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Chronic Nonallergic Rhinitis

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101. Sinusitis, Acute (Overview)

detail. Diagnosis Acute sinusitis is a clinical diagnosis. However, the evaluation might include the following laboratory tests [ ] : Nasal cytology Nasal-sinus biopsy Tests for immunodeficiency, cystic fibrosis, or ciliary dysfunction Nasal cytology examinations may be useful to elucidate the following entities: Allergic rhinitis [ ] Eosinophilia Nasal polyposis Aspirin sensitivity Tests for immunodeficiency are indicated if history findings indicate recurrent infection; they include the following (...) , intracranial), and associated factors (nasal polyposis, immunosuppression, anatomic variants). (See , , and .) Acute sinusitis is a clinical diagnosis; thus, an understanding of its presentation is of paramount importance in differentiating this entity from allergic or vasomotor rhinitis and common upper respiratory infections. No specific clinical symptom or sign is sensitive or specific for acute sinusitis, so the overall clinical impression should be used to guide management. (See .) The primary goals

2014 eMedicine.com

102. Allergic and Environmental Asthma (Treatment)

. In genetically susceptible individuals, these interactions can lead the patient with asthma to symptoms of breathlessness, wheezing, cough, and chest tightness. Causes or triggers of asthma can be divided into allergic and nonallergic etiologies. Aeroallergens can include seasonal pollen, mold spores, dust mites, animal allergens, and food (especially in children). Monosodium glutamate does not appear to be an allergen. [ , , ] Nonallergic causes of asthma can include smoke, odors, cold air and weather (...) in the entire grass pollen season. [ ] A third SL immunotherapy for (Ragwitek) was also approved in April 2014 for adults aged 18 years or older. Effectiveness studies included about 760 patients. Phase 3 clinical trials showed reduced rhinoconjunctivitis symptoms over the entire season by 27-43% compared with placebo. [ , ] A sublingual (SL) (Odactra) was approved by the FDA in 2017. It is a standardized allergen extract indicated as daily SL immunotherapy for allergic rhinitis, with or without

2014 eMedicine.com

103. Hypersensitivity Reactions, Immediate (Treatment)

of five grass allergen extracts. It is approved for patients 10-65 years old who has grass pollen allergy. One tablet is taken sublingually for four months prior to grass pollen season and throughout the season. [ ] Asthma Avoid the offending allergen, if possible. A key factor in controlling allergic asthma is controlling allergic rhinitis symptoms. Therapy depends on the severity of disease as well as age of patient. In 2007, the National Asthma Education and Prevention Program (NAEPP) Expert Panel (...) , and also congestion. Azelastine has been shown to be helpful in treating both allergic and nonallergic vasomotor rhinitis. Nasal antihistamines have a rapid onset of action and can be used on an as-needed basis. Topical nasal decongestants can provide immediate relief of nasal congestion and can be used temporarily and as needed. Patients should be cautioned not to use them for more than a few days, however, as they can cause rebound congestion ( ). Topical decongestants, mast cell stabilizers

2014 eMedicine.com

104. Upper Respiratory Tract Infection (Treatment)

; however, swallowing may be impaired if sensation is reduced. Saline gargles may reduce swelling in individuals with pharyngitis. Cromolyn Intranasal cromolyn sodium is typically used for relief of allergic rhinitis. Data are insufficient, however, to permit evidence-based recommendations regarding its use to treat URI-related nasal symptoms in nonallergic patients. Cough relief Cough suppression may increase comfort when cough is severe or when it prevents sleep. [ ] As stated earlier, the risk (...) , or noninfectious etiology. In such patients, cultures should be obtained by direct sinus puncture or middle meatus endoscopy rather than with nasopharyngeal swabs. [ ] Adjunctive therapy for adults includes nasal saline irrigation. Intranasal steroids may be considered, especially for those with a previous history of allergic rhinitis. Neither oral nor nasal antihistamines or decongestants are recommended for acute bacterial sinusitis. [ ] Previous Next: Group A Streptococcal Disease Beginning treatment

