What is rhinitis?
Rhinitis is a chronic respiratory disorder, characterized by inflammation of the nasal mucous membranes due to the exaggerated reaction of antibodies called immunoglobulin E (IgE).
Rhinitis can be allergic or non-allergic. Allergic attacks are usually induced by allergenic agents such as dust mites, pollen, dust, animal epithelia (hair).
However, there is non-allergic rhinitis which can also be a condition caused by hormonal variations, temperature changes, exposure to strong smells (cigarette smoke, perfumes, cleaning products etc.), medications and a rebound effect of nasal decongestants.
It is a condition that can have different types, but the most frequent and well-known manifestation is mixed rhinitis, in which there is the presence of allergic components, as well as irritants of the nasal mucosa. Along with asthma , this is the most common respiratory disorder among people.
The characteristic symptoms are the presence of recurrent sneezing, runny nose, nasal itch and, mainly, nasal congestion. Eye irritation and tearing may also occur, among other signs.
The persistence of symptoms may vary for each patient, and may last for two or more days, in crises of more than an hour a day. To avoid these attacks, it is recommended that patients avoid exposure to allergens.
In general, rhinitis does not have a cure, but these cases can also be controlled and treated with hygiene habits, distance from allergens and the use of medications prescribed by the doctor.
In the International Disease Code (ICD-10), rhinitis can be consulted by the ICD code 10 – J30 and the following subtopics:
- ICD 10 – J30 : Vasomotor rhinitis;
- ICD 10 – J30.1 : Allergic rhinitis due to pollen;
- ICD 10 – J30.2 : Other seasonal allergic rhinitis;
- ICD 10 – J30.3 : Other allergic rhinitis;
- ICD 10 – J30.4 : Unspecified allergic rhinitis:
Chronic rhinitis, caused by reaction to allergens and variations in nasal anatomy, is the most severe form of the disease, in which allergic attacks are more intense and symptoms persist for more than 3 months.
The condition differs from acute rhinitis precisely because of the time the symptoms persist and the severity of the condition.
The manifestations, also common among other types of rhinitis, include runny nose, constant sneezing and nasal congestion.
The most frequent manifestation of rhinitis is allergic rhinitis, but there are also other types, such as non-allergic, vasomotor, hormonal and infectious rhinitis. However, according to the duration, rhinitis can be considered acute (lasts 7 to 10 days) or chronic (lasts more than 3 months) .
Allergic rhinitis is an inflammation of the nasal mucosa, which can be diagnosed by the amount of IgE antibodies (Immunoglobulin E). This inflammation occurs due to exposure to allergens and triggers typical symptoms of rhinitis.
In general, the cause is due to contact with agents such as mites, pollen and epithelium (hair) from pets or other substances common to allergies. It can also be exposure to fungi (mold / mildew) and food.
Non-allergic rhinitis, or vasomotor, is an inflammation of the nasal passages unrelated to allergens, characterized by the dilation of blood vessels in the nose, causing swelling, nasal congestion and other typical symptoms also of allergic rhinitis.
The cause for this dilation, however, is not so evident when compared to allergic rhinitis. It is very common that it is due to exposure to strong smells such as cigarette smoke, perfumes, cleaning products and atmospheric temperature changes or exposure to air conditioning.
Infectious rhinitis is most often caused by a bacterial or viral infection, which can be an acute or chronic condition.
Many microorganisms can cause this type of rhinitis, and among viruses, rhinovirus is the most common. It is estimated that this microorganism is responsible for 30% to 50% of cases of infectious viral rhinitis.
Infectious bacterial rhinitis, on the other hand, usually occurs when the patient already has a viral rhinitis. In this case, the organism is already weakened and more vulnerable to infection by bacteria.
It is the most common type during pregnancy, menstruation, in patients with hypothyroidism , acromegaly (overproduction of growth hormone) or when using oral contraceptives due to hormonal changes caused in the body
This type of rhinitis occurs in reaction to the effects of progesterone , a hormone capable of relaxing the smooth muscle of the nasal vessels, which ends up raising the blood volume in the region.
The hormone estrogen, in turn, increases hyaluronic acid and inhibits acetylcholinesterase (substances that participate in the maintenance of the skin, muscles and other tissues), which can cause an accumulation of fluid ( edema ) in the nasal mucosa.
During pregnancy, rhinitis does not usually cause all typical symptoms, such as itching and sneezing. The main clinical manifestation during pregnancy occurs due to the presence of nasal congestion, which usually worsens in the last trimester of pregnancy.
