Rhinitis: symptoms, causes, diagnosis and treatment

By Cristiano Antonino On Jun 13, 2023

Rhinitis, also known as ‘coriitis’ or ‘nasal congestion’, is an inflammation of the respiratory tract, the symptoms of which can be as diverse as rhinorrhoea to nasal obstruction

It is often accompanied by bronchial asthma, conjunctivitis, otitis, sinusitis, adenoid hypertrophy, sleep disturbances and alterations of the facial mass.

Moreover, among the most common forms is certainly allergic rhinitis.

This type of inflammation should not be associated with other forms of rhinopathy such as infectious rhinitis (e.g. the common cold), irritative rhinitis, vasomotor rhinitis (caused by temperature excursions), atrophic rhinitis, tumour rhinitis, hormonal rhinitis (as in the case of hypothyroidism) or rhinopathy caused by drugs.

Today, the most recent classification in the field subdivides allergic rhinitis into ‘intermittent’ or ‘persistent’ if the symptoms go beyond four weeks, ‘mild’ or ‘moderate-severe’ depending on its intensity, how it affects the patient’s daily habits, e.g. sleep.

Symptoms of rhinitis

As we mentioned above, rhinitis and colds are different inflammations in terms of cause and duration.

In fact, if the symptoms last for more than one or two weeks, it is advisable to consult your doctor, because it could be rhinitis and not just a common cold.

So what are the most common symptoms of rhinitis?

We list them below:

rhinorrhoea (runny nose);
frequent sneezing;
nasal obstruction (stuffy nose);
nasal voice;itching nose;
burning eyes and throat;
retronasal drip (accumulation of mucus in the throat).

Rhinitis can be acute and therefore of limited duration, but also chronic, with a longer duration over time.

Causes of rhinitis

Again, to make a comparison with colds, while here the causes are usually viral, in rhinitis we find different ones, which we can schematise into three main pathologies

allergic rhinitis;
vasomotor rhinitis;
infectious rhinitis.

Allergic rhinitis

Allergic rhinitis is certainly the most common one, manifested by lacrimation, headaches and a feeling of tiredness.

It generally results from contact with allergens, e.g. pollen, dust mites or animal hair.

When the doctor identifies a case of rhinitis, he will treat it according to its intensity and severity.

Possible treatments are

antihistamines;
decongestant nose and throat medications;
decongestant eye drops;
immunotherapy.

Vasomotor rhinitis

Vasomotor or pseudo-allergic rhinitis is defined as hyper-reactivity of the nasal mucous membranes to an unspecific stimulus: change in air humidity, temperature, exposure to light, change in body posture.

The symptomatology is similar to allergic rhinitis (sneezing, watery rhinorrhoea, nasal congestion), but the pathological mechanism does not originate from a reaction to an allergen, but rather to a non-specific stimulus.

The therapy relies on drugs for local use (cortisone sprays and nasal washes with seawater).

Infectious rhinitis

Infectious rhinitis, on the other hand, manifests itself with viral or bacterial infections, to which symptoms such as fever, halitosis, tiredness, cough and general physical malaise may be added.

To treat it, anti-inflammatories are generally prescribed for fever and rest, and in more severe cases antivirals.

If of bacterial origin with anti-inflammatories for fever, rest and antibiotics

It is important to act promptly to prevent viruses and bacteria from spreading to the paranasal sinuses causing sinusitis or generating a rhinobronchial syndrome by descending to the lungs, a situation that could lead to pneumonia.

Diagnosis

When a specialist is called in, an anamnesis is generally taken and then the ENT specialist performs an objective examination (anterior rhinoscopy) and if necessary an endoscopic test, this to verify the cause of the nasal obstruction such as the presence of any polyps.

Later, allergy tests and nasal secretions can also be performed to further the diagnosis and identify the most effective treatment.

For example, verifying whether or not one is suffering from allergic rhinitis requires more than a doctor’s questions and analysis of symptoms.

Certain diagnostic tests are also necessary.

Tests that help the doctor determine whether there is specific IgE, i.e. the typical antibodies that are ‘released’ as a result of the activation of our immune system when it encounters an allergen.

These tests consist of putting the patient in contact with the suspected allergen and measuring the release of IgE or allergic reactions.

The specialist can then collaborate with the allergist to investigate whether the rhinitis is allergic-based.

This information can be obtained through tests called skin-prick tests and through the quantification of IgE in serum, a blood component.

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The first test, carried out on the skin by bringing the allergen into contact and checking for swelling, gives a result within fifteen minutes.

The blood test for IgE, on the other hand, can take several days.

The former requires a suspension of antihistamine use and cannot be performed on individuals with severe atopic dermatitis.

Obviously, before undergoing these tests, it is important to know the patient’s medical history and to analyse his or her symptoms to avoid misleading results.

The nasal provocation test

The literature states that the nasal provocation test makes it possible to avoid these risks and thus to identify cases of allergic rhinitis even when both the blood IgE test and the skin-prick test have given negative results.

This is because IgE is often only produced and released in the nasal mucosa.

So, in summary, the usual tests include: the patient’s medical history and objective examination, some allergy tests such as skin-prick, RAST for antibodies in the blood, nasal endoscopy, analysis of nasal secretions and a nasal provocation test with allergen, as well as possible CT scans and X-rays.

There are also optional tests that can be performed such as nasal biopsy, MRI, swabbing to identify possible bacteria and evaluation of upper airway patency.

How to treat rhinitis: treatments

So what are the most common treatments for treating rhinitis? For example, in the case of allergic rhinitis, one proceeds to identify the allergen and remove it from the patient.

Medical therapy, on the other hand, makes use of new-generation oral antihistamines or cortisone-based products in the form of nasal sprays, and frequent washings with hypertonic saline solution.

If there are other symptoms or concomitant illnesses, such as bronchial asthma or conjunctivitis, eye drops or antileukotrienic drugs may be prescribed in addition to therapy.

However, vaccine administration is always the most effective therapeutic choice.

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