View source for Rhinitis

{{Short description|Irritation and inflammation of the mucous membrane inside the nose}}
{{Redirect|Coryza|the genus of beetles|Coryza (beetle)}}

{{Infobox medical condition (new)
| name            = Rhinitis
| synonyms        = Coryza
| image           = Misc pollen.jpg
| caption         = [[Pollen]] grains from a variety of common plants can cause [[Allergic rhinitis|hay fever]].
| pronounce       = {{Plainlist|
* rhinitis {{IPAc-en|r|aɪ|ˈ|n|aɪ|t|ɪ|s}}<ref>{{Cite web | title = rhinitis {{!}} Definition, meaning & more {{!}} Collins Dictionary | publisher = www.collinsdictionary.com | url = https://www.collinsdictionary.com/dictionary/english/rhinitis | access-date = 4 January 2017 }}</ref>
* coryza /kəˈraɪzə/<ref>{{Cite web | title = coryza {{!}} Definition, meaning & more {{!}} Collins Dictionary | publisher = www.collinsdictionary.com | url = https://www.collinsdictionary.com/dictionary/english/coryza | access-date = 4 January 2017 }}</ref> }}
| field           = [[Infectious disease (medical specialty)|Infectious disease]], allergy and [[immunology]]
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<!-- Definition and symptoms -->
'''Rhinitis''', also known as '''coryza''',<ref>{{cite book|last1=Pfaltz|first1=Carl Rudolf | first2 = Walter | last2 = Becker | first3 = Hans Heinz | last3 = Naumann | name-list-style = vanc |title=Ear, nose, and throat diseases: with head and neck surgery| year=2009| publisher=Thieme| location=Stuttgart|isbn=978-3-13-671203-0|page=150|url=https://books.google.com/books?id=HlrHjWQsRGEC&pg=PA150|edition=3rd}}</ref> is irritation and [[inflammation]] of the [[Mucous membrane of nose|mucous membrane]] inside the [[nose]]. Common symptoms are a [[nasal congestion|stuffy nose]], [[rhinorrhea|runny nose]], [[sneeze|sneezing]], and [[post-nasal drip]].<ref>{{cite web | url=http://www.mayoclinic.com/health/nonallergic-rhinitis/DS00809/DSECTION=symptoms | archive-url=https://web.archive.org/web/20080924131752/http://www.mayoclinic.com/health/nonallergic-rhinitis/DS00809/DSECTION=symptoms | url-status=dead | archive-date=2008-09-24 | title=Nonallergic rhinitis }}</ref>

<!-- Cause -->
The inflammation is caused by [[virus]]es, [[bacteria]], irritants or [[allergen]]s. The most common kind of rhinitis is [[allergic rhinitis]],<ref name=epid>{{cite journal |vauthors=Settipane RA |title=Rhinitis: a dose of epidemiological reality |journal=Allergy Asthma Proc |volume=24 |issue=3 |pages=147–54 |date=2003 |pmid=12866316 }}</ref> which is usually triggered by airborne [[allergen]]s such as [[pollen]] and [[dander]].<ref>{{cite book |last1= Sullivan |first1= John B. |last2= Krieger |first2= Gary R. | name-list-style = vanc |title= Clinical environmental health and toxic exposures |year= 2001 |page= 341}}</ref> Allergic rhinitis may cause additional symptoms, such as sneezing and nasal itching, [[cough]]ing, [[headache]],<ref name="umm">{{cite web | url=http://www.umm.edu/altmed/articles/allergic-rhinitis-000003.htm | title=Allergic rhinitis}}</ref> [[fatigue (medical)|fatigue]], [[malaise]], and [[Cognitive deficit|cognitive impairment]].<ref>{{cite journal | vauthors = Quillen DM, Feller DB | title = Diagnosing rhinitis: allergic vs. nonallergic | journal = American Family Physician | volume = 73 | issue = 9 | pages = 1583–90 | date = May 2006 | pmid = 16719251 }}</ref><ref name="pmid10795648">{{cite journal | vauthors = Marshall PS, O'Hara C, Steinberg P | title = Effects of seasonal allergic rhinitis on selected cognitive abilities | journal = Annals of Allergy, Asthma & Immunology | volume = 84 | issue = 4 | pages = 403–10 | date = April 2000 | pmid = 10795648 | doi = 10.1016/S1081-1206(10)62273-9 }}</ref> The allergens may also affect the eyes, causing watery, reddened, or itchy eyes and puffiness around the eyes.<ref name="umm" /> The inflammation results in the generation of large amounts of [[mucus]], commonly producing a runny nose, as well as a stuffy nose and post-nasal drip. In the case of allergic rhinitis, the inflammation is caused by the [[degranulation]] of [[mast cell]]s in the nose. When mast cells degranulate, they release [[histamine]] and other chemicals,<ref>{{cite web | url=http://www.medscape.org/viewarticle/532192_2 |title=Inflammatory Nature of Allergic Rhinitis: Pathophysiology}}</ref> starting an inflammatory process that can cause symptoms outside the nose, such as fatigue and malaise.<ref>{{cite web | url=http://www.espai-eg.org/Journal/8-1/Deraz.pdf | title=Immunopathogenesis of allergic rhinitis | access-date=2012-01-11 | archive-date=2017-08-09 | archive-url=https://web.archive.org/web/20170809121155/http://espai-eg.org/Journal/8-1/Deraz.pdf | url-status=dead }}</ref> In the case of infectious rhinitis, it may occasionally lead to [[pneumonia]], either [[viral pneumonia|viral]] or [[bacterial pneumonia|bacterial]]. Sneezing also occurs in infectious rhinitis to expel bacteria and viruses from the respiratory tract.