This type of manifestation of the disease represents 5% of the cases, being characterized by nasal congestion due mainly to the rebound effect.
This rebound effect is usually caused by excessive and prolonged use of decongestant medications – those nasal droplets that many people carry everywhere and use on their noses from time to time. It happens as a consequence of the vasodilation effect, which ends up causing a reduction in vascular tone (vascular atony).
When rhinitis occurs due to the induction of these vasoconstrictors, it is called the condition of medicated rhinitis.
It can also occur through the use of systemic drugs, such as drugs used to treat patients with hypertension, in addition to aspirin, anti-inflammatories, oral contraceptives, guanetidine, reserpine and inhalation drugs, such as cocaine, for example.
Vasomotor rhinitis, or idiopathic, is one of the types of rhinitis in which the runny nose (rhinorrhea) is one of the most common and uncomfortable symptoms. However, it is different from other types of rhinitis because, in the test to detect a possible allergy , the result is usually negative.
Thus, identifying the cause of the allergy in these patients becomes even more complicated, as soon as it is not known which or if there is a responsible allergen. There is still no scientific evidence regarding this, but it is believed that this may be a vascular or neurovascular problem.
Allergic rhinitis and sinusitis are different pathologies, but they occur simultaneously at the same time. It is not yet known exactly what the relationship between cause and effect is for them to manifest together, but it is a recurrent condition in both adults and children.
This type of manifestation is called rhinosinusitis , characterized by inflammation of the nasosinusal mucosa, nasal region and nearby cavities (sinus). Like rhinitis, rhinosinusitis also receives some classifications according to the duration of symptoms, and can be diagnosed as follows:
- Acute : when symptoms persist for up to four weeks;
- Subacute : permanent symptoms for 4 to 12 weeks;
- Chronic : symptoms persist for more than 12 weeks;
- Recurrent : when symptoms appear for 6 or more acute episodes over the course of a year.
Rhinitis can be caused by an overreaction of the body when trying to defend itself against an allergen, in the presence of an infection (viral or bacterial) or by hormonal changes.
Thus, there are certain factors that are capable of triggering allergic reactions in some people, but that are harmless to others.
These allergenic factors cause an inflammation of the mucous membranes of the nasal cavity, the most frequent agents being some foods, mites, animals, dust, drugs or even chemical substances.
Read more: Why eat fruits and vegetables?
They can come into contact with the organism in different ways, such as by ingestion, inhalation, insertion through the skin (mosquito bites) and in direct contact with the skin (such as perfumes, creams, plants, etc.).
Substances capable of being inhaled are usually the main causes of allergic rhinitis. Therefore, as part of preventive behavior, greater care is recommended when avoiding exposure to factors such as smoke, dust, chemicals and pollen, for example.
Allergic rhinitis attacks happen due to exposure to certain allergens, which play a role in inducing nasal inflammation. Consequently, they trigger the onset of symptoms.
Greater attention should be paid to the risk of rhinitis in people who are always exposed to or work in contact with the following substances or elements:
- Cigarette smoke;
- Animal epithelia (hair);
- Foods such as soy, chocolate, cow’s milk, wheat, crustaceans, etc. (rarest condition);
- Changes in temperature;
- Dry weather;
- Changes in emotional state, such as excessive stress, nervousness, anxiety;
- Respiratory infection caused by viruses and fungi;
- Inhalation of chemical sprays, such as deodorants, perfumes and hair products;
- Family history.
The symptoms of rhinitis usually occur soon after contact with the allergen and usually manifest runny nose, itchy eyes and nose, nasal congestion and repeated sneezing.
These symptoms are due to the body’s attempt to expel the agent that caused this irritation. Variation of clinical symptoms may occur, according to the patient’s age and type of rhinitis.
Other manifestations include:
- Shortness of breath or need to breathe through your mouth;
- Bad breath;
- Facial pain;
- Skin irritation;
- Reduction of smell, taste and hearing;
- Swelling in the eyes;
- Accentuated lower eyelid lines (Dennie-Morgan lines)
- Sore throat;
The permanence of symptoms can vary, being recurrent only at specific times of the year, sporadically or persistently.
Asthma is a chronic respiratory disease characterized by inflammation, swelling and narrowing of the airways, which ends up impairing the patient’s breathing capacity. Like rhinitis, asthma is one of the most common respiratory diseases.
