Rhinitis overview
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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
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 estimate of indirect cost from lost productivity in the US ranges between $0.1-$9.7 billion dollars. Chronic rhinitis is one of the most common problems seen by physicians, and allergic rhinitis is the most common type of chronic rhinitis. The prevalence of allergic rhinitis has been steadily increasing in various countries across the world. Unfortunately, rhinitis is often overlooked, underdiagnosed, undertreated, and mistreated. An understanding of the etiology of the different types of rhinitis, and the treatment modalities would improve the quality of care offered to patients, 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. Nonallergic Rhinitis with Eosinophilic Syndrome(NARES) was first described in 1981 by Jacobs et al.[3] 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.
Classification
Rhinitis can be broadly classified into allergic and nonallergic rhinitis.[1] Some forms of rhinitis are not easily classified as either allergic or nonallergic,[1] and sometimes, there also appear to be an overlap of both allergic and nonallergic rhinitis (sometimes referred to as 'mixed' rhinitis).[2] 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.[3]
Pathophysiology
Rhinitis refers to a heterogeneous group of nasal disorders characterized by the presence of one or more nasal symptoms such as sneezing, nasal itching, rhinorrhea(anterior and posterior), and nasal congestion.[4] It is broadly classified into allergic and nonallergic rhinitis, although some forms of rhinitis cannot be easily classified into these categories.[2] Allergic rhinitis is a multifactorial disease, its development is influenced by an interplay of genetic and environmental factors.[5] Aeroallergens in the nasal tissue undergo antigen processing, eliciting allergen-specific allergic responses and also promoting the development of allergic airway disease.[6][7] 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.[6][7] 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.[8]
Causes
One of the most common diseases presenting to physicians is chronic rhinitis, and determination of the etiology is crucial to ensure appropriate management.[2] Allergic rhinitis is the most common type of chronic rhinitis,[4][9] and it has been estimated as the fifth most common chronic ailment overall in the U.S.[9] Allergic rhinitis is triggered by the inhalation of indoor and outdoor aeroallergens such as pollens, molds, and animal dander.[10][7] Nonallergic rhinitis comprises of a heterogenous group of disorders, some of which are still poorly defined and understood.[11] Nonallergic rhinitis can be induced by non-specific triggers such as exposure to chemical odors, cigarette smoke, spicy food, exercise, and cold air.[3]
Differentiating Rhinitis from other Diseases
Rhinitis is often frequently overlooked or undertreated.[12] It is associated with several comorbidities which can have significant impact on the quality of life. It can also be the initial presentation of overt systemic illnesses which can be potentially fatal.[13] 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.
Epidemiology and Demographics
Rhinitis is a very frequent and highly prevalent global disease.[13] Allergic rhinitis is estimated to affect one in every six Americans, and it is the fifth most chronic disease in the U.S.[9] Allergic rhinitis is the most common chronic disease in the pediatric age group in the U.S,[9] and it was the most common diagnosis reported in the 2000 Otolaryngology Workforce study.[14] The estimated prevalence of allergic rhinitis ranges from 9-42%.[2] 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.[13] Allergic rhinitis generates between $1.6-$4.9 billion in direct healthcare expenditure in the United States, and an indirect cost of about $0.1-$9.7 billion due to lost productivity.[14] 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.
Risk factors
Natural History, Complications and Prognosis
History and Symptoms
Physical Examination
Laboratory Findings
X ray
CT
Other Diagnostic Studies
Medical Therapy
Surgery
- ↑ 1.0 1.1 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). - ↑ 2.0 2.1 2.2 2.3 Settipane RA, Charnock DR (2007). "Epidemiology of rhinitis: allergic and nonallergic". Clin Allergy Immunol. 19: 23–34. PMID 17153005.
- ↑ 3.0 3.1 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.
- ↑ 4.0 4.1 Sacre-Hazouri JA (2012). "[Chronic rhinosinusitis in children]". Rev Alerg Mex. 59 (1): 16–24. PMID 24007929.
- ↑ 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.
- ↑ 6.0 6.1 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). - ↑ 7.0 7.1 7.2 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.
- ↑ 9.0 9.1 9.2 9.3 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.
- ↑ 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.
- ↑ 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.
- ↑ Skoner DP (2001). "Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis". J Allergy Clin Immunol. 108 (1 Suppl): S2–8. PMID 11449200.
- ↑ 13.0 13.1 13.2 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.
- ↑ 14.0 14.1 Mims JW (2014). "Epidemiology of allergic rhinitis". Int Forum Allergy Rhinol. 4 Suppl 2: S18–20. doi:10.1002/alr.21385. PMID 25182349.