2014 eMedicine.com

105. Allergic and Environmental Asthma (Overview)

. In genetically susceptible individuals, these interactions can lead the patient with asthma to symptoms of breathlessness, wheezing, cough, and chest tightness. Causes or triggers of asthma can be divided into allergic and nonallergic etiologies. Aeroallergens can include seasonal pollen, mold spores, dust mites, animal allergens, and food (especially in children). Monosodium glutamate does not appear to be an allergen. [ , , ] Nonallergic causes of asthma can include smoke, odors, cold air and weather (...) in the entire grass pollen season. [ ] A third SL immunotherapy for (Ragwitek) was also approved in April 2014 for adults aged 18 years or older. Effectiveness studies included about 760 patients. Phase 3 clinical trials showed reduced rhinoconjunctivitis symptoms over the entire season by 27-43% compared with placebo. [ , ] A sublingual (SL) (Odactra) was approved by the FDA in 2017. It is a standardized allergen extract indicated as daily SL immunotherapy for allergic rhinitis, with or without

2014 eMedicine.com

106. Asthma and Sinusitis

detail. Diagnosis Acute sinusitis is a clinical diagnosis. However, the evaluation might include the following laboratory tests [ ] : Nasal cytology Nasal-sinus biopsy Tests for immunodeficiency, cystic fibrosis, or ciliary dysfunction Nasal cytology examinations may be useful to elucidate the following entities: Allergic rhinitis [ ] Eosinophilia Nasal polyposis Aspirin sensitivity Tests for immunodeficiency are indicated if history findings indicate recurrent infection; they include the following (...) , intracranial), and associated factors (nasal polyposis, immunosuppression, anatomic variants). (See , , and .) Acute sinusitis is a clinical diagnosis; thus, an understanding of its presentation is of paramount importance in differentiating this entity from allergic or vasomotor rhinitis and common upper respiratory infections. No specific clinical symptom or sign is sensitive or specific for acute sinusitis, so the overall clinical impression should be used to guide management. (See .) The primary goals

2014 eMedicine Surgery

107. Nasal Polyps, Surgical Treatment

31, 2019 Author: Andrew T Cheng, MD; Chief Editor: Arlen D Meyers, MD, MBA Share Email Print Feedback Close Sections Sections Nasal Polyp Surgery Overview Background Polyp formation in the nasal cavity is due to chronic allergic rhinitis, chronic sinusitis, and, less commonly, underlying disease such as cystic fibrosis. Patients usually present with nasal obstruction, persistent nasal discharge (rhinorrhea), sinus infection, and loss of the sense of smell (anosmia) of prolonged duration. Next (...) . Not insignificantly, these patients may have undergone recurrent surgery and costly medical therapy. Previous Next: Indications The patient may require surgical intervention if severe symptoms of obstruction and infection prove refractory to medical treatment. Medical therapies include treatment for underlying chronic allergic rhinitis using antihistamines and topical nasal . For severe nasal polyposis causing severe nasal obstruction, treatment with short-term steroids may be beneficial. Topical use of cromolyn

2014 eMedicine Surgery

108. Nasal Polyps, Nonsurgical Treatment

with cystic fibrosis and persons with known aspirin hypersensitivity. Nasal polyposis can impair a person's quality of life more than perennial allergic rhinitis. Olfaction and nasal obstruction are the most important considerations in terms of symptoms. Next: Pathophysiology Nasal polyposis results from chronic inflammation of the nasal and sinus mucous membranes. Chronic inflammation causes a reactive hyperplasia of the intranasal mucosal membrane, which results in the formation of polyps. The precise (...) but their significance has not been completely elucidated. Some of these mediators may be released by the polyps themselves and others by the eosinophils found in certain subsets of polyps. Cysteinyl leukotriene receptors and interleukin-5 (IL-5) appear to be the most well studied. Previous Next: Epidemiology Frequency United States Nasal polyps are present in 5% of nonallergic people and only 1.5% of people with allergic rhinitis. No racial or sexual predilection is reported. The prevalence is increased in patients

2014 eMedicine Surgery

109. Nasal Physiology

, and acute and chronic maxillary sinusitis, whereas high concentrations were detected in upper airway infection, allergic rhinitis, and nasal polyposis. Previous Next: Tests of Nasal Physiology Tests of nasal physiology include studies of airflow, ciliary function, and olfaction. Rhinomanometry attempts to quantify nasal airflow and total nasal area during exclusive nasal breathing. Differential pressure measurements are obtained by placing a nasal catheter into the nasopharynx. Nasal resistance (...) , in which in-phase and reciprocal airflow changes are explained through incorporation of a hypothalamic center and two brainstem half centers. [ ] Previous Next: Abnormal Nasal Physiology Environmental allergies are the most common causes of inflammation of nasal membranes, followed by inhaled irritants (eg, cigarette smoke, perfumes, various chemicals, and other noxious odorants). Nonallergic or vasomotor rhinitis results from dysfunction of the autonomic nervous system or blood flow changes from