In addition, rhinitis is also considered a risk factor for asthma. These two conditions, when they occur simultaneously, can increase the chances of hospitalization, as rhinitis can further aggravate the condition of patients with asthma, and can cause complications such as respiratory failure.
People who have the type of persistent rhinitis should also investigate the possibility of an asthma condition and the opposite as well, as the proper treatment of both diseases is the best way to avoid complications.
Rhinoconjunctivitis is the name given to the condition in which the patient is affected by a combination of rhinitis with allergic conjunctivitis , presenting an inflammatory reaction of the nasal and ocular mucous membranes.
It is estimated that the prevalence of both conditions concomitantly occurs in approximately 70% of patients with severe allergic rhinitis.
Like rhinitis, rhinoconjunctivitis can also occur by inducing different infectious agents or allergens, such as bacteria, fungi, viruses, chemicals, pollen and other frequent triggers.
Symptoms are characteristic of both conditions, in which the patient may present with runny nose, nasal congestion, itchy nose and (itchy), watery eyes, redness, edema (swelling) in the eyelids and a feeling that there is a foreign body in the eye, such as a speck, for example.
Rhinitis diagnosis can be made by a general practitioner, but patients are usually seen or referred by specialists in the field of otolaryngology .
The doctor must evaluate the patient to investigate his medical history (anamnesis) and symptoms.
Some simpler exams can be performed at the beginning, such as inspecting the patient’s nasal cavity with a flashlight.
Complementary tests include blood tests to check the dosage of IgE antibodies, skin-allergic tests, analysis of nasal secretion and rhinomanometry, an examination performed to check nasal potency.
Find out how they work:
Immediate hypersensitivity skin tests (TCHI)
Immediate hypersensitivity skin tests are recurrent in the diagnosis of respiratory allergies that occur when IgE antibodies react. They are considered very specific and highly sensitive tests.
This examination should be done under prescription and medical monitoring, preferably with antigens corresponding to the clinical history, age, environment in which the patient lives and works.
In this type of test, the percentage of positive results for an allergic reaction to dust mites can be from 30% to 40%, which does not mean that all patients with positive results show symptoms of allergy, for example.
This test is done to measure intranasal pressure and airflow (nasal resistance), but it is not usually performed for the diagnosis of rhinitis. You are asked to assess how the patient reacts to the nasal provocation test, to monitor clinical or surgical treatment and also to check how much the nasal passages are obstructed.
The examination to verify the IgE dosage is done by collecting a blood sample, which undergoes an analysis to identify this antibody and in what quantity it is found.
It may present inconclusive results for the diagnosis of rhinitis, due to the fact that other diseases or infections may affect its values.
It is important that the test is complementary and analyzed along with other results, as it alone is not able to confirm rhinitis.
It depends on the type of rhinitis. In the case of allergic rhinitis, for example, there is no cure. In this condition, patients can be diagnosed with the allergen that causes the condition and treatment.
In non-allergic rhinitis, on the other hand, depending on the cause, it is possible that the patient can have his condition resolved more easily, as in the case of rhinitis caused by specific chemicals or medicated rhinitis.
Rhinitis caused by hormonal changes, frequent during pregnancy, can also be cured, as this is usually a condition that resolves spontaneously after delivery.
The treatment of rhinitis is based on care with environmental hygiene, the use of medicines and vaccines (immunotherapy).
It is recommended that in addition to the use of medications, the patient also maintains a routine of preventive care, such as avoiding the allergen that can incite a crisis. When the patient is unaware of the agent, skin tests can be done to recognize this trigger.
Learn more about the main forms of treatment:
Drug treatment should be indicated by the doctor, according to the type of rhinitis and the symptoms. The time of use, in the same way, must be done according to the recommendations of a specialist, because like other medications, there are possible side effects and even the possibility of a rebound effect, such as medicated rhinitis.
It is worth remembering that the best medicine for the treatment of rhinitis in the long run is the nasal spray, as it acts directly on the nose. It is important to avoid prolonged use of oral medications and, in particular, injectable corticosteroids.
It is the use of saline solutions, such as saline, to clean the nostrils and help eliminate allergens. It is usually indicated for milder cases of rhinitis, and can be used in conjunction with drug treatment.
There are also saline solutions made from the combination of water, salt and sodium bicarbonate.
The patient can apply the solution, for hygiene of the nasal region, in three ways: by application by syringe, by aspiration (when placing the solution in the palm of the hand) or by aerosols, always following medical guidelines.
