamssain M, Mohammed S, Zhang J, Wu J, Fu C; et al. (2014). "Prevalence, severity and risk factors of asthma, rhinitis and eczema in a large group of Chinese schoolchildren". J Asthma. 51 (3): 232–42. doi:10.3109/02770903.2013.867973. PMID 24303994.
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- ↑ 27.0 27.1 27.2 Westman M, Stjärne P, Asarnoj A, Kull I, van Hage M, Wickman M; et al. (2012). "Natural course and comorbidities of allergic and nonallergic rhinitis in children". J Allergy Clin Immunol. 129 (2): 403–8. doi:10.1016/j.jaci.2011.09.036. PMID 22056609.
- ↑ Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR; et al. (2015). "Clinical practice guideline: Allergic rhinitis". Otolaryngol Head Neck Surg. 152 (1 Suppl): S1–43. doi:10.1177/0194599814561600. PMID 25644617.
- ↑ 29.0 29.1 K Maru Y, Gupta Y (2016). "Nasal Endoscopy Versus Other Diagnostic Tools in Sinonasal Diseases". Indian J Otolaryngol Head Neck Surg. 68 (2): 202–6. doi:10.1007/s12070-014-0762-y. PMC 4899354. PMID 27340637.
- ↑ Cox L, Nelson H, Lockey R, Calabria C, Chacko T, Finegold I; et al. (2011). "Allergen immunotherapy: a practice parameter third update". J Allergy Clin Immunol. 127 (1 Suppl): S1–55. doi:10.1016/j.jaci.2010.09.034. PMID 21122901.