<!-- Epidemiology -->
Rhinitis is very common. Allergic rhinitis is more common in some countries than others; in the United States, about 10–30% of adults are affected annually.<ref>{{cite web | url=http://www.medscape.com/viewarticle/472667_2 | title=Economic Impact and Quality-of-Life Burden of Allergic Rhinitis: Prevalence}}</ref> Mixed rhinitis (MR) refers to patients with nonallergic rhinitis and allergic rhinitis. MR is a specific rhinitis subtype. It may represent between 50 and 70% of all AR patients. However, true prevalence of MR has not been confirmed yet.<ref>{{Cite journal|last=Bernstein|first=Jonathan A.|date=September 2010|title=Allergic and mixed rhinitis: Epidemiology and natural history|journal=Allergy and Asthma Proceedings|volume=31|issue=5|pages=365–369|doi=10.2500/aap.2010.31.3380|issn=1539-6304|pmid=20929601}}</ref>

==Types==
Rhinitis is categorized into three types (although infectious rhinitis is typically regarded as a separate clinical entity due to its transient nature): (i) infectious rhinitis includes acute and chronic [[bacterial infection]]s; (ii) [[nonallergic rhinitis]]<ref>{{Cite journal|last=Kaliner|first=Michael A|date=2009-06-15|title=Classification of Nonallergic Rhinitis Syndromes With a Focus on Vasomotor Rhinitis, Proposed to be Known henceforth as Nonallergic Rhinopathy|journal=The World Allergy Organization Journal|volume=2|issue=6|pages=98–101|doi=10.1097/WOX.0b013e3181a9d55b|issn=1939-4551|pmc=3650985|pmid=24229372}}</ref> includes vasomotor, idiopathic, [[hormonal]], [[atrophic]], occupational, and [[gustatory rhinitis]], as well as [[rhinitis medicamentosa]] (rebound congestion); (iii) [[allergic rhinitis]], triggered by [[pollen]], [[Mold (fungus)|mold]], animal [[dander]], dust, [[Balsam of Peru]], and other inhaled allergens.<ref name="meds">{{cite web | url=http://emedicine.medscape.com/article/134825-overview | title=Allergic rhinitis| date=2018-12-26}}</ref>

===Infectious===
{{See also|Common cold|Sinusitis}}

Rhinitis is commonly caused by a [[Biological virus|viral]] or [[bacterial]] infection, including the common cold, which is caused by [[Rhinovirus]]es, [[Coronavirus]]es, and [[Orthomyxoviridae|influenza viruses]], others caused by [[Adenoviridae|adenoviruses]], [[human parainfluenza viruses]], [[human respiratory syncytial virus]], [[enterovirus]]es other than rhinoviruses, [[metapneumovirus]], and [[measles virus]], or bacterial [[sinusitis]], which is commonly caused by ''[[Streptococcus pneumoniae]]'', ''[[Haemophilus influenzae]]'', and ''[[Moraxella catarrhalis]]''. Symptoms of the common cold include [[rhinorrhea]], sneezing, sore throat ([[pharyngitis]]), [[cough]], [[Nasal congestion|congestion]], and slight [[headache]].<ref>{{cite journal | vauthors = Troullos E, Baird L, Jayawardena S | title = Common cold symptoms in children: results of an Internet-based surveillance program | journal = Journal of Medical Internet Research | volume = 16 | issue = 6 | pages = e144 | date = June 2014 | pmid = 24945090 | pmc = 4090373 | doi = 10.2196/jmir.2868 | doi-access = free }}</ref>{{Citation needed|date=January 2012}}