2014 eMedicine Surgery

110. Asthma

findings may be observed with chronic bronchitis and viral bronchopneumonia, among other conditions, and these similarities limit the specificity of chest radiography. Clinical correlation remains beneficial in the interpretation of findings, as it is in so many other areas of radiology. HRCT High-resolution computed tomography (HRCT) is a second-line examination (see the images below). It is useful in patients with chronic or recurring symptoms and in those with possible complications such as allergic (...) than 120% had at least some emphysema, no nonsmoking patients with asthma had emphysema. The authors concluded that, in patients with asthma, elevated TLC between attacks can be explained by hyperinflation, which is entirely due to asthma and not coexisting emphysema. [ ] Paganin et al studied airway remodeling in nonsmokers with allergic asthma and in those with nonallergic asthma. On HRCT scans, the authors observed emphysema, cylindrical and varicose bronchiectasis, bronchial wall thickening (ie

2014 eMedicine Radiology

111. Sinusitis, Acute, Medical Treatment

partial pressure. This environment is then suitable for growth of pathogenic organisms. Factors that predispose the sinuses to obstruction and decreased ciliary function are allergic, nonallergic, or viral insults, which produce inflammation of the nasal and sinus mucosa and result in ciliary dysmotility and sinus obstruction. Approximately 90% of patients who have (URTIs) have sinus involvement, but only 5-10% of these patients have bacterial superinfection requiring antimicrobial treatment (...) weeks' duration that resolves completely with appropriate treatment. Subacute sinusitis represents a temporal progression of symptoms for 4-12 weeks. Recurrent acute sinusitis [ ] is diagnosed when 2-4 episodes of infection occur per year with at least 8 weeks between episodes, and, as in acute sinusitis, the sinus mucosa completely normalizes between attacks. Chronic sinusitis is the persistence of insidious symptomatology beyond 12 weeks, with or without acute exacerbations, and is discussed

2014 eMedicine Surgery

112. Rhinoplasty, Turbinate Reduction

address any alteration or unilaterality of the obstruction, which may indicate a dynamic versus structural problem. Address symptoms of rhinitis. Obstruction, rhinorrhea, and sneezing may occur with and . Elicit systemic symptoms of allergy such as watery itchy eyes, asthma, and seasonal variation. Initial general examination should note "allergic shiners" or a facial appearance that may indicate signs of chronic nasal obstruction. Vasomotor rhinitis is typically exacerbated by irritants, temperature (...) or humidity changes, or psychological factors. Nonallergic eosinophilic rhinitis is generally perennial without allergen-induced symptoms. Atrophic rhinitis is characterized by nasal dryness and crusting, frequently with a foul odor. Rhinitis can also be associated with pregnancy and with systemic disorders such as hypothyroidism. Medications can also cause rhinitis and nasal obstruction. Rhinitis medicamentosa results from rebound vasodilation after prolonged use of topical nasal decongestants. Typically

2014 eMedicine Surgery

113. Upper Respiratory Tract Infection (Follow-up)

; however, swallowing may be impaired if sensation is reduced. Saline gargles may reduce swelling in individuals with pharyngitis. Cromolyn Intranasal cromolyn sodium is typically used for relief of allergic rhinitis. Data are insufficient, however, to permit evidence-based recommendations regarding its use to treat URI-related nasal symptoms in nonallergic patients. Cough relief Cough suppression may increase comfort when cough is severe or when it prevents sleep. [ ] As stated earlier, the risk (...) , or noninfectious etiology. In such patients, cultures should be obtained by direct sinus puncture or middle meatus endoscopy rather than with nasopharyngeal swabs. [ ] Adjunctive therapy for adults includes nasal saline irrigation. Intranasal steroids may be considered, especially for those with a previous history of allergic rhinitis. Neither oral nor nasal antihistamines or decongestants are recommended for acute bacterial sinusitis. [ ] Previous Next: Group A Streptococcal Disease Beginning treatment

