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* Antihypertensives and cardiovascular agents- [[ACE inhibitor|ACE inhibitors]], Beta blockers(oral and intraocular), [[Calcium channel blockers]], Thiazides diuretics, centrally acting sympatholytics(clonidine, guanfacine, methyldopa, moxonidine, [[reserpine]]), peripherally acting sympatholytics(prazosin, guanethidine,indoramin, doxazosin, phentolamine), Hydralazine.
* Antihypertensives and cardiovascular agents- [[ACE inhibitor|ACE inhibitors]], Beta blockers(oral and intraocular), [[Calcium channel blockers]], Thiazides diuretics, centrally acting sympatholytics(clonidine, guanfacine, methyldopa, moxonidine, [[reserpine]]), peripherally acting sympatholytics(prazosin, guanethidine,indoramin, doxazosin, phentolamine), Hydralazine.
* [[Aspirin]]/[[NSAIDs]]
* [[Aspirin]]/[[NSAIDs]]
* Other medications such as phosphodiesterase-5 selective inhibitors(sildenafil, tadalafil, vardenafil), Gabapentin, some antipsychotic medications(chlordiazepoxide, chlorpromazine, risperidone, thioridazine)
* Other medications such as phosphodiesterase-5 selective inhibitors(sildenafil, tadalafil, vardenafil), Gabapentin, some psychotropic medications(chlordiazepoxide-amitryptiline, chlorpromazine, risperidone, thioridazine)
|-
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|Primary atrophic rhinitis- causes include:
|Primary atrophic rhinitis- causes include:
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|- bgcolor="lightsteelblue"
|- bgcolor="lightsteelblue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
| bgcolor="beige" |  [[Butorphanol]], [[Cefpodoxime]], [[Desmopressin]], [[Dimercaprol]], [[Dornase Alfa]], [[Flunisolide]], [[Flurbiprofen]], [[Ivacaftor]], [[Moxifloxacin ophthalmic]], [[Nilutamide]], [[Rifaximin]], [[Rimexolone]], [[Sertraline]], [[Tamsulosin]], [[trichophyton mentagrophytes and trichophyton rubrum]], [[Thalidomide]], [[Tizanidine]], [[Topiramate]]
| bgcolor="beige" |  Aspirin, NSAID, Clonidine, Guanfacine, Methyldopa,, Moxonidine, Rescinnamine, Reserpine, Rilmenidine, Mecamylamine, Trimethaphan,Prazosin, Guanethidine,Indoramin, Doxazosin, Phentolamine, Sildenafil,Tadalafil, Vardenafil, Amiloride, ACE inhibitors, oral Beta blockers, intraocular beta blockers, calcium channel blockers, Chlorothiazide, Hydralazine, Hydrochlorothiazide, Exogenous estrogens,oral contraceptives,Chlordiazepoxide-Amitryptiline, Chlorpromazine, Riseperidone, Thioridazine, Gabapentin,[[Butorphanol]], [[Cefpodoxime]], [[Desmopressin]], [[Dimercaprol]], [[Dornase Alfa]], [[Flunisolide]], [[Flurbiprofen]], [[Ivacaftor]], [[Moxifloxacin ophthalmic]], [[Nilutamide]], [[Rifaximin]], [[Rimexolone]], [[Sertraline]], [[Tamsulosin]], [[trichophyton mentagrophytes and trichophyton rubrum]], [[Thalidomide]], [[Tizanidine]], [[Topiramate]]
|-
|-
|- bgcolor="lightsteelblue"
|- bgcolor="lightsteelblue"
| '''Ear Nose Throat'''
| '''Ear Nose Throat'''
| bgcolor="beige" | No underlying causes
| bgcolor="beige" | Upper respiratory tract infections- Viral, Bacterial, Fungal and Parasitic
|-
|-
|- bgcolor="lightsteelblue"
|- bgcolor="lightsteelblue"
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|- bgcolor="lightsteelblue"
|- bgcolor="lightsteelblue"
| '''Environmental'''
| '''Environmental'''
| bgcolor="beige" | No underlying causes
| bgcolor="beige" |Pollens, molds, animal dander, coakroach residues, dust mite fecal particles
|-
|-
|- bgcolor="lightsteelblue"
|- bgcolor="lightsteelblue"
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|- bgcolor="lightsteelblue"
|- bgcolor="lightsteelblue"
| '''Genetic'''
| '''Genetic'''
| bgcolor="beige" | No underlying causes
| bgcolor="beige" | Genetic predisposition(Allergic rhinitis)
|-
|-
|- bgcolor="lightsteelblue"
|- bgcolor="lightsteelblue"
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|- bgcolor="lightsteelblue"
|- bgcolor="lightsteelblue"
| '''Iatrogenic'''
| '''Iatrogenic'''
| bgcolor="beige" | No underlying causes
| bgcolor="beige" | Secondary atrophic rhinitis (Surgical removal of nasal turbinates, Radiation)
|-
|-
|- bgcolor="lightsteelblue"
|- bgcolor="lightsteelblue"
| '''Infectious Disease'''
| '''Infectious Disease'''
| bgcolor="beige" | No underlying causes
| bgcolor="beige" | Rhinovirus, adenovirus, Influenza and Parainfluenza viruses, Klebsiella ozaenae, Klebsiella rhinoscleromatis, syphilis
|-
|-
|- bgcolor="lightsteelblue"
|- bgcolor="lightsteelblue"
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|- bgcolor="lightsteelblue"
|- bgcolor="lightsteelblue"
| '''Oncologic'''
| '''Oncologic'''
| bgcolor="beige" | No underlying causes
| bgcolor="beige" | Midline granuloma
|-
|-
|- bgcolor="lightsteelblue"
|- bgcolor="lightsteelblue"
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|- bgcolor="lightsteelblue"
|- bgcolor="lightsteelblue"
| '''Rheumatology/Immunology/Allergy'''
| '''Rheumatology/Immunology/Allergy'''
| bgcolor="beige" | No underlying causes
| bgcolor="beige" | Pollens, Animal danders, Molds, Protein and chemical allergens
|-
|-
|- bgcolor="lightsteelblue"
|- bgcolor="lightsteelblue"
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|- bgcolor="lightsteelblue"
|- bgcolor="lightsteelblue"
| '''Trauma'''
| '''Trauma'''
| bgcolor="beige" | No underlying causes
| bgcolor="beige" | Nose trauma
|-
|-
|- bgcolor="lightsteelblue"
|- bgcolor="lightsteelblue"