===Nonallergic rhinitis===
{{Main|Nonallergic rhinitis}}

Nonallergic rhinitis refers to rhinitis that is not due to an allergy. The category was formerly referred to as vasomotor rhinitis, as the first cause discovered was vasodilation due to an overactive parasympathetic nerve response. As additional causes were identified, additional types of nonallergic rhinitis were recognized. Vasomotor rhinitis is now included among these under the more general classification of nonallergic rhinitis.<ref name="Vasomotor rhinitis">{{cite journal | vauthors = Wheeler PW, Wheeler SF | title = Vasomotor rhinitis | journal = American Family Physician | volume = 72 | issue = 6 | pages = 1057–62 | date = September 2005 | pmid = 16190503 }}</ref> The diagnosis is made upon excluding allergic causes.<ref>{{cite journal | vauthors = Brown KR, Bernstein JA | title = Clinically relevant outcome measures of novel pharmacotherapy for nonallergic rhinitis | journal = Current Opinion in Allergy and Clinical Immunology | volume = 15 | issue = 3 | pages = 204–12 | date = June 2015 | pmid = 25899692 | doi = 10.1097/ACI.0000000000000166 | s2cid = 22343815 }}</ref> It is an umbrella term of rhinitis of multiple causes, such as occupational (chemical), smoking, gustatory, hormonal, senile (rhinitis of the elderly), atrophic, medication-induced (including rhinitis medicamentosa), local allergic rhinitis, non-allergic rhinitis with eosinophilia syndrome (NARES) and idiopathic (vasomotor or non-allergic, non-infectious perennial allergic rhinitis (NANIPER), or non-infectious non-allergic rhinitis (NINAR).<ref>{{cite journal | vauthors = Van Gerven L, Boeckxstaens G, Hellings P | title = Up-date on neuro-immune mechanisms involved in allergic and non-allergic rhinitis | journal = Rhinology | volume = 50 | issue = 3 | pages = 227–35 | date = September 2012 | pmid = 22888478 | doi = 10.4193/Rhino11.152 | doi-access = free }}</ref><references group="PMID 21991571" />

In vasomotor rhinitis,<ref>{{cite journal | date = Sep 2005 | title = Vasomotor rhinitis | url = http://www.aafp.org/afp/2005/0915/p1057.html | journal = Am Fam Physician | volume = 72 | issue = 6| pages = 1057–62 | pmid = 16190503 | last1 = Wheeler | first1 = P. W. | last2 = Wheeler | first2 = S. F. }}</ref><ref>{{cite web|url=https://www.nlm.nih.gov/medlineplus/ency/article/001648.htm |title=Vasomotor rhinitis ''Medline Plus |publisher=Nlm.nih.gov |access-date=2014-04-23}}</ref> certain nonspecific stimuli, including changes in environment (temperature, humidity, [[barometric pressure]], or weather), airborne irritants (odors, fumes), dietary factors (spicy food, alcohol), sexual arousal, exercise,<ref>{{cite journal | vauthors = Silvers WS, Poole JA | title = Exercise-induced rhinitis: a common disorder that adversely affects allergic and nonallergic athletes | journal = Annals of Allergy, Asthma & Immunology | volume = 96 | issue = 2 | pages = 334–40 | date = February 2006 | pmid = 16498856 | doi = 10.1016/s1081-1206(10)61244-6 }}</ref> and emotional factors trigger rhinitis.<ref>{{cite book|last=Adelman|first=Daniel | name-list-style = vanc |title=Manual of Allergy and Immunology: Diagnosis and Therapy|year=2002|publisher=Lippincott Williams & Wilkins|isbn=9780781730525|page=66}}</ref> There is still much to be learned about this, but it is thought that these non-allergic triggers cause dilation of the blood vessels in the lining of the nose, which results in swelling and drainage.

