Rhinitis: causes, symptoms, diagnosis, treatment

Allergic rhinitis is an inflammation of the nasal mucosa. It is accompanied by a profuse flow of mucous masses from the nasal passages, bouts of sneezing, swelling and a feeling of nasal congestion.

Despite the presence of unpleasant symptoms that bring significant discomfort and interfere with the quality of life, many patients do not consider this illness to be a disease, so they are in no hurry to see a doctor, but engage mainly in self-medication: watching advertisements on television, buying “magic” drops and uncontrollably accepted. Friends! This is completely wrong!

Hay fever is an independent disease, as confirmed by the international classification of diseases (ICD 10). In our country, the proportion of people susceptible to allergic rhinitis reaches almost forty percent.

Allergic rhinitis: causes of the disease

Let us highlight the most common types of airborne allergens that cause rhinitis.

House dust mites are tiny insects that feed on dead flakes of human skin. They can be found in mattresses, carpets, upholstered furniture, pillows and beds. Rhinitis is not caused by dust mites themselves, but by a chemical contained in their excrement. Dust mites are present year-round, although their numbers peak in winter.

Tiny particles of tree and grass pollen can sometimes cause allergic rhinitis. Most trees pollinate in early to mid-spring, while grasses pollinate in late spring to early summer. Rhinitis can also be caused by mold and fungal spores.

Many people are allergic to animals, such as cats and dogs. The allergic reaction is not caused by animal hair, but by flakes of dead animal skin, urine and saliva. Some people are affected by horses, cattle, rabbits and rodents (guinea pigs and hamsters).

Some people suffer from allergens found in their work environment, such as wood dust, flour dust or latex.

Causes and classification of rhinitis

Risk factors for developing the disease include a decrease in general immunity, unfavorable living conditions (strong or prolonged exposure to irritants) and individual intolerance to certain allergens.
According to the course of the disease, they are distinguished:

• acute rhinitis (occurs after the initial exposure to a pathogen or allergen and lasts up to 3 days);
• chronic rhinitis (usually develops as a complication of an acute process and persists for several weeks and even years).

Depending on the cause, there are:

• allergic rhinitis, which develops when the nasal mucosa comes into contact with an allergen - pets, pollen, house dust, mite or yeast allergens. Symptoms can be seasonal (for example, with aggravation in spring, during the flowering period of plants) or year-round;
• non-allergic rhinitis is caused by hypothermia or sudden changes in humidity, viral infections, strong irritants (strong odors, smoke, dust), certain medications (including vasoconstrictor drops), food allergies, disruption of certain organs (thyroid diseases, gastroesophageal reflux), and rhinitis of pregnant women and senile rhinitis are also distinguished;
• Vasomotor rhinitis is not associated with either allergens or pathogens, and develops with hyperactivity and dilation of the blood vessels of the nasal cavity wall. The cause is considered to be an imbalance of the autonomic nervous system, which cannot cope with the function of “inhibiting” the reaction of the nasal mucosa to environmental conditions. The causes may be stress, physical activity, endocrine diseases, as well as hereditary predisposition. In a third of such patients, the disorder is chronic, and in half it manifests itself to a moderate or severe degree.

The causes of rhinitis in children are considered to be imperfect immunity and unfavorable environmental conditions. In addition, this disease in children can be caused by a deviated nasal septum, diathesis, adenoids and polyps, foreign bodies in the nose, sinuses, and long-term use of vasoconstrictor drops.

Who is most at risk

It is not entirely clear why some people become hypersensitive to allergens, although the likelihood of developing allergies is higher if there is a history of allergies in the family. Heredity forms atopy, a genetic tendency to develop allergic conditions. Their heightened immune response to allergens leads to increased production of IgE antibodies.

Environmental factors may also play a role. Research has shown that certain factors can increase a child's chance of developing allergies, such as smoking in the home and early exposure to dust mitesSource: Allergic Rhinitis: What is it? Osipova V.V. Asthma and allergies, 2021. p. 19-20.