Revision as of 17:43, 17 January 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fatimo Biobaku M.B.B.S [2]

Overview

One of the most common diseases presenting to physicians is chronic rhinitis, and determination of the etiology is crucial to ensure appropriate management.[1] Allergic rhinitis is the most common type of chronic rhinitis,[2][3] and it has been estimated as the fifth most common chronic ailment overall in the U.S.[3] Allergic rhinitis is triggered by the inhalation of indoor and outdoor aeroallergens such as pollens, molds, and animal dander.[4][5] Nonallergic rhinitis comprises of a heterogenous group of disorders, some of which are still poorly defined and understood.[6]

Causes

Common Causes

  • Allergic rhinitis- This is the most common cause of chronic rhinitis.[7] The common triggers are listed in the table below.
  • Infectious rhinitis- 98% of acute infectious rhinitis are due to viral upper respiratory infections.[8] Common viruses implicated are rhinoviruses, influenza viruses and parainfluenza viruses.[9]
  • Vasomotor rhinitis- This is the most common type of nonallergic rhinitis in the adult population.[10][6] The causes of vasomotor rhinitis are listed below.
Class Causes of Rhinitis[8][11][12][4]
Allergic rhinitis Indoor and outdoor airborne substances such as:
  • Pollens
  • Molds
  • Dust mite fetal particles
  • Coakroach residues
  • Animal danders
Nonallergic rhinitis Vasomotor rhinitis
  • Irritant triggered- Strong odors from chemicals like chlorine, cooking smells, flowers, perfumes, environmental tobacco smoke and pollutants
  • Cold air/Dry air
  • Exercise
  • Emotional
  • Trauma[13]
  • Undetermined or poorly defined triggers
Gustatory rhinitis- Triggered by solid/liquid food ingestion such as
  • Hot food
  • Spicy food
  • Alcohol
Infectious
  • Viruses
  • Bacteria
  • Fungi
  • Parasites
Occupational rhinitis Caused by protein and chemical allergens, chemical respiratory sensitizers, or unknown mechanisms
  • Noxious fumes/vapors/smoke/dust- Pesticides, chromium vapors, volatile organic compounds, tthermal degradation products of polyurethanes, grain and cotton dust, chlorine, formaldehyde, ammonia, wood dust, waste handling, solder fumes, detergent powder
Other rhinitis syndrome Hormonally induced
  • Gestational/Pregnancy-induced
  • Menstrual cycle related
Drug-induced[14]
  • Rhinitis medicamentosa
  1. Nasal decongestant sprays- Sympathomimetics(Amphetamine, Benzedrine, Ephedrine, Phenylephrine, Phenylpropanolamine), Imidazolines(Naphazoline, Oxymetazoline, Xylometazoline)
  2. Intranasal cocaine and methamphetamine
  • Oral contraceptives and Exogenous estrogens
  • Antihypertensives and cardiovascular agents- ACE inhibitors, Beta blockers(oral and intraocular), Calcium channel blockers, Thiazides diuretics, centrally acting sympatholytics(clonidine, guanfacine, methyldopa, moxonidine, reserpine), peripherally acting sympatholytics(prazosin, guanethidine,indoramin, doxazosin, phentolamine), Hydralazine.
  • Aspirin/NSAIDs
  • Other medications such as phosphodiesterase-5 selective inhibitors(sildenafil, tadalafil, vardenafil), Gabapentin, some psychotropic medications(chlordiazepoxide-amitryptiline, chlorpromazine, risperidone, thioridazine)
Primary atrophic rhinitis- causes include:
  • Infection with organisms such as Klebsiella ozaenae
  • Turbulent air flow
  • Climate factors
  • Racial factors