Non-allergic rhinitis can co-exist with allergic rhinitis, and is referred to as "mixed rhinitis".<ref>(Middleton's Allergy Principles and Practice, seventh edition.)</ref> The pathology of vasomotor rhinitis appears to involve [[neurogenic inflammation]]<ref>{{cite journal | vauthors = Knipping S, Holzhausen HJ, Riederer A, Schrom T | title = [Ultrastructural changes in allergic rhinitis vs. idiopathic rhinitis] | journal = Hno | volume = 56 | issue = 8 | pages = 799–807 | date = August 2008 | pmid = 18651116 | doi = 10.1007/s00106-008-1764-4 | s2cid = 24135943 }}</ref> and is as yet not very well understood. The role of transient receptor potential ion channels on the non-neuronal nasal epithelial cells has also been suggested. Overexpression of these receptors have influence the nasal airway hyper-responsiveness to non-allergic irritant environmental stimuli (e.g., extremes of temperature, changes in osmotic or barometric pressure).<ref name="Bernstein_2015">{{cite journal | vauthors = Bernstein JA, Singh U | title = Neural Abnormalities in Nonallergic Rhinitis | journal = Current Allergy and Asthma Reports | volume = 15 | issue = 4 | pages = 18 | date = April 2015 | pmid = 26130469 | doi = 10.1007/s11882-015-0511-7 | s2cid = 22195726 }}</ref> Vasomotor rhinitis appears to be significantly more common in women than men, leading some researchers to believe that [[hormone]] imbalance plays a role.<ref name="NHS">{{cite web |url= https://www.nhs.uk/conditions/non-allergic-rhinitis/|title=What causes non-allergic rhinitis? |author=<!--Not stated--> |date= 2018-09-07|website=NHS |publisher=Gov.uk |access-date= December 18, 2018}}</ref><ref name="pmid28474799">{{cite journal | vauthors = Hellings PW, Klimek L, Cingi C, Agache I, Akdis C, Bachert C, Bousquet J, Demoly P, Gevaert P, Hox V, Hupin C, Kalogjera L, Manole F, Mösges R, Mullol J, Muluk NB, Muraro A, Papadopoulos N, Pawankar R, Rondon C, Rundenko M, Seys SF, Toskala E, Van Gerven L, Zhang L, Zhang N, Fokkens WJ | title = Non-allergic rhinitis: Position paper of the European Academy of Allergy and Clinical Immunology | journal = Allergy | volume = 72 | issue = 11 | pages = 1657–1665 | date = November 2017 | pmid = 28474799 | doi = 10.1111/all.13200 | doi-access = free }}</ref> In general, age of onset occurs after 20 years of age, in contrast to allergic rhinitis which can be developed at any age. Individuals with vasomotor rhinitis typically experience symptoms year-round, though symptoms may be exacerbated in the spring and autumn when rapid weather changes are more common.<ref name="Vasomotor rhinitis"/> An estimated 17 million United States citizens have vasomotor rhinitis.<ref name="Vasomotor rhinitis"/>

Drinking alcohol may cause rhinitis as well as worsen [[asthma]] (see [[alcohol-induced respiratory reactions]]). In certain populations, particularly those of East Asian countries such as Japan, these reactions have a nonallergic basis.<ref name=AA2013>{{cite journal | vauthors = Adams KE, Rans TS | title = Adverse reactions to alcohol and alcoholic beverages | journal = Annals of Allergy, Asthma & Immunology | volume = 111 | issue = 6 | pages = 439–45 | date = December 2013 | pmid = 24267355 | doi = 10.1016/j.anai.2013.09.016 }}</ref> In other populations, particularly those of European descent, a genetic variant in the gene that metabolizes ethanol to acetaldehyde, ADH1B, is associated with alcohol-induced rhinitis. It is suggested that this variant metabolizes ethanol to acetaldehyde too quickly for further processing by ALDH2 and thereby leads to the accumulation of acetaldehyde and rhinitis symptoms.<ref>{{cite journal | vauthors = Macgregor S, Lind PA, Bucholz KK, Hansell NK, Madden PA, Richter MM, Montgomery GW, Martin NG, Heath AC, Whitfield JB | title = Associations of ADH and ALDH2 gene variation with self report alcohol reactions, consumption and dependence: an integrated analysis | journal = Human Molecular Genetics | volume = 18 | issue = 3 | pages = 580–93 | date = February 2009 | pmid = 18996923 | pmc = 2722191 | doi = 10.1093/hmg/ddn372 }}</ref> In these cases, alcohol-induced rhinitis may be of the ''mixed rhinitis'' type and, it seems likely, most cases of alcohol-induced rhinitis in non-Asian populations reflect true allergic response to the non-ethanol and/or contaminants in alcoholic beverages, particularly when these beverages are wines or beers.<ref name=AA2013/> Alcohol-exacerbated rhinitis is more frequent in individuals with a history of rhinitis exacerbated by aspirin.<ref>{{cite journal | vauthors = Cardet JC, White AA, Barrett NA, Feldweg AM, Wickner PG, Savage J, Bhattacharyya N, Laidlaw TM | title = Alcohol-induced respiratory symptoms are common in patients with aspirin exacerbated respiratory disease | journal = The Journal of Allergy and Clinical Immunology. In Practice | volume = 2 | issue = 2 | pages = 208–13 | date = 2014 | pmid = 24607050 | doi = 10.1016/j.jaip.2013.12.003 | pmc = 4018190 }}</ref>

Aspirin and other [[non-steroidal anti-inflammatory drugs]] (NSAIDs), particularly those that inhibit [[cyclooxygenase 1]] ([[COX1]]), can worsen rhinitis and asthma symptoms in individuals with a history of either one of these diseases.<ref>{{cite journal | vauthors = Rajan JP, Wineinger NE, Stevenson DD, White AA | title = Prevalence of aspirin-exacerbated respiratory disease among asthmatic patients: A meta-analysis of the literature | journal = The Journal of Allergy and Clinical Immunology | volume = 135 | issue = 3 | pages = 676–81.e1 | date = March 2015 | pmid = 25282015 | doi = 10.1016/j.jaci.2014.08.020 }}</ref> These exacerbations most often appear due to [[NSAID hypersensitivity reactions]] rather than NSAID-induced allergic reactions.<ref>{{cite journal | vauthors = Choi JH, Kim MA, Park HS | title = An update on the pathogenesis of the upper airways in aspirin-exacerbated respiratory disease | journal = Current Opinion in Allergy and Clinical Immunology | volume = 14 | issue = 1 | pages = 1–6 | date = February 2014 | pmid = 24300420 | doi = 10.1097/aci.0000000000000021 | s2cid = 205433452 }}</ref>