Development mechanism

Allergic rhinitis is caused by an allergic reaction to an allergen such as pollen, dust and certain animals. The main mechanism of development is the formation of hypersensitivity of the immune system. If allergic rhinitis occurs, the immune system, a natural defense against infection and disease, will react to the allergen as if it were harmful, producing antibodies to fight them. Antibodies are special proteins in the blood that are usually produced to fight viruses and infections.

Allergic reactions do not occur upon first contact with an allergen. Successive stages are typical for it. The immune system must recognize and “remember” it before producing antibodies to fight it. This process is known as sensitization. Once sensitivity to an allergen develops, it will be detected by antibodies called immunoglobulin E (IgE) whenever it comes into contact with the lining of the nose and throat. These antibodies cause cells to release a number of chemicals, including histamine, which can cause inflammation and the production of excess mucus. This is what causes the typical symptoms of sneezing and swelling of the nose, runny nose. Source: Allergic rhinitis from the perspective of an allergist. Sidorovich O.I., Luss L.V. Consilium Medicum, 2021. p. 75-78.

Publications in the media

Acute rhinitis is an acute inflammation of the nasal mucosa.

Etiology. Bacteria (staphylococci, streptococci, gonococci, corynebacteria), viruses (influenza, parainfluenza, measles, adenoviruses). Classification • Acute catarrhal rhinitis • Acute traumatic rhinitis (nasal injuries, burns, frostbite, other factors of physical impact) • Acute allergic rhinitis (seasonal form - immediate reaction). Stages • I - dry, characterized by a feeling of dryness and tension in the nose, nasal congestion, swelling of the mucous membrane • II - wet. The feeling of nasal congestion increases, nasal breathing is sharply difficult (often absent), profuse mucous discharge from the nose • III - suppuration. Reduced swelling of the mucous membrane, improved nasal breathing, discharge becomes mucopurulent (in large quantities at first, then gradually decreases). Recovery is coming. Clinical picture . The course of acute catarrhal rhinitis depends on the condition of the nasal mucosa before the disease: if it is atrophied, the reactive phenomena will be less pronounced, and the acute period will be shorter. With hypertrophy of the mucous membrane, on the contrary, acute phenomena and the severity of symptoms will be much more pronounced, and the course will be longer. • Features of infections •• Influenza runny nose is characterized by hemorrhages, up to profuse nosebleeds, and rejection of the epithelium of the nasal mucosa in layers. All this is so characteristic that it allows one to diagnose the influenza nature of a runny nose before obtaining the results of a serological study and serves as an indication of the need to use IFN for instillation into the nose. body temperature; such patients become carriers of the bacteria and infect others. This form of the runny nose is characterized by mucous-scratchy nasal discharge, severe dermatitis in the vestibule of the nose, and lack of effect from conventional treatment •• A runny nose with measles is a common occurrence in the prodromal period; it is characterized by copious mucous discharge from the nose; anterior rhinoscopy reveals individual red spots in the area of ​​the inferior turbinate, standing out against the background of the hyperemic mucous membrane. These spots are observed for a short time and only in the prodromal period •• Scarlet fever is not specific and proceeds like ordinary catarrhal rhinitis •• A runny nose with gonorrhea can occur in a child if it is infected during childbirth. Therefore, a runny nose that occurs during the first days of life is always suspicious of gonorrheal. • The duration of symptoms is 7–8 days, in some cases, with a good immune status, acute catarrhal rhinitis occurs abortively within 2–3 days; with a weakened state of protective forces, it can last up to 3–4 weeks with a tendency to become chronic. Diagnostics - instrumental methods for studying the ENT organs, in particular the nasal cavity (anterior rhinoscopy).

TREATMENT Management tactics • The regimen is outpatient in most cases. For acute catarrhal rhinitis, for rhinitis accompanying infectious diseases - treatment in an infectious diseases hospital • Patients with acute rhinitis should be recognized as temporarily disabled • Thermal, distracting procedures, for example, foot, hand, lumbar baths, mustard plasters on the calf muscles • Physiotherapy: UV rays, UHF or diathermy to the nasal area.

