61 RHINITIS General Discussion Rhinitis can be practically viewed as a heterogeneous group of nasal disorders characterized by symptoms such as rhinorrhea, nasal congestion, nasal itching, and sneezing. These classic symptoms of rhinitis overlap significantly in allergic rhinitis and other forms of rhinitis, as well as with various anatomic abnormalities of the upper airway. Rhinitis may be caused by allergic, nonallergic, hormonal, infectious, occupational, and other factors. Allergic rhinitis is the most common type of chronic rhinitis, though 30–50% of patients with rhinitis have nonallergic causes. Allergic rhinitis can be categorized as seasonal, perennial, or occupational. Characteristics of allergic rhinitis include onset of symptoms early in life, a positive family history of allergic rhinitis, seasonal variability, itching in the nose, throat, or eyes, and the presence of identifiable suspected allergens. Physical examination often reveals moist and slightly blue nasal turbinates. The diagnosis of nonallergic rhinitis is made after allergic or IgE-mediated causes have been eliminated. Characteristics that suggest nonallergic rhinitis include onset of symptoms after age 30, a negative family history of allergic rhinitis, perennial symptoms, the absence of nasal or throat itching, symptoms that are precipitated by irritants or weather changes, and the presence of viral or flu-like symptoms. Physical examination often reveals nasal mucosa that is dry, erythematous, or irritated. Since 1998, three expert panels have published reviews of rhinitis. None of the three reports on rhinitis provides specific recommendations on when to perform allergy testing for patients with rhinitis. Empiric treatment is appropriate in patients with classic symptoms. In general, diagnostic tests may be appropriate if they will change outcomes, change treatment plans, if the symptoms are severe, if an unclear diagnosis is present, or if the patient is a potential candidate for allergen avoidance treatment or immunotherapy. The most common diagnostic tests for allergic rhinitis are the percutaneous skin test and the allergen-specific immunoglobulin E (IgE) antibody test. Other diagnostic tools include nasal cytology and nasolaryngoscopy. Skin testing involves introducing allergen and control substances into the skin. The primary goal of skin testing is to detect the immediate allergic response caused by the release of mast cell or basophil IgE-specific mediators. Allergen-specific IgE antibody testing, also known as radioallergosorbent testing (RAST) is highly specific but not as sensitive as skin testing. RAST is useful for identifying common allergens such as pet dander, dust mites, pollen, and common molds but is less useful for identifying food, venom, and drug allergies. Generally speaking, skin testing or RAST testing should be used to confirm suspicions but should not be relied on to make a diagnosis. Medications Associated with Rhinitis ACE inhibitors Anti-hypertensives Aspirin Beta blockers Chlorpromazine NSAIDs Oral contraceptives Causes of Rhinitis Allergic rhinitis • Occupational rhinitis • Perennial rhinitis Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA HAIR LOSS HYPOTHYROIDISM SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on RHINITIS Full access? Get Clinical Tree
61 RHINITIS General Discussion Rhinitis can be practically viewed as a heterogeneous group of nasal disorders characterized by symptoms such as rhinorrhea, nasal congestion, nasal itching, and sneezing. These classic symptoms of rhinitis overlap significantly in allergic rhinitis and other forms of rhinitis, as well as with various anatomic abnormalities of the upper airway. Rhinitis may be caused by allergic, nonallergic, hormonal, infectious, occupational, and other factors. Allergic rhinitis is the most common type of chronic rhinitis, though 30–50% of patients with rhinitis have nonallergic causes. Allergic rhinitis can be categorized as seasonal, perennial, or occupational. Characteristics of allergic rhinitis include onset of symptoms early in life, a positive family history of allergic rhinitis, seasonal variability, itching in the nose, throat, or eyes, and the presence of identifiable suspected allergens. Physical examination often reveals moist and slightly blue nasal turbinates. The diagnosis of nonallergic rhinitis is made after allergic or IgE-mediated causes have been eliminated. Characteristics that suggest nonallergic rhinitis include onset of symptoms after age 30, a negative family history of allergic rhinitis, perennial symptoms, the absence of nasal or throat itching, symptoms that are precipitated by irritants or weather changes, and the presence of viral or flu-like symptoms. Physical examination often reveals nasal mucosa that is dry, erythematous, or irritated. Since 1998, three expert panels have published reviews of rhinitis. None of the three reports on rhinitis provides specific recommendations on when to perform allergy testing for patients with rhinitis. Empiric treatment is appropriate in patients with classic symptoms. In general, diagnostic tests may be appropriate if they will change outcomes, change treatment plans, if the symptoms are severe, if an unclear diagnosis is present, or if the patient is a potential candidate for allergen avoidance treatment or immunotherapy. The most common diagnostic tests for allergic rhinitis are the percutaneous skin test and the allergen-specific immunoglobulin E (IgE) antibody test. Other diagnostic tools include nasal cytology and nasolaryngoscopy. Skin testing involves introducing allergen and control substances into the skin. The primary goal of skin testing is to detect the immediate allergic response caused by the release of mast cell or basophil IgE-specific mediators. Allergen-specific IgE antibody testing, also known as radioallergosorbent testing (RAST) is highly specific but not as sensitive as skin testing. RAST is useful for identifying common allergens such as pet dander, dust mites, pollen, and common molds but is less useful for identifying food, venom, and drug allergies. Generally speaking, skin testing or RAST testing should be used to confirm suspicions but should not be relied on to make a diagnosis. Medications Associated with Rhinitis ACE inhibitors Anti-hypertensives Aspirin Beta blockers Chlorpromazine NSAIDs Oral contraceptives Causes of Rhinitis Allergic rhinitis • Occupational rhinitis • Perennial rhinitis Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA HAIR LOSS HYPOTHYROIDISM SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on RHINITIS Full access? Get Clinical Tree
