Chapter 10: Rhinitis: Treatment Strategies for Healthcare Providers 1 Contact Hour
By: Dr. Karen Scaglione, DNP, APRN, AGACNP-BC, ACNP-BC, CLNC Author Disclosure: Dr. Karen Scaglione, and Colibri Healthcare, LLC do not have any actual or potential conflicts of interest in relation to this lesson. Universal Activity Number UAN: 0607-0000-22-046-H01-P Target Audience: Pharmacists in a community-based setting. To Obtain Credit: A minimum test score of 75 percent is needed to obtain a credit. Please submit your answers either by mail, fax, or online at EliteLearning.com/Book Learning objectives After completing this course, the learner should be able to: Describe the epidemiology of allergic and nonallergic rhinitis. Discuss the pathophysiology of allergic and nonallergic rhinitis. Activity Type: Knowledge-based Initial Release Date: 12/26/2022 Expiration Date: 12/26/2025
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Review assessment and diagnostic testing for allergic and nonallergic rhinitis. Explain the pharmacologic and nonpharmacologic treatment strategies for allergic and nonallergic rhinitis.
INTRODUCTION
Rhinitis is common, impacting many people worldwide. Nearly all types of rhinitis are caused by inflammation and are correlated with symptoms in the ears, eyes, and/or throat. This educational Allergic rhinitis The most common type of rhinitis is acute allergic rhinitis (AR), which is usually caused by a viral illness, allergies, or seasonal triggers (hay fever), which are activated when allergens, such as pollen from trees, grasses, and weeds, in the air cause the release of histamines in the body (DeShazo & Kemp, 2022). This type Nonallergic rhinitis Nonallergic rhinitis (NAR) is a syndrome of chronic nasal congestion symptoms and rhinorrhea unrelated to a specific allergen. Nonallergic rhinitis can be divided into numerous subtypes, with vasomotor rhinitis (VMR) being the most common: ● Vasomotor rhinitis is a term often used to describe rhinitis symptoms associated with noninfectious triggers with no clear etiology after an extensive search for a diagnosis. ● Gustatory rhinitis involves the sudden onset of watery na- sal discharge when eating, especially foods that are spicy or heated ● Nonallergic rhinitis with eosinophilia syndrome (NARES) is an eosinophilic inflammation of the nasal mucosa without evidence of an allergy or other nasal pathologies. Patients complain about perennial symptoms like nasal obstruction, rhinorrhea, itchiness of the nose, and sneezing, sometimes In 2018, approximately 24 million people in the U.S. were diag- nosed with seasonal allergic rhinitis. This includes approximately eight percent adults (19.2 million) and seven percent of children (5.2 million). Today, the number of people affected by allergic rhi- nitis is estimated to be 60 million and will likely continue to rise (Centers for Disease Control and Prevention [CDC], 2020). The epidemiological data and presentation of allergic and non- allergic rhinitis can be challenging. Rhinitis symptoms are among the most common problems presented to clinicians. The diagnos- tic challenge is determining the etiology, specifically whether it is allergic, nonallergic, or overlap of both etiologies. Although the
program provides an overview of the various forms of acute and chronic rhinitis that are most common among adults.
of rhinitis occurs mainly in the spring and fall when pollen from trees, grasses, and weeds is in the air. Perennial allergic rhinitis is a chronic allergic condition that causes nasal congestion and a runny nose. Unlike other types of allergies, it doesn’t go away during certain seasons or months of the year. accompanied by hyposmia (a reduced ability to smell and to detect odors). Nonallergic rhinitis is often characterized by onset after age 20, with most patients seeking medical care for it between the ages of 30 and 60; female predominance; nasal hyperactivity; perenni- al symptoms; and nasal eosinophilia. Nonallergic rhinitis occurs in approximately one-third of the population. Positive tests for relevant specific immunoglobulin E (IgE) antibody sensitivity in the setting of rhinitis do not rule out “mixed rhinitis” (the com- bination of allergic and nonallergic rhinitis) and may not rule out nonallergic rhinitis. The significance of symptom exacerbation by nonallergic triggers in the setting of allergic rhinitis remains to be established (DeShazo & Kemp, 2022).
EPIDEMIOLOGY
prevalence of nonallergic rhinitis has not been definitively deter - mined, it appears to be common, with an estimated prevalence in the U.S. of approximately 19 million (Settipane & Charnock, 2007). In comparison, the prevalence of mixed rhinitis is approximately 26 million, and allergic rhinitis (“pure” and “mixed” combined) is 58 million. Challenges in the differential diagnosis of rhinitis result from two significant factors. Not only are presenting symptoms of allergic, nonallergic, and mixed rhinitis often undifferentiated from one another, but the differential diagnosis of nonallergic rhi- nitis is vast.
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