Rhinitis is one of the most prevalent and chronic diseases worldwide. A group of nasal symptoms known as "rhinitis" includes a runny or stuffy nose, sneezing, pruritus (itching), rhinorrhea, and nasal congestion or obstruction. It may endure for an hour or the entire year. During rhinitis, the nasal mucosa may be swollen or become dysfunctional. Since most symptoms of rhinitis disappear on their own without medical intervention, most cases go undiagnosed. Rhinitis can result in significant morbidity and place a major financial burden on the patients.
Rhinitis symptoms can be both persistent and sporadic throughout the year and depend on the underlying etiology. The following are the common rhinitis-associated symptoms:
Stuffy/ Runny nose
Anterior or posterior rhinorrhea
Itching, redness, and swelling of the eyes
Itchy sensation in the nose and throat
Clear nasal drainage
Recurrent ear infections
Most often, the diagnosis of rhinitis is made based on an in-depth clinical history and physical examination of the individual supported by a skin prick test. In addition to this, some other tests may be advised which include:
Laboratory investigations (pulmonary and thyroid function tests, complete blood eosinophil count, microbiological examination of sputum and sinus, asialotransferrin in nasal secretions, and urine toxicology)
Nasal nitric oxide (nNO) and fractional exhaled nitric oxide (FeNO)
Depending on how severe the symptoms are, a step-by-step approach can be adopted. Avoiding allergens or triggers is one of the key therapeutic methods. A progressive pharmacotherapeutic strategy should be used, which includes:
The first-generation H1 antihistamines like diphenhydramine, brompheniramine, chlorpheniramine, and hydroxyzine are effective in controlling sneezing, rhinorrhea, and itching associated with allergic rhinitis. However, second-generation H1 antagonists including fexofenadine, loratadine, desloratadine, cetirizine, and levocetirizine are more effective for allergic rhinitis. Whereas, in the case of nonallergic rhinitis first-generation antihistamines are more effective than second-generation antihistamines due to their anticholinergic effects.
Topical steroids are an effective treatment option for all the symptoms of allergic and nonallergic rhinitis, and they frequently reduce nasal obstruction, itching, sneezing, and watery rhinorrhea. Intranasal corticosteroids have been found to effectively treat non-allergic rhinitis, especially in cases of vasomotor rhinitis and non-allergic rhinitis with eosinophilia syndrome.
Decongestants are available in oral and topical preparations. They successfully reduce nasal congestion. Oral decongestants are not recommended for anyone who is over 60, under 1 year old, or who has a cardiac problem or a heart ailment.
It might be particularly effective in reducing congestion, sneezing, and postnasal drip. It is ideally performed right before intranasal corticosteroids or azelastine. The nasal saline spray might be useful to reduce biofilm and thin mucus and to eliminate antigens and inflammatory mediators.
Leukotriene receptor antagonists
Leukotriene receptor antagonists (LTRAs) should be taken into consideration when oral antihistamines, intranasal corticosteroids, and/or sprays containing a mix of corticosteroids and antihistamines are not well tolerated in managing the symptoms of allergic rhinitis.
Allergen-specific immunotherapy (AIT) can be administered subcutaneously or sublingually and is a successful therapeutic strategy for allergic rhinitis that results in long-term clinical tolerance to the sensitizing allergen. Allergen immunotherapy should be attempted if a combination of pharmacological treatments, including oral antihistamines, intranasal corticosteroids, sprays containing both corticosteroids and antihistamines, and LTRAs, is ineffective or poorly tolerated.
Surgery is provided in some cases, such as septum anatomical variations and inferior turbinate hypertrophy resistant to medication.
Early diagnosis and management of rhinitis can prevent serious complications and will yield optimistic outcomes and greatly enhance the patient's quality of life. Further progress in the therapeutics of rhinitis undoubtedly will enhance the understanding of the underlying pathogenesis of rhinitis and might thus help to manage rhinitis as well as its symptoms more effectively.