The antihistamine [[azelastine]], applied as a nasal spray, may be effective for vasomotor rhinitis.<ref>{{cite journal | vauthors = Bernstein JA | title = Azelastine hydrochloride: a review of pharmacology, pharmacokinetics, clinical efficacy and tolerability | journal = Current Medical Research and Opinion | volume = 23 | issue = 10 | pages = 2441–52 | date = October 2007 | pmid = 17723160 | doi = 10.1185/030079907X226302 | s2cid = 25827650 }}</ref> [[Fluticasone propionate]] or [[budesonide]] (both are [[steroid]]s) in nostril spray form may also be used for symptomatic treatment. The antihistamine [[cyproheptadine]] is also effective, probably due to its [[Serotonin antagonist|antiserotonergic]] effects.

A systematic review on non-allergic rhinitis reports improvement of overall function after treatment with [[capsaicin]] (the active component of chili peppers). The quality of evidence is low, however.<ref>{{cite journal | vauthors = Gevorgyan A, Segboer C, Gorissen R, van Drunen CM, Fokkens W | title = Capsaicin for non-allergic rhinitis | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 7 | pages = CD010591 | date = July 2015 | pmid = 26171907 | doi = 10.1002/14651858.CD010591.pub2 | pmc = 10669782 }}</ref>

===Allergic===
{{Main|Allergic rhinitis}}
Allergic rhinitis or hay fever may follow when an allergen such as [[pollen]], dust, or [[Balsam of Peru]]<ref>{{cite book |url=https://books.google.com/books?id=eReGG6UtxbcC&q=%22balsam+of+peru%22+allergy&pg=PT413 |title=The Daily Telegraph: Complete Guide to Allergies |first=Pamela |last=Brooks |name-list-style=vanc |date=2012-10-25 |publisher=Little, Brown Book |access-date=2014-04-23 |isbn=9781472103949 }}{{Dead link|date=October 2023 |bot=InternetArchiveBot |fix-attempted=yes }}</ref> is inhaled by an individual with a sensitized immune system, triggering [[antibody]] production. These antibodies mostly bind to [[mast cells]], which contain [[histamine]]. When the mast cells are stimulated by an allergen, histamine (and other chemicals) are released. This causes itching, swelling, and mucus production.

Symptoms vary in severity between individuals. Very sensitive individuals can experience [[hives]] or other [[rash]]es. Particulate matter in polluted air and chemicals such as [[chlorine]] and detergents, which can normally be tolerated, can greatly aggravate the condition.{{Citation needed|date=January 2012}}

Characteristic physical findings in individuals who have allergic rhinitis include [[conjunctival]] swelling and [[erythema]], eyelid swelling, lower eyelid [[venous stasis]], lateral crease on the nose, swollen nasal [[turbinate]]s, and [[middle ear]] [[effusion]].<ref>{{cite journal | vauthors = Valet RS, Fahrenholz JM | url = http://www.consultantlive.com/display/article/10162/1465701 | title = Allergic rhinitis: update on diagnosis | journal = Consultant | date = 2009 | volume = 49 | pages = 610–613 | access-date = 2010-02-22 | archive-date = 2010-01-14 | archive-url = https://web.archive.org/web/20100114135815/http://www.consultantlive.com/display/article/10162/1465701 | url-status = dead }}</ref>

Even if a person has negative [[skin allergy test|skin-prick, intradermal]] and [[RAST test|blood tests]] for allergies, they may still have allergic rhinitis, from a local allergy in the nose. This is called [[allergic rhinitis#Local allergic rhinitis|local allergic rhinitis]].<ref>{{cite journal | vauthors = Rondón C, Canto G, Blanca M | title = Local allergic rhinitis: a new entity, characterization and further studies | journal = Current Opinion in Allergy and Clinical Immunology | volume = 10 | issue = 1 | pages = 1–7 | date = February 2010 | pmid = 20010094 | doi = 10.1097/ACI.0b013e328334f5fb | s2cid = 3472235 }}</ref> Many people who were previously diagnosed with nonallergic rhinitis may actually have local allergic rhinitis.<ref>{{cite journal | vauthors = Rondón C, Fernandez J, Canto G, Blanca M | title = Local allergic rhinitis: concept, clinical manifestations, and diagnostic approach | journal = Journal of Investigational Allergology & Clinical Immunology | volume = 20 | issue = 5 | pages = 364–71; quiz 2 p following 371 | year = 2010 | pmid = 20945601 }}</ref>

A [[patch test]] may be used to determine if a particular substance is causing the rhinitis.