Also called allergen immunotherapy, this treatment is the most specific when it comes to allergic rhinitis. Medications treat symptoms, while immunotherapy acts effectively on the disease, due to the inactive manipulation of the allergens that cause the symptoms.
The method can be carried out by injecting small doses of the allergen responsible for causing the allergic reaction in the patient or more and more routinely through sublingual drops.
This type of treatment is recommended so that the patient’s body can adapt to the agent, reducing the allergic reaction during exposure, which may be necessary in more severe cases of rhinitis.
Immunotherapy with allergens is performed when the patient proves sensitization (when there is the presence of IgE antibodies to the allergen), when there is a medical recommendation and according to the availability of the allergen for treatment, as the treatment is carried out with the most common elements (mites, pollen, animal hair, etc.).
The duration of treatment varies according to the patient, and may take 3 to 5 years.
The main drugs used to treat rhinitis are oral antihistamines, antileukotrienes, nasal corticosteroids and, in specific cases and for a few days, nasal decongestants based on substances such as Phenylephrine , Oxymetazoline and pseudoephedrine.
Among the medications that can be prescribed by the doctor are:
They are anti-inflammatory drugs, usually recommended for patients with allergic and non-allergic rhinitis. The application is done via the nose and the amount of jets applied must be in accordance with the medical recommendation.
Some of the nasal corticosteroids used to treat rhinitis include Fluticasone , Beclomethasone , Mometasone , Budesonide and Triamcinolone .
Antihistamines, taken as pills or syrups, are recommended drugs for the relief of symptoms such as itching, sneezing and runny nose, but they are not usually effective in relation to nasal congestion. Some antihistamines used are diphenhydramine and Dexchlorpheniramine , which can cause drowsiness as an adverse reaction. Other drugs in this class that can be prescribed by the doctor are:
- Cetirizine ;
- Clemastina ;
Nasal decongestants are drugs used to minimize nasal congestion and facilitate breathing. Due to the risk of rebound effect or the addiction they can cause, when used in excess, the recommendation divides opinions.
For this reason, they must be used with adequate medical monitoring, always avoiding self-medication .
Some decongestants that can be used, as recommended by a doctor, are:
- Sorine ;
- Rinosoro ;
- Naridrin ;
- Neosoro .
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
There are some homemade recipes that can help patients reduce their symptoms. Among them are tea tips, nasal sprays, juices and some spices that help to strengthen the immune system.
They are prescriptions recommended as a complement to the treatments prescribed by the responsible physician and, therefore, they should not replace the use of medications or other therapies.
Some tips include:
- Eucalyptus tea;
- Ginger tea;
- Garlic tea;
- Mint tea;
- Apple vinegar;
- Chamomile, in tea and for steam inhalation;
- Mango and orange juice.
Read more: Garlic tea and its benefits
Rhinitis can progress to more severe conditions when the patient does not receive adequate treatment. One of the reasons that lead to this is the fact that it is a condition that makes the body favorable to the emergence of other diseases (comorbidities).
In addition to health problems, rhinitis is also associated with impairments in quality of life, learning and social interaction. Therefore, complications that can occur in the absence of treatment include:
The otitis media is an inflammation that occurs in the external ear or middle ear. It is a disease characterized mainly by the presence of earache and is usually caused by the entry of microorganisms in the region.
Excess mucus, characteristic of the inflammatory process of rhinitis, can lead to the appearance of this condition.
Usually, treatment is done through the use of medications, prescribed by the responsible physician. It is common for this to be a condition considered a comorbidity of rhinitis, not just a complication.
Mouth breathing and snoring
The nasal congestion that rhinitis causes usually makes it difficult for the patient to breathe normally through the nose. As a consequence, the patient may end up snoring or developing a condition of sleep apnea , due to the obstruction caused by the inflammation.
In the case of snoring, specifically, what happens is a blockage of the air passage (pharyngeal space), due to the reduction of local muscle tone.
With less air reaching the lungs, the body works to inhale with more force and speed, which is the reason for the noise we know as snoring.
Rhinitis is not considered a serious disease, but it is still a pathology capable of affecting the social life of patients, in different age groups.
It is believed that it is a condition responsible for interfering in activities such as study and work, and may be the reason for the decrease in productivity. This is due to the symptoms present, which can be quite uncomfortable for patients.
Associated with snoring and mouth breathing, patients with rhinitis may also have the appearance of associated sleep problems, such as snoring and sleep apnea, as a complication.
