Nonallergic rhinitis case add learner interaction SD, a 52-year-old female, presented to her primary care provider with a chief complaint of profuse “runny nose” for one week. She initially attributed the rhinorrhea to prolonged mothball exposure in her small office space. She was treated for allergic rhinitis verses vasomotor rhinitis with intranasal corticosteroids and oral antihis- tamines. She is now seen at the emergency department complaining of a diffuse headache, imbalance, cough, and right ear fullness. She denies any history of previous rhinitis, as well as eye or sneezing symptoms. Her past medical history is significant for hyperten - sion, hypercholesterolemia, diabetes mellitus (poorly controlled), and excision of a benign scalp lesion at age 18. Family history is significant for a father and eight siblings with allergic rhinitis, as well as one brother with asthma. Her social history is significant for pet and tobacco smoke exposure. She denies any illicit drug use. A review of systems was negative for trauma, fevers, chills, weight loss, night sweats, shortness of breath, chest pain, nau - sea, vomiting, and diarrhea. It was positive for diffuse headaches, unsteadiness, and a cough productive of clear sputum that was worse when supine. Physical exam: Vital signs were BP 172/86, P 89, R 18, T 36.2 C. Upon presentation, she is holding a tissue over her nose, cough - ing but not in distress. She had an atraumatic head; tympanic membranes and conjunctivae were transparent. She had copious clear nasal discharge from the right naris with a continual drip. The patient states the nasal drainage has a sweet taste. The nasal mu- cosa was otherwise moist and mildly erythematous, with slightly atrophic turbinates. There was no chest deformity. The lungs were
clear to auscultation without wheezes, rubs, or rhonchi. She had a regular heart rate and rhythm without murmurs, rubs, or gallops. A skin exam revealed no lesions. Extremity examination did not reveal any cyanosis, clubbing, or edema. Lastly, she had no en - larged cervical lymph nodes. This case shows the importance of obtaining a correct diagnosis of nonallergic rhinitis and what etiologies should be considered when NAR presents as a diagnosis. Healthcare Consideration: ● Obtain a thorough history of allergy and seasonal variation. ● Understand the triggers. ● Teach the patient how to use a nasal spray. ● Encourage medication compliance. ● Encourage avoiding triggers. ● If tobacco use: Counsel about how to quit smoking. Patients often misjudge the severity of rhinitis and fail to seek medical therapy. It is essential to get rhinitis under control, mainly due to the link between AR and asthma, and poor con- trol of rhinitis typically predicts poor asthma control. The con- nection between AR and asthma is based on a shared physio- logical response; both are part of the body’s immune response to an identified foreign substance. Patient compliance with the treatment regimen is crucial in appropriately managing and mit- igating symptoms. Patients should receive educational materi- als with information about rhinitis and its implications.
RECOMMENDATIONS FOR FUTURE PRACTICE
Goals for the future include attaining a consensus on the defi - nitions of rhinitis and rhinitis subtypes, including the formation of mixed rhinitis; imparting guidelines for the interpretation of nonrelevant positive tests for specific IgE sensitivity; and reaching Conclusion Rhinitis is a condition that affects productivity and quality of life in children and adults, resulting in them seeking relief from health care providers. An accurate diagnosis of allergic or nonallergic rhinitis is needed before selecting optimal treatment. A careful References • Akhouri, S., House, S. A., & Doerr, C. (2022). Allergic rhinitis nursing. StatPearls . https:// www.ncbi.nlm.nih.gov/books/NBK568690/ • Centers for Disease Control and Prevention (CDC). (2020). Allergens and pollen. U.S. Department of Health and Human Services . https://www.cdc.gov/climateandhealth/effects/ allergen.htm • DeShazo, D. R., & Kemp, F. S. (2022). Allergic rhinitis: Clinical manifestations, epidemiology, and diagnosis. UpToDate . https://www.uptodate.com/contents/allergic-rhinitis-clinical- manifestations-epidemiology-and-diagnosis • Dykewicz, M. S., Wallace, D. V., Baroody, F., et al. (2017). Treatment of seasonal allergic rhinitis: An evidence-based focused 2017 guideline update. Annals of Allergy, Asthma and Immunology, 119 (6), 489-511.e41. doi: 10.1016/j.anai.2017.08.012 • John Hopkins Medicine. (2022). Rhinitis . https://www.hopkinsmedicine.org/health/ conditions- and-diseases/rhinitis • Leader, P., & Geiger, Z. (2022). Vasomotor rhinitis. StatPearls . https://www.ncbi.nlm.nih.gov/ books/NBK547704/ • Nozad, C. H., Michael, L. M., Betty Lew, D., & Michael, C. F. (2010). Non-allergic rhinitis: A case report and review. Clinical and molecular allergy, CMA , 8, 1. https://doi. org/10.1186/1476-7961-8-1
agreement on the nonallergic triggers that best define VMR and VMR subtypes. The desired result is the delivery of the most ap- propriate treatment, specifically tailored to the accurate diagnosis of patients with rhinitis. history and physical exam will elucidate the extent and type of rhi- nitis, allowing practitioners to select the best treatment strategies for symptom management, which will lead to an increased quality of patient heath. • Seidman, M. D., Gurgel, R. K., Lin, S. Y., Schwartz, S. R., Baroody, F. M., Bonner, J. R., Dawson, D. E., Dykewicz, M. S., Hackell, J. M., Han, J. K., Ishman, S. L., Krouse, H. J., Malekzadeh, S., Mims, J. (., Omole, F. S., Reddy, W. D., Wallace, D. V., Walsh, S. A., Warren, B. E., … Nnacheta, L. C. (2015). undefined. Otolaryngology–Head and Neck Surgery, 152 (1_ suppl), S1-S43. https://doi.org/10.1177/0194599814561600 • Settipane, R. A., & Charnock, D. R. (2007). Epidemiology of rhinitis: Allergic and non- allergic. Journal of Allergy and Clinical Immunology, 19 , 23-34. PMID: 17153005. • Skoner, D. P. (2001). Allergic rhinitis: Definition, epidemiology, pathophysiology, detection, and diagnosis. Journal of Allergy and Clinical Immunology, 108 (1), S2-S8. https://doi. org/10.1067/mai.2001.115569 • Small, P., & Kim, H. (2011). Allergic rhinitis. Allergy, Asthma & Clinical Immunology, 10 (7), S3. doi: 10.1186/1710-1492-7-S1-S3 • Sur, D.K., & Plesa, M.L. (2018). Chronic nonallergic rhinitis. American Family Physician, 98 (3):171-176 https://www.aafp.org/pubs/afp/issues/2018/0801/p171.html • Wheatley, L. M., & Togias, A. (2015). Clinical practice: Allergic rhinitis. New England Journal of Medicine, 372 (5), 456-463. doi: 10.1056/NEJMcp1412282
RHINITIS: TREATMENT STRATEGIES FOR HEALTHCARE PROVIDERS Final Examination Questions Select the best answer for each question and then proceed to EliteLearning.com/Book to complete your final examination.
106. What is caused by a viral illness, allergic or seasonal (hay fever), which activates when allergens in the air trigger the release of histamines in the body? a. Nonallergic rhinitis. b. Allergic rhinitis.
107. Which condition involves the sudden onset of watery nasal discharge with eating, especially spicy or heated foods? a. Nonallergic rhinitis. b. Allergic rhinitis.
c. Vasomotor rhinitis. d. Gustatory rhinitis.
c. Vasomotor rhinitis. d. Gustatory rhinitis.
EliteLearning.com/Pharmacy
Book Code: RPTX3024
Page 140
Powered by FlippingBook