===Rhinitis medicamentosa===
{{Main|Rhinitis medicamentosa}}
Rhinitis medicamentosa is a form of drug-induced nonallergic rhinitis which is associated with [[nasal congestion]] brought on by the use of certain oral medications (primarily [[sympathomimetic amine]] and [[2-imidazoline]] derivatives) and [[topical decongestant]]s (e.g., [[oxymetazoline]], [[phenylephrine]], [[xylometazoline]], and [[naphazoline]] [[nasal spray]]s) that constrict the blood vessels in the lining of the nose.<ref name="rhinitis">{{cite journal | vauthors = Ramey JT, Bailen E, Lockey RF | title = Rhinitis medicamentosa | journal = Journal of Investigational Allergology & Clinical Immunology | volume = 16 | issue = 3 | pages = 148–55 | year = 2006 | pmid = 16784007 | url = http://www.jiaci.org/issues/vol16issue03/1.pdf }}</ref>

===Chronic atrophic rhinitis===
{{main|Chronic atrophic rhinitis}}
Chronic rhinitis is a form of [[atrophy]] of the mucous membrane and glands of the nose.

===Rhinitis sicca===
Chronic form of dryness of the mucous membranes.

===Polypous rhinitis===
Chronic rhinitis associated with [[nasal polyp|polyps in the nasal cavity]].

==Pathophysiology==
[[File:Neural abnormalities.tif|thumb|Pathological changes in non-allergic rhinitis<ref name = "Bernstein_2015" />]]
[[File:Non-allergic rhinitis mechanism.tif|thumb|Mechanism of non-allergic rhinitis: Imbalance between sympathetic and parasympathetic components in the nasal mucous membrane<ref name = "Bernstein_2015" />]]
Most prominent pathological changes observed are nasal airway '''epithelial [[metaplasia]]''' in which [[goblet cell]]s replace [[Cilium|ciliated columnar epithelial cells]] in the nasal mucous membrane.<ref name="Bernstein_2015" /> This results in mucin hypersecretion by goblet cells and decreased mucociliary activity. Nasal secretion are not adequately cleared with clinical manifestation of nasal congestion, sinus pressure, post-nasal dripping, and headache. Over-expression of transient receptor potential [[Transient receptor potential channel|(TRP) ion channels]], such as TRPA1 and TRPV1, may be involved in the pathogenesis of non-allergic rhinitis.<ref>{{cite journal | vauthors = Millqvist E | title = TRP channels and temperature in airway disease-clinical significance | journal = Temperature | volume = 2 | issue = 2 | pages = 172–7 | date = April 2015 | pmid = 27227021 | pmc = 4843868 | doi = 10.1080/23328940.2015.1012979 }}</ref>

=== Association between rhinitis and asthma ===
Neurogenic inflammation produced by neuropeptides released from sensory nerve endings to the airways is a proposed common mechanism of association between both allergic and non-allergic rhinitis with asthma. This may explain higher association of rhinitis with asthma developing later in life.<ref name=":1">{{cite journal | vauthors = Eriksson J, Bjerg A, Lötvall J, Wennergren G, Rönmark E, Torén K, Lundbäck B | title = Rhinitis phenotypes correlate with different symptom presentation and risk factor patterns of asthma | journal = Respiratory Medicine | volume = 105 | issue = 11 | pages = 1611–21 | date = November 2011 | pmid = 21764573 | doi = 10.1016/j.rmed.2011.06.004 | doi-access = free }}</ref> Environmental irritants acts as modulators of airway inflammation in these contiguous airways. Development of [[occupational asthma]] is often preceded by occupational rhinitis. Among the causative agents are flours, enzymes used in processing food, latex, isocyanates, welding fumes, epoxy resins, and formaldehyde. Accordingly, prognosis of [[occupational asthma]] is contingent on early diagnosis and the adoption of protective measures for rhinitis.<ref>{{cite journal | vauthors = Scherer Hofmeier K, Bircher A, Tamm M, Miedinger D | title = [Occupational rhinitis and asthma] | journal = Therapeutische Umschau | volume = 69 | issue = 4 | pages = 261–7 | date = April 2012 | pmid = 22477666 | doi = 10.1024/0040-5930/a000283 }}</ref>