Secondary atrophic rhinitis- causes include:

  • Extensive surgery
  • Granulomatous diseases
  • Direct trauma
  • Radiotherapy
Rhinitis associated with inflammatory-immunologic disorders


Causes by Organ System

Cardiovascular No underlying causes
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Aspirin, NSAID, Clonidine, Guanfacine, Methyldopa,, Moxonidine, Rescinnamine, Reserpine, Rilmenidine, Mecamylamine, Trimethaphan,Prazosin, Guanethidine,Indoramin, Doxazosin, Phentolamine, Sildenafil,Tadalafil, Vardenafil, Amiloride, ACE inhibitors, oral Beta blockers, intraocular beta blockers, calcium channel blockers, Chlorothiazide, Hydralazine, Hydrochlorothiazide, Exogenous estrogens,oral contraceptives,Chlordiazepoxide-Amitryptiline, Chlorpromazine, Riseperidone, Thioridazine, Gabapentin,Butorphanol, Cefpodoxime, Desmopressin, Dimercaprol, Dornase Alfa, Flunisolide, Flurbiprofen, Ivacaftor, Moxifloxacin ophthalmic, Nilutamide, Rifaximin, Rimexolone, Sertraline, Tamsulosin, trichophyton mentagrophytes and trichophyton rubrum, Thalidomide, Tizanidine, Topiramate
Ear Nose Throat Upper respiratory tract infections- Viral, Bacterial, Fungal and Parasitic
Endocrine No underlying causes
Environmental Pollens, molds, animal dander, coakroach residues, dust mite fecal particles
Gastroenterologic No underlying causes
Genetic Genetic predisposition(Allergic rhinitis)
Hematologic No underlying causes
Iatrogenic Secondary atrophic rhinitis (Surgical removal of nasal turbinates, Radiation)
Infectious Disease Rhinovirus, adenovirus, Influenza and Parainfluenza viruses, Klebsiella ozaenae, Klebsiella rhinoscleromatis, syphilis
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Midline granuloma
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy Pollens, Animal danders, Molds, Protein and chemical allergens
Sexual No underlying causes
Trauma Nose trauma
Urologic No underlying causes
Miscellaneous No underlying causes

References

  1. ↑ Settipane RA, Charnock DR (2007). "Epidemiology of rhinitis: allergic and nonallergic". Clin Allergy Immunol. 19: 23–34. PMID 17153005.
  2. ↑ Sacre-Hazouri JA (2012). "[Chronic rhinosinusitis in children]". Rev Alerg Mex. 59 (1): 16–24. PMID 24007929.
  3. ↑ 3.0 3.1 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.
  4. ↑ 4.0 4.1 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.
  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.
  6. ↑ 6.0 6.1 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.
  7. ↑ 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).
  8. ↑ 8.0 8.1 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 18662584.
  9. ↑ Brook I (2011). "Microbiology of sinusitis". Proc Am Thorac Soc. 8 (1): 90–100. doi:10.1513/pats.201006-038RN. PMID 21364226.
  10. ↑ Pattanaik D, Lieberman P (2010). "Vasomotor rhinitis". Curr Allergy Asthma Rep. 10 (2): 84–91. doi:10.1007/s11882-010-0089-z. PMID 20425499.
  11. ↑ Kaliner MA (2011). "Nonallergic rhinopathy (formerly known as vasomotor rhinitis)". Immunol Allergy Clin North Am. 31 (3): 441–55. doi:10.1016/j.iac.2011.05.007. PMID 21737036.
  12. ↑ 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.
  13. ↑ Segal S, Shlamkovitch N, Eviatar E, Berenholz L, Sarfaty S, Kessler A (1999). "Vasomotor rhinitis following trauma to the nose". Ann Otol Rhinol Laryngol. 108 (2): 208–10. PMID 10030243.
  14. ↑ Varghese M, Glaum MC, Lockey RF (2010). "Drug-induced rhinitis". Clin Exp Allergy. 40 (3): 381–4. doi:10.1111/j.1365-2222.2009.03450.x. PMID 20210811.

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