Generality
Chronic rhinitis is an irritative and inflammatory process affecting the nasal mucosa, the symptoms of which appear gradually, last several months and are of moderate severity.
Chronic rhinitis can be allergic or non-allergic (or vasomotor).
Chronic allergic rhinitis arises as a result of an "allergy to substances, such as pollen, dust, animal hair or the so-called Balsam of Peru.
Chronic rhinitis of the non-allergic type, on the other hand, appears as a result of an excessive dilation of the blood vessels of the nasal mucosa, which leads to an accumulation of blood and fluids in the nasal cavities.
Treatment of chronic rhinitis depends on the underlying causes. Therefore, a correct diagnosis is crucial.
Medical significance of Rhinitis
Rhinitis is the medical term for any irritative and inflammatory process affecting the nasal mucosa.
- Heats and humidifies the air entering the nose;
- It traps the harmful (or in any case foreign) substances that could be found in the air entering the nose;
- It supports the sense of smell, as it has connections with the first cranial nerve (or olfactory nerve).
Highly vascularized, the nasal mucosa is the mucus-secreting epithelium, which lines and moistens the nasal cavities.
What is chronic rhinitis?
A chronic rhinitis is a form of rhinitis whose symptoms appear gradually, last several months and are of moderate severity.
According to a more specialized definition, coined by doctors, a rhinitis is chronic when its clinical manifestations last at least one "hour a day, for about a year.
It is important to underline that what has just been stated is valid in most cases, not for all (there may therefore be variations).
DIFFERENCES FROM ACUTE RHINITIS
A rhinitis is acute when the symptoms that characterize it appear quickly, last a few days and are very severe.
Causes
There are two types of chronic rhinitis: chronic allergic-type rhinitis and chronic vasomotor (or non-allergic) type rhinitis.
These two types of rhinitis differ in their triggering causes.
CAUSES OF ALLERGIC TYPE CHRONIC RHINITIS
The causes of chronic allergic-type rhinitis are the same as for generic allergic rhinitis.
Allergic rhinitis is the result of an allergic response (therefore it is an "allergy) to substances, such as pollen, dust, the so-called Balsam of Peru or animal hair.
From a pathophysiological point of view, in the presence of an allergic rhinitis it happens that the allergens (i.e. the aforementioned substances) induce the mast cells present in the nose to become the protagonists of an anomalous and massive degranulation, from which large quantities of inflammatory substances derive. A substance deriving from degranulation, particularly active in causing the inflammatory processes that characterize allergic rhinitis, is histamine.
What is an allergy?
An "allergy can be defined as an exaggerated, inappropriate and harmful antibody response triggered by the immune system to substances (so-called allergens) that, for most people, are completely harmless.
CAUSES OF VASOMOTOR TYPE CHRONIC RHINITIS
Chronic vasomotor rhinitis arises in the same way as generic vasomotor rhinitis (or non-allergic rhinitis).
According to the most accredited medical theories, the inflammatory process that characterizes non-allergic rhinitis would be initiated by an excessive dilation of the blood vessels of the nasal mucosa and the consequent accumulation, in the nasal cavities covered by the latter (ie the nasal mucosa), of large amounts of blood and fluids.
On the basis of various scientific studies, some of the main factors that would seem capable of favoring the aforementioned vasodilation process in circumstances that are still poorly understood are:
- The high temperature, sudden changes in temperature, high humidity, exposure to toxic fumes (eg cigarette smoke), spicy foods, too hot foods, stress, alcoholic substances, intense perfumes, etc. All these factors are labeled with the term environmental factors;
- Hormonal imbalances, which characterize particular moments in the life of a human being, such as pregnancy (exclusively for women) or puberty;
- Hormonal therapies or hormonal contraceptives;
- Particular pharmacological substances, including: some NSAIDs (eg: ibuprofen or aspirin), beta-blockers, ACE inhibitors (or inhibitors of the angiotensin converting enzyme), nasal decongestants in the form of sprays (in these situations , we speak of medicamentous rhinitis), drugs for the treatment of erectile dysfunction and some tranquilizers (eg benzodiazepines);
- The presence of damage to the turbinates or the absence of the latter, for example due to surgical removal. The turbinates are specific areas of the nasal cavity, made up of tissues that have the task of humidifying the inside of the nose and preventing the entry into the body of bacterial agents and other potentially dangerous microorganisms.
Vasomotor rhinitis, which depends on damage to the turbinates or their absence, is also called atrophic rhinitis; - Intense physical exercise;
- Strong emotions;
- Sexual arousal.
It is important to point out that, in some cases, vasomotor rhinitis appears without the occurrence of any of the aforementioned circumstances; in other words, it appears for inexplicable reasons. In these situations, doctors describe the inflammatory condition as an idiopathic disorder (idiopathic vasomotor rhinitis).
EPIDEMIOLOGY
Chronic rhinitis is quite common.
It can affect individuals of all ages, however it has a particular predilection for adults.