==Diagnosis==
The different forms of rhinitis are essentially diagnosed clinically.{{clarify|date=October 2022}}<!-- What does this mean, other than, "by a doctor"? In contrast to lab tests? --> Vasomotor rhinitis is differentiated from viral and bacterial infections by the lack of purulent exudate and crusting. It can be differentiated from allergic rhinitis because of the absence of an identifiable allergen.<ref>{{Cite web|url=https://www.msdmanuals.com/en-pt/professional/ear,-nose,-and-throat-disorders/nose-and-paranasal-sinus-disorders/nonallergic-rhinitis?query=rhinitis|title=Nonallergic Rhinitis - Ear, Nose, and Throat Disorders|website=MSD Manual Professional Edition|language=en-PT|access-date=2019-03-07}}</ref>

Evidence has been published from a few health [[Mobile app|apps for mobile devices]] that show potential to assist in the diagnosis of rhinitis and rhinosinusitis and to evaluate management and treatment adherence. While this shows promise for clinical management, {{As of|2022|lc=y}} few had been validated in the scientific literature, and even fewer included considerations for [[multimorbidity]].<ref>{{cite journal |display-authors=5 | last1=Sousa-Pinto | first1=Bernardo | last2=Anto | first2=Aram | last3=Berger | first3=Markus | last4=Dramburg | first4=Stephanie | last5=Pfaar | first5=Oliver | last6=Klimek | first6=Ludger | last7=Jutel | first7=Marek | last8=Czarlewski | first8=Wienczyslawa | last9=Bedbrook | first9=Anna | last10=Valiulis | first10=Arunas | last11=Agache | first11=Ioana | last12=Amaral | first12=Rita | last13=Ansotegui | first13=Ignacio J. | last14=Bastl | first14=Katharina | last15=Berger | first15=Uwe | last16=Bergmann | first16=Karl C. | last17=Bosnic-Anticevich | first17=Sinthia | last18=Braido | first18=Fulvio | last19=Brussino | first19=Luisa | last20=Cardona | first20=Victoria | last21=Casale | first21=Thomas | last22=Canonica | first22=G. Walter | last23=Cecchi | first23=Lorenzo | last24=Charpin | first24=Denis | last25=Chivato | first25=Tomás | last26=Chu | first26=Derek K. | last27=Cingi | first27=Cemal | last28=Costa | first28=Elisio M. | last29=Cruz | first29=Alvaro A. | last30=Devillier | first30=Philippe | last31=Durham | first31=Stephen R. | last32=Ebisawa | first32=Motohiro | last33=Fiocchi | first33=Alessandro | last34=Fokkens | first34=Wytske J. | last35=Gemicioğlu | first35=Bilun | last36=Gotua | first36=Maia | last37=Guzmán | first37=Maria-Antonieta | last38=Haahtela | first38=Tari | last39=Ivancevich | first39=Juan Carlos | last40=Kuna | first40=Piotr | last41=Kaidashev | first41=Igor | last42=Khaitov | first42=Musa | last43=Kvedariene | first43=Violeta | last44=Larenas-Linnemann | first44=Désirée E. | last45=Lipworth | first45=Brian | last46=Laune | first46=Daniel | last47=Matricardi | first47=Paolo M. | last48=Morais-Almeida | first48=Mario | last49=Mullol | first49=Joaquim | last50=Naclerio | first50=Robert | last51=Neffen | first51=Hugo | last52=Nekam | first52=Kristoff | last53=Niedoszytko | first53=Marek | last54=Okamoto | first54=Yoshitaka | last55=Papadopoulos | first55=Nikolaos G. | last56=Park | first56=Hae-Sim | last57=Passalacqua | first57=Giovanni | last58=Patella | first58=Vincenzo | last59=Pelosi | first59=Simone | last60=Pham-Thi | first60=Nhân | last61=Popov | first61=Ted A. | last62=Regateiro | first62=Frederico S. | last63=Reitsma | first63=Sietze | last64=Rodriguez-Gonzales | first64=Monica | last65=Rosario | first65=Nelson | last66=Rouadi | first66=Philip W. | last67=Samolinski | first67=Boleslaw | last68=Sá-Sousa | first68=Ana | last69=Sastre | first69=Joaquin | last70=Sheikh | first70=Aziz | last71=Ulrik | first71=Charlotte Suppli | last72=Taborda-Barata | first72=Luis | last73=Todo-Bom | first73=Ana | last74=Tomazic | first74=Peter Valentin | last75=Toppila-Salmi | first75=Sanna | last76=Tripodi | first76=Salvatore | last77=Tsiligianni | first77=Ioanna | last78=Valovirta | first78=Erkka | last79=Ventura | first79=Maria Teresa | last80=Valero | first80=Antonio A. | last81=Vieira | first81=Rafael José | last82=Wallace | first82=Dana | last83=Waserman | first83=Susan | last84=Williams | first84=Sian | last85=Yorgancioglu | first85=Arzu | last86=Zhang | first86=Luo | last87=Zidarn | first87=Mihaela | last88=Zuberbier | first88=Jaron | last89=Olze | first89=Heidi | last90=Antó | first90=Josep M. | last91=Zuberbier | first91=Torsten | last92=Fonseca | first92=João A. | last93=Bousquet | first93=Jean | title=Real-world data using mHealth apps in rhinitis, rhinosinusitis and their multimorbidities | journal=Clinical and Translational Allergy | publisher=Wiley | volume=12 | issue=11 | year=2022 | pages=e12208 | issn=2045-7022 | doi=10.1002/clt2.12208| pmid=36434742 | pmc=9673175 |doi-access=free}}</ref><ref>{{cite web | last=May | first=Brandon | title=Study Finds 7 Apps for Rhinitis and Rhinosinusitis With Evidence | website=Medscape | date=6 December 2022 | url=https://www.medscape.com/viewarticle/985131}}</ref>

