What is Rhinitis

Rhinitis is the condition where there is inflammation and irritation of the mucous membranes of the nose. It can be caused by infection, irritant exposure or allergens. Specifically, Allergic Rhinitis is an inflammation of the nasal mucous membranes caused by exposure to inhaled allergens, such as from dust mite, cockroaches, moulds and animal hair. People who are sensitive to these allergens may then experience one or more of the following symptoms that lasts several weeks and does not seem to go away.

  • Blocked nose
  • Running nose
  • Bouts of sneezing
  • Itching in the nose/throat
  • Mouth breathing
  • Throat clearing cough
  • Disturbed sleep

In Singapore, about one in six children suffer from rhinitis all year round. Up to 40% of 12-15 year old children suffer from rhinitis. Rhinitis in adults is around 20%.

 

  1. Inhaled allergen
  2. Nasal symptoms
  3. Eye symptoms

 

Allergy Rhinitis can sometimes be associated with itchy, watery or puffy eyes (Allergic conjunctivitis).

Non allergic rhinitis with nasal symptoms triggered by the following environmental allergies can also occur.

  • Environmental or occupational irritants. Dust, smog, secondhand smoke or strong odors, such as perfumes, can trigger non-allergic rhinitis. Chemical fumes, such as those you might be exposed to in certain occupations, also may be to blame.
  • Occupational rhinitis. If you have symptoms of rhinitis are more serious in the work- place, work related rhinitis maybe aggrevated by allergens in the workplace.
  • Weather changes. Temperature or humidity changes can trigger the membranes inside your nose to swell and cause a runny or stuffy nose.
  • Infections. A common cause of nonallergic rhinitis is a viral infection — a cold.
  • Foods and beverages. Non-allergic rhinitis may occur when you eat, especially when eating hot or spicy foods. Drinking alcoholic beverages also may cause the membranes inside your nose to swell, leading to nasal congestion.
  • Certain medications. Some medications can cause nonallergic rhinitis. These include aspirin, ibuprofen and high blood pressure (hypertension) medications, such as beta blockers.
  • Hormone changes. Hormonal changes due to pregnancy, menstruation, oral contraceptive use or other hormonal conditions such as hypothyroidism.

Managing Allergic Rhinitis

  • Suggestive history including the frequency and severity of symptoms
  • Allergy Testing (Skin Prick Testing OR Blood Tests) to the environmental allergens such as dust mite, cockroaches, moulds, animal hair and pollen may be required
  • Rhinoscopy (Viewing of the nasal passages, Sinuses)
  • Topical (nasal spray) steroids are often prescribed. These are generally safe and should be used consistently as prescribed over a period of time and not on an as needed basis. Most patients attain good control and it alleviates nasal obstruction, itching, sneezing and runny nose. Children as young as 2 years old can be treated with intranasal steroids.
  • Antihistamines are safe and effective, even in very young children. They may be required to be taken over a sustained period of time to be effective. Generally only the newer second generation antihistamines should be used to minimize unwanted side effects. Their effect is mainly on symptoms of itch, sneeze and rhinorrhea with less effect on nasal obstruction and congestion.
  • Leukotriene inhibitors Montelukast may be helpful for symptom management especially in patients with co-exisiting asthma. It is typically not used as a first line treatment for allergic rhinitis and not typically used alone.
  • Sublingual Immunotherapy (under the tongue) may be recommended if your allergy test is positive for one of the inhalent allergens and response to first line therapy is suboptimal. This therapy involves allergen drops deposited under the tongue with a spray bottle or a tablet placed under the tongue. The minimum duration of treatment is about three years. However, patients often begin to feel improvement in their symptoms after 4 to 6 months. The benefit of this therapy is that the effect is long lasting  and there is a concurrent reduction in asthma symptoms.
  • Turbinate reduction may be another option should nasal obstruction fail to respond to medical therpay.

Establishing other associated chronic conditions and co-morbids

Asthma, eczema and allergy to NSAIDs can co-exist and have implications to long term treatment and prognosis.

Otitis media with effusion, sinusitis may be more common in patients with allergic rhinitis

Sleep disordered breathing and obstructive sleep apnoea can also been aggravated by allergic rhinitis.

Living with Rhinitis

In Singapore, the allergic rhinitis symptoms continue all year round and are mostly related to dust mites. House dust mites are microscopic creatures that are found commonly in mattresses, pillows, bed sheets, clothing, soft toys, sofas and carpets. They live in all our homes and feed mainly on the scales of skin that we shed.

Some simple measures to reduce house dust mite allergy

  • Wash bed sheets and pillowcases in hot water (>60°C) once a week.
  • Avoid having soft furry toys on the bed.
  • No thick heavy curtains in the bedroom and wash them regularly in hot water (>60°C).
  • Clothes and books should be stored in a closed cupboard.
  • Damp dusting should be used to clean surfaces –  avoid feather dusters!
  • Vacuum (HEPA grade) or mop floors regularly.
  • Air-conditioners, if used, should be cleaned regularly.
  • Cover your mattresses and pillows with anti-house dust mite covers.

Exposure to pets

  • Wash your hands immediately after petting any animals; wash your clothes after visiting friends with pets.
  • If you are allergic to household pet, keep the animal out of your home as much as possible. If the pet must be inside, keep it out of the bedroom so you are not exposed to animal allergens while you sleep.
  • Replace carpeting with hardwood, tile or linoleum, all of which are easy to keep dander-free

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