Q&A: Treatment of Rhinitis

Rhinitis is common, affecting nearly everyone at one time or another. There are various types of acute and chronic rhinitis which commonly affect adults and children. Rhinitis caused by viral respiratory infection is usually self-evident. There are multiple causes of rhinitis. Different syndromes are recognized mainly by clinical history, patterns of symptoms, and to a lesser extent, physical signs.

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This is a Question & Answer revision article designed for medical students and professionals preparing for the PLAB, MRCP or USMLE examinations. They are based on actual questions from these examinations. You may find the Allergies article more useful, or one of our many articles on Diseases & Conditions, Medical Syndromes, Health & Wellness or Home Remedies.

In this article:
Definitions of rhinitis
MCQ: clinical scenario
MCQ: answer
MCQ: explanation

Definitions of rhinitis

Rhinitis is the presence of one or more of the following nasal symptoms:

• Sneezing
• Rhinorrhea (anterior and/or posterior)
• Nasal congestion (stuffiness)
• Nasal itching

"Rhinosinusitis" (also known as sinusitis) is a term that encompasses disorders affecting both the nasal passages and paranasal sinuses and has overlapping but distinct symptoms from pure rhinitis. Symptoms of sinus involvement may include nasal congestion, posterior nasal drainage (which is often purulent), facial pressure and/or pain, headache, and in some cases, reduced sense of smell.

MCQ: clinical scenario

An 8-year-old boy regularly experiences moderately severe sneezing spells and watery eyes in May and June, September and October, and occasionally during January through March. Immediate skin test show a positive reaction to Alternaria, Cladosporium, house dust and grass and ragweed pollens.

The most appropriate treatment would include:

a) Antigen avoidance
b) Immunotherapy against the known offending antigen
c) Antihistamine-decongestant preparation
d) Topical adrenergic agonist
e) Oral adrenergic agonist

MCQ: answer

The correct answer is C

MCQ: explanation

Antihistamine-decongestant preparations remain the initial drug of choice for allergic rhinitis. Nasal cromolyn sodium, which in some cases is as effective as an antihistamine-decongestant in treating seasonal allergic rhinitis, could have been recommended for the 8-year-old boy with seasonal symptoms. Administration to nasal cromolyn sodium, however, requires the patient to carry a nasal pump and administer the treatment approximately four times daily prior to expected antigen exposure, making it inconvenient for some patients. Patients who cannot tolerate oral medications may respond to cromolyn sodium, however. It is sometimes effective for perennial allergic rhinitis, but is more often used to alleviate acute seasonal symptoms.

Reference(s)
1). UpToDate: An overview of rhinitis. Available online: https://www.uptodate.com/contents/an-overview-of-rhinitis