Drug therapy . • For bacterial etiology - antibiotics, 20% sulfacetamide solution (topically) •• Vasoconstrictors (topically), for example phenylephrine (0.25% solution) every 3-4 hours, no more than 7 days. Long-term (more than a week) use of vasoconstrictors can lead to the development of drug-induced rhinitis. Simanovsky ointment and complex ointment (protargol - 0.4; menthol - 0.4; diphenhydramine - 0.1; petroleum jelly - 4.0; petroleum jelly - 16.0) are prescribed into the nose on a cotton ball for 15 minutes 2-3 r /day •• Kameton, Ingacamp •• Ascorbic acid 1 g/day in stages I and II of the disease •• To accelerate the period of convalescence - 20% splenin ointment. The prognosis for adults is favorable, although the infection may spread to the paranasal sinuses and lower respiratory tract, especially in people prone to lung diseases. In infancy, acute rhinitis is always dangerous, especially for weakened children who are predisposed to various pulmonary and allergic complications. Prevention. Hardening the body to cooling, overheating, humidity and dry air. The fight for clean air in working and living spaces, maintaining optimal temperature and humidity in them.

ICD-10 • J00 Acute nasopharyngitis [runny nose]

Allergic rhinitis: symptoms

Symptoms that occur soon after exposure to the substance to which you are allergic may include:

• itching in the nose, mouth, eyes, throat, skin or any other area;
• problems with recognizing odors (but whether the sense of smell disappears partially or completely depends on the severity of the process);
• runny nose;
• sneezing;
• teary eyes.

Symptoms that may develop later if the course is prolonged include:

• nasal congestion;
• cough or slight coughing;
• stuffy ears and decreased sense of smell;
• sore throat;
• dark circles, puffiness under the eyes;
• fatigue and irritability;
• headache.

Complications of rhinitis

Postnasal drip is a consequence of any rhinitis in adults and children.
It is expressed in the flow of nasal secretions down the back of the throat into the lower respiratory tract, causing throat irritation and coughing. Other common consequences include the transition of acute rhinitis to a chronic form, inflammation of the underlying respiratory tract (laryngitis, pharyngitis, bronchitis), middle ear (otitis), paranasal sinuses (sinusitis), and lacrimal glands.

Atrophic rhinitis is a complication of a chronic disease and develops due to atrophy of the nasal mucosa against the background of a long-term inflammatory process. As a result, the normal ciliated epithelium, which secretes protective nasal mucus and is responsible for the sense of smell, is replaced by squamous epithelium, which does not have such functions.

Symptoms include:

• nosebleeds;
• perforation of the nasal septum;
• deformation of the nose and face;
• pain and a constant feeling of unpleasant odor in the nose (which is accompanied by bad breath);
• decreased or absent sense of smell;
• difficulty breathing through the nose due to the formation of crusts in the nose against the background of dry mucous membrane.

In newborns with rhinitis, there is a sharp difficulty or cessation of nasal breathing.
The child switches to mouth breathing, as a result, the sucking reflex and sleep are disrupted. Swallowing air leads to dyspeptic disorders (diarrhea, vomiting, belching). Oxygen starvation causes a slowdown in the development of psychomotor skills. Convulsions are observed due to muscle strain when reflexively throwing the head back to facilitate breathing. Due to the tendency for any inflammation to quickly spread, rhinitis in infants is accompanied by pharyngitis, stomatitis, otitis, tracheitis, bronchitis and bronchopneumonia.

Diagnostics

To make an accurate diagnosis, consultation with an allergist is necessary. Often, a doctor can diagnose allergic rhinitis by symptoms as well as personal and family history, noting seasonality and triggers. He may examine the inside of your nose to look for nasal polyps. Allergic rhinitis is usually confirmed at the beginning of treatment. If a patient responds well to antihistamines, the symptoms are almost certainly caused by an allergy.

If the exact cause of allergic rhinitis is not determined, your doctor may refer you to a clinic for allergy testing.

Two main allergy tests:

• Skin testing - an allergen is placed on the arm and the surface of the skin is pierced with a needle to allow the allergen to affect the immune system. If you are allergic to this substance, a small itchy spot (blister) will appear.
• Blood tests – to check for the presence of immunoglobulin E (IgE) antibodies in the blood; the immune system produces this antibody in response to a suspected allergen.

In some cases, additional tests may be needed to detect complications, such as nasal polyps or sinusitis. Source: Rhinitis: Differential Diagnosis and Treatment Guidelines. Guseva A.L., Derbeneva M.L. Medical Council, 2021. p. 102-108.

