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rhinitis

Inflammation of the nasal mucosa. Coryza is acute rhinitis. Etiology: 1) allergic rhinitis - seasonal allergens - perennial allergens 2) infectious agents - viral, bacterial or fungal rhinitis - sinusitis 3) non-infectious a) vasomotor rhinitis - smoke - air pollution - perfumes - detergents & soaps - solvents or fumes - changes in temperature, light, or atmospheric pressure - emotion b) rhinitis medicamentosa - sympathomimetic nasal drops or sprays - cocaine - antihypertensives - reserpine - guanethidine - hydralazine - oral contraceptives - antidepressants - also see nasal congestion c) nasal obstruction - nasal polyps - deviated septum - nasal neoplasm - foreign body d) systemic disorders - rhinitis of pregnancy - hypothyroidism - Wegener's granulomatosis - sarcoidosis - ciliary - cystic fibrosis e) cerebrospinal fluid leak (CSF rhinorrhea) f) atrophy of nasal mucosa Clinical manifestations: - congestion, rhinorrhea, sneezing, & pruritus typical of allergic rhinitis [6] - congestion & postnasal drainage without pruritus typical of nonallergic rhinitis Differential diagnosis: - sinusitis - congestion & anosmia common in chronic sinusitis with nasal polyps [6] Management: 1) antibiotics for patients with bacterial sinusitis [4] otherwise, antibiotics not indicated 2) nasal glucocorticoids &/or nasal antihistamines - intranasal glucogorticoids first line for allergic rhinitis - start working in 2 hours but may take up to 2 weeks for full effects - intranasal antihistamines provide relief in 15-30 minutes - use only 2nd generation antihistamines in allergic thinitis [6] 3) intranasal decongestants (oxymetazoline [Afrin]): - limit to short-term use to prevent rebound congestion - in patients with severe refractory congestion, they can be combined with intranasal glucocorticoids for as long as 4 weeks. [6] 3) evidence does not support adding an oral medication to an intranasal spray - montelukast rarely useful for allergic rhinitis - avoid with non-allergic rhinitis [6] 4) also see allergic rhinitis, vasomotor rhinitis or other specific etiology

Related

nasal congestion upper respiratory tract infection (URI, common cold)

Specific

allergic rhinitis (hay fever, ragwood allergy) common cold; acute nasopharyngitis; viral rhinosinusitis nasopharyngitis; rhinopharyngitis nonallergic vasomotor rhinitis rhinitis medicamentosa rhinosinusitis

General

sign/symptom

References

  1. Taber's Cyclopedic Medical Dictionary, FA Davis, Philadelphia, 1977
  2. Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
  3. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  4. Arrol B and Kenealy T Are antibiotics effective for acute purulent rhinitis? Systematic review and meta-analysis of placebo-controlled randomised trials. BMJ 2006, 333:279 PMID: 16861253
  5. Wallace DV, Dykewicz MS, Bernstein DI et al Joint Task Force on Practice; American Academy of Allergy; Asthma & Immunology; American College of Allergy; Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol. 2008 Aug;122(2 Suppl):S1-84. PMID: 18662584
  6. Dykewicz MS et al. Rhinitis 2020: A practice parameter update. J Allergy Clin Immunol 2020 Oct; 146:72 PMID: 32707227 https://www.jacionline.org/article/S0091-6749(20)31023-X/fulltext
  7. Acute rhinosinusitis in Adults: Guidelines for Clinical Care University of Michigan Health System http://cme.med.umich.edu/pdf/guideline/rhino05.pdf