Because snoring means a loss in respiratory quality, since it indicates that our body is not receiving enough oxygen, it also becomes bad for the quality of sleep.
This interferes with other activities of the patient throughout the day, as it can make him less productive, with reduced attention and other problems.
Sinusitis is an inflammation that affects the mucosa of the sinuses, part formed by the bony cavities around the eyes, nose and cheekbones. In many patients who do not have rhinitis, sinusitis is absent. On the other hand, it is more rare for patients with sinusitis who do not also have rhinitis.
The joint occurrence is so frequent that there is the term rhinosinusitis, used for this situation.
Although most types of rhinitis are not curable, the prognosis of patients is usually positive. Diagnosis and treatment, when performed correctly, usually present good results for the patient, improving their quality of life and significantly reducing the number of crises.
Rhinitis attacks can be prevented with some changes in habit and care for the environment. Indoors, small cares already help to reduce the triggers that cause allergic rhinitis. It is recommended, for this:
- Keep all environments well ventilated and sunny;
- Avoid using rugs, curtains, cushions and carpets, preferring floors and surfaces that can be washed more easily, such as wooden and ceramic floors. Opting for blinds may be the best option for those who suffer from the condition, since cleaning can be done with a cloth;
- Avoid mold and moisture, especially in the bedroom;
- Check the damp areas of the house, such as the bathroom and kitchen, to check for mold. Using a solution with bleach diluted in water can be used to clean these areas;
- Prevent the garbage from being stored inside the house;
- Use a damp cloth daily for cleaning or use a vacuum cleaner with special filters twice a week to clean the house;
- If possible, prevent the allergic person from staying in the environment while cleaning or using masks during cleaning;
- Avoid mops, common vacuum cleaners and brooms for cleaning.
To maintain or restore the patient’s quality of sleep, room care, avoiding allergens, is essential. Tips include:
- Use a mattress and pillows made of materials that are waterproof, which minimize the risks of dust mite accommodation;
- Clean the bed frame, at least twice a month;
- Wash bedding and blankets frequently, allowing them to dry completely in the sun or warm air before using them again;
- Avoid woolen blankets, preferring comforters (except those that are down);
- Avoid smoking in the room and the movement of pets in the environment.
Avoiding exposure to irritants
- Avoid the accumulation of books, boxes, magazines, stuffed animals and other objects that can increase the chances of the appearance of mite colonies;
- Do not smoke;
- Prevent smoking in the car or inside the house. In addition, in other environments, avoid attending the smokehouse;
- Avoid cleaning products or personal hygiene with a strong odor;
- Opt for baths with body temperature, avoiding excessively hot baths;
- Practice outdoor activities, but avoid exposure to pollens or pollution, as far as possible;
- Avoid, when facing an allergic reaction, contact with pet hair, feathers or saliva;
- Avoid contact with incense or odorants from environments;
- Use masks, when necessary, as professionals who work in beauty salons and are exposed to the odor of chemicals;
- Avoid leaving the air conditioner on all the time, due to the dryness of the air. It is also important to maintain hydration especially when it is on.
When I have rhinitis, the medications are of little help. What can I do?
During crises, the use of medications can help to alleviate the symptoms, but the ideal is to avoid the onset of symptoms. Sometimes, medications may not be as effective in relieving manifestations, having a delayed or unsatisfactory effect.
The best way to avoid this situation is through environmental hygiene, that is, with the removal of allergens.
For example, if you are a patient who has allergic rhinitis due to contact with pollen, being away from this agent will be more effective than using drugs. As the saying goes, prevention is better than cure.
In addition to distancing yourself from the cause, using saline solutions or using saline to clean your nose can also help.
Can rhinitis lead to sinusitis?
Yes. Because it is one of the risk factors for sinusitis, rhinitis when not properly treated or in severe cases can end up evolving into a sinus condition, such as comorbidity.
Does rhinitis give you a fever?
No. Fever is usually not a common symptom in patients with rhinitis. However, if the patient has another concomitant illness, such as sinusitis, feverish conditions may occur.
Rhinitis is the response to an inflammatory process of the nasal mucous membranes, being one of the most frequent respiratory problems. There are several risk factors that can trigger a crisis, such as exposure to allergens, irresponsible use of medications, pregnancy, temperature, dry air, among other inducers.
We seek in this article to clarify the different types of rhinitis and its causes, as well as to present some changes in daily life that can help in the prevention of crises and control of the disease.
Share this information so that more people can know the characteristics of the condition. Thanks for reading!