==Management==
The management of rhinitis depends on the underlying cause.

For allergic rhinitis, intranasal [[corticosteroid]]s are recommended.<ref name=Wal2017>{{cite journal | vauthors = Wallace DV, Dykewicz MS, Oppenheimer J, Portnoy JM, Lang DM | title = Pharmacologic Treatment of Seasonal Allergic Rhinitis: Synopsis of Guidance From the 2017 Joint Task Force on Practice Parameters | journal = Annals of Internal Medicine | volume = 167 | issue = 12 | pages = 876–881 | date = December 2017 | pmid = 29181536 | doi = 10.7326/M17-2203 | doi-access = free }}</ref> For severe symptoms intranasal [[antihistamine]]s may be added.<ref name=Wal2017/>

==Pronunciation and etymology==
Rhinitis is pronounced {{IPAc-en|r|aɪ|ˈ|n|aɪ|t|ɪ|s}},<ref>{{Cite web   | title = rhinitis {{!}} Definition, meaning & more {{!}} Collins Dictionary   | publisher = www.collinsdictionary.com   | url = https://www.collinsdictionary.com/dictionary/english/rhinitis   | access-date = 4 January 2017 }}</ref> while coryza is pronounced {{IPAc-en|k|ə|ˈ|r|aɪ|z|ə}}.<ref>{{Cite web   | title = coryza {{!}} Definition, meaning & more {{!}} Collins Dictionary   | publisher = www.collinsdictionary.com  | url = https://www.collinsdictionary.com/dictionary/english/coryza   | access-date = 4 January 2017 }}</ref>

''Rhinitis'' comes from the [[Ancient Greek]] {{serif|{{lang|grc|ῥίς}}}} ''rhis'', ''gen''.: {{serif|{{lang|grc|ῥινός}}}} ''rhinos'', "nose". ''Coryza'' comes through Latin from Ancient Greek {{serif|{{lang|grc|κόρυζα}}}}.<!-- [Do we need this? Beekes also opines a pre-Greek origin for ῥίς.] which has an uncertain etymology. [[Robert S. P. Beekes|Robert Beekes]] does not favor an [[Proto-Indo-European language|Indo-European]] derivation and suggests a [[Pre-Greek]] reconstruction {{nowrap|''*karut<sup>y</sup>a''}}.<ref>{{cite book | author-link = Robert S. P. Beekes | vauthors = Beekes RS | title = Etymological Dictionary of Greek | publisher = Brill | year = 2009 | page = 756 }}</ref> --> According to physician Andrew Wylie, "we use the term [''coryza''] for a cold in the head, but the two are really synonymous. The [[Ancient Rome|ancient Romans]] advised their patients to clean their nostrils and thereby sharpen their wits."<ref>{{cite journal | vauthors = Wylie A | title = Rhinology and laryngology in literature and Folk-Lore. | journal = The Journal of Laryngology & Otology | volume = 42 |issue = 2 | pages = 81–87 | year = 1927 | doi=10.1017/S0022215100029959| s2cid = 71281077 }}</ref>

== References ==
{{reflist}}

{{Medical resources
|  DiseasesDB       = 26380 
|  ICD10            = {{ICD10|J|00||j|00}}, {{ICD10|J|30||j|30}}, {{ICD10|J|31|0|j|30}} 
|  ICD9             = {{ICD9|472.0}}, {{ICD9|477}} 
|  ICDO             = 
|  OMIM             = 607154 
|  MedlinePlus      = 000813 
|  eMedicineSubj    = ent 
|  eMedicineTopic   = 194 
|  eMedicine_mult   = {{eMedicine2|med|104}}, {{eMedicine2|ped|2560}} 
|  MeshID           = D012220
| medlinePlus_mult= {{MedlinePlus2|001648}}
}}

{{Respiratory pathology}}
{{Nasal preparations}}
{{Allergic conditions}}
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[[Category:Allergology]]
[[Category:Enterovirus-associated diseases]]
[[Category:Inflammations]]
[[Category:Nose disorders]]
[[Category:Otorhinolaryngology]]