How to treat allergic rhinitis

An allergist treats allergic rhinitis in adults. Clinical guidelines have been developed that define specific treatment methods and certain medications for the treatment of seasonal and year-round forms of rhinitis.

The best treatment is to avoid the pollen that causes symptoms, but sometimes this is not possible. Your doctor may prescribe medication for allergic rhinitis depending on the severity of your symptoms and their severity. Your age, contraindications, and whether you have other diseases, such as asthma, will also be taken into account.

For mild allergic rhinitis, rinsing the nose with saline (saline) solution may help remove mucus from the nose. For treatment the following are used:

• Medicines called antihistamines. They are good for treating allergy symptoms. They can be used when symptoms occur infrequently or do not last long. Be aware of the following: Some may cause drowsiness. You should not drive or operate machinery after taking this medicine.
• Antihistamine nasal sprays. They are good for treating allergic rhinitis.
• Corticosteroid nasal sprays are the most effective treatment for allergic rhinitis. They work best when used continuously, but can also be helpful when used for shorter periods of time.
• Decongestants may also be helpful in reducing symptoms such as nasal congestion. Do not use decongestant nasal sprays for more than 3 days.
• Leukotriene inhibitors are prescription medications that block leukotrienes. These are chemicals that the body releases in response to an allergen that also cause symptoms.
• Allergy shots (immunotherapy) are sometimes recommended if the patient cannot avoid pollen and symptoms are difficult to control. This involves regular injections of microdoses of the pollen to which you are allergic. Each dose is a little more than the previous one until the person reaches a dose that helps control symptoms. Instead of injections, medicine is sometimes used under the tongue for allergies to grass and ragweed. Source: Pharmacotherapy of allergic rhinitis. Palchun V.T., Guseva A.L., Levina Yu.V., Derbeneva M.L. Medical Council, 2020. p. 122-127.

Allergic rhinitis according to ICD 10

The ICD is a list of all known diseases. Each diagnosis is assigned a unique alphanumeric code. For the average person, these codes do not carry any meaning.

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However, this classification is used in healthcare in every country in the world and clearly structures absolutely all diagnoses that exist today. It is reviewed and updated every ten years. Judging by the number 10 in the title, it is not difficult to guess that the ICD has already been revised ten times.

Allergic rhinitis is classified under the category “Other upper respiratory tract diseases”. The ICD 10 code value for this disease is J30.

In turn, hay fever is divided into narrower varieties of the disease, each of which has its own code. Below is an excerpt from this document - opposite each diagnosis is its ICD 10 code:

• J30.0 - vasomotor rhinitis;
• J30.1 - allergic rhinitis provoked by pollen of flowering plants;
• J30.2 - other seasonal allergic rhinitis;
• J30.3 - other allergic rhinitis;
• J30.4 - hay fever of unknown origin (that is, after all the research results, the cause of the disease could not be found).

Prevention and cure forecasts

Most symptoms of allergic rhinitis are manageable. In more severe cases, allergy shots are needed. For some people, especially children, allergies may improve or go away as the immune system becomes less sensitive to the trigger. But if a substance, such as pollen, causes an allergy, it often continues to have long-term effects on the person.

The patient can prevent symptoms by avoiding the pollen to which they are allergic. During pollen season, you should stay indoors with air conditioning if possible. Sleep with the windows closed and drive with the windows closed.

Sources:

1. Pharmacotherapy of allergic rhinitis. Palchun V.T., Guseva A.L., Levina Yu.V., Derbeneva M.L. Medical Council, 2021. p. 122-127
2. Rhinitis: differential diagnosis and principles of treatment. Guseva A.L., Derbeneva M.L. Medical Council, 2021. p. 102-108
3. Allergic rhinitis: what is it? Osipova V.V. Asthma and allergies, 2017. p. 19-20
4. Allergic rhinitis from the perspective of an allergist. Sidorovich O.I., Luss L.V. Consilium Medicum, 2021. p. 75-78
5. Allergic rhinitis. Ryazantsev S.V., Goncharov O.I. Medical Council, 2021. p. 76-79