In most cases, chronic rhinitis episodes are allergic.
Symptoms and Complications
The classic symptoms of chronic rhinitis are the typical symptoms of a generic rhinitis, namely: stuffy nose, runny nose, repeated sneezing, postnasal drip (or discharge) and nasal voice.
If chronic rhinitis is of the allergic type, the following disorders can be added to the aforementioned disorders:
- Nasal itching;
- Cough;
- Headache;
- Sense of fatigue;
- Malaise;
- Itchy throat
- Conjunctivitis;
- Tearing
- Eyelid swelling (or swollen eyelids);
If, on the other hand, chronic rhinitis is of the vasomotor type, they can complete the classic symptomatic picture:
- Moderate irritation and a sense of discomfort in and around the nose
- A reduced sense of smell (anosmia);
- The formation of one or more scabs inside the nasal cavities. These scabs can be responsible for a bad smell coming out of the nose and for bleeding (if you try to remove them);
- The tendency to snore and halitosis.
INTENSITY AND PERIODICITY OF SYMPTOMS
The intensity of chronic rhinitis symptoms varies from patient to patient, with some suffering more than others.
However, symptom severity is always lower than that which can be observed in acute rhinitis.
Generally, those suffering from chronic rhinitis alternate periods in which the symptomatological picture is particularly evident with periods in which the clinical manifestations are barely mentioned; in some situations, this alternation can take place during the same day and within a few hours.
COMPLICATIONS
A chronic rhinitis characterized by particularly intense symptoms can strongly affect the patient's quality of life, affecting work activity, interpersonal relationships, school performance, etc.
In the specific case of chronic vasomotor type rhinitis, this, if not treated adequately, can lead to the onset of sinusitis, nasal polyps and / or otitis.
Diagnosis
To diagnose chronic rhinitis and understand its triggering causes (ie if it is allergic or vasomotor type), the following are necessary: physical examination, anamnesis and a series of allergic tests (skin tests and blood tests).
A positive response to allergic tests is indicative of chronic allergic-type rhinitis; a negative answer, on the other hand, indicates a chronic vasomotor type rhinitis.
Knowledge of the precise causes of chronic rhinitis is essential for planning the most appropriate therapy.
Treatment
The treatment of chronic rhinitis mainly depends on the triggering causes. In fact, allergic-type chronic rhinitis requires a therapy which, in various respects, is different from the therapy envisaged in the case of chronic vasomotor-type rhinitis.
ALLERGIC TYPE CHRONIC RHINITIS
The most used therapy in case of chronic allergic rhinitis includes:
- A series of precautions aimed at avoiding exposure to allergens triggering the symptoms;
- The administration of antihistamines in sprays, tablets or liquid solution. Antihistamine drugs are used to block the release of histamine, which, as readers will remember, is the substance responsible for inflammatory processes of an allergic nature;
- The use of decongestants that can be administered by spray or orally. Decongestants are useful for clearing a blocked nose.
They are contraindicated in case of hypertension and genitourinary diseases. They must not be used for long periods of time; - The use of eye drops and spray saline solutions. Eye drops are used to relieve itchy eyes, while spray saline solutions, on the other hand, are used to free the nose from excess mucus;
- Immunotherapy. Allergies are exaggerated responses of the immune system. Immunotherapy aims to reduce the strength of the immune system, so that the likelihood of an exaggerated response from the immune system to some type of allergen is less likely .
VASOMOTOR TYPE CHRONIC RHINITIS
The treatment of non-allergic rhinitis includes:
- A series of attentions aimed at avoiding exposure to those factors that seem to induce the dilation of the blood vessels of the nasal mucosa and the consequent inflammatory process. This is clearly possible in all those cases in which vasomotor rhinitis is not idiopathic;
- Nasal washes with saline solutions. They are used to cleanse the nasal cavities of excess mucus and irritants. In addition to reducing the inflammatory state, they are a source of relief;
- The use of corticosteroid nasal sprays. Corticosteroids are powerful anti-inflammatory drugs, which are medicines that reduce inflammation. Their prolonged use can lead to various side effects, therefore it is good to take them only after medical prescription;
- The use of anticholinergic nasal sprays. They limit the production of mucus inside the nasal cavities, thus relieving the symptom known as a runny nose;
- The use of decongestant nasal sprays. They reduce the excessive dilation of the blood vessels of the nasal mucosa.
DURATION OF TREATMENTS
Chronic rhinitis is a long-lasting condition, so treatments are likely to have to go on for long periods of time.
Generally, doctors recommend stopping treatments after a few months for at least two reasons:
- Because some of the aforementioned therapies, if applied for long periods of time, can have serious side effects;
- To see if the condition has resolved or if, on the other hand, when the therapy fails, it reappears.
Prognosis
Generally, if patients avoid exposing themselves to the factors triggering the symptoms, they are fairly likely to recover from chronic rhinitis or, at least, limit the resulting disorders.