2014 eMedicine.com

114. Allergic and Environmental Asthma (Follow-up)

. In genetically susceptible individuals, these interactions can lead the patient with asthma to symptoms of breathlessness, wheezing, cough, and chest tightness. Causes or triggers of asthma can be divided into allergic and nonallergic etiologies. Aeroallergens can include seasonal pollen, mold spores, dust mites, animal allergens, and food (especially in children). Monosodium glutamate does not appear to be an allergen. [ , , ] Nonallergic causes of asthma can include smoke, odors, cold air and weather (...) in the entire grass pollen season. [ ] A third SL immunotherapy for (Ragwitek) was also approved in April 2014 for adults aged 18 years or older. Effectiveness studies included about 760 patients. Phase 3 clinical trials showed reduced rhinoconjunctivitis symptoms over the entire season by 27-43% compared with placebo. [ , ] A sublingual (SL) (Odactra) was approved by the FDA in 2017. It is a standardized allergen extract indicated as daily SL immunotherapy for allergic rhinitis, with or without

2014 eMedicine.com

115. Sinusitis, Acute (Diagnosis)

detail. Diagnosis Acute sinusitis is a clinical diagnosis. However, the evaluation might include the following laboratory tests [ ] : Nasal cytology Nasal-sinus biopsy Tests for immunodeficiency, cystic fibrosis, or ciliary dysfunction Nasal cytology examinations may be useful to elucidate the following entities: Allergic rhinitis [ ] Eosinophilia Nasal polyposis Aspirin sensitivity Tests for immunodeficiency are indicated if history findings indicate recurrent infection; they include the following (...) , intracranial), and associated factors (nasal polyposis, immunosuppression, anatomic variants). (See , , and .) Acute sinusitis is a clinical diagnosis; thus, an understanding of its presentation is of paramount importance in differentiating this entity from allergic or vasomotor rhinitis and common upper respiratory infections. No specific clinical symptom or sign is sensitive or specific for acute sinusitis, so the overall clinical impression should be used to guide management. (See .) The primary goals

2014 eMedicine.com

116. Allergic and Environmental Asthma (Diagnosis)

. In genetically susceptible individuals, these interactions can lead the patient with asthma to symptoms of breathlessness, wheezing, cough, and chest tightness. Causes or triggers of asthma can be divided into allergic and nonallergic etiologies. Aeroallergens can include seasonal pollen, mold spores, dust mites, animal allergens, and food (especially in children). Monosodium glutamate does not appear to be an allergen. [ , , ] Nonallergic causes of asthma can include smoke, odors, cold air and weather (...) in the entire grass pollen season. [ ] A third SL immunotherapy for (Ragwitek) was also approved in April 2014 for adults aged 18 years or older. Effectiveness studies included about 760 patients. Phase 3 clinical trials showed reduced rhinoconjunctivitis symptoms over the entire season by 27-43% compared with placebo. [ , ] A sublingual (SL) (Odactra) was approved by the FDA in 2017. It is a standardized allergen extract indicated as daily SL immunotherapy for allergic rhinitis, with or without

2014 eMedicine.com

117. Nasal Polyps (Overview)

conditions are associated with multiple benign polyps: Bronchial asthma - In 20-50% of patients with polyps CF - Polyps in 6-44% of patients with CF [ ] Allergic rhinitis AFS - Polyps in 85% of patients with AFS Chronic rhinosinusitis Aspirin intolerance - In 8-26% of patients with polyps Alcohol intolerance - In 50% of patients with nasal polyps Churg-Strauss syndrome - Nasal polyps in 50% of patients with Churg-Strauss syndrome Young syndrome (ie, chronic sinusitis, nasal polyposis, azoospermia (...) ) Nonallergic rhinitis with eosinophilia syndrome (NARES) - Nasal polyps in 20% of patients with NARES Most studies suggest that polyps are associated more strongly with nonallergic disease than with allergic disease. Statistically, nasal polyps are more common in patients with nonallergic asthma (13%) than with allergic asthma (5%), and only 0.5% of 3000 atopic individuals have nasal polyps. Several theories have been postulated to explain the pathogenesis of nasal polyps, although none seems to account

2014 eMedicine Pediatrics

118. Sinusitis (Overview)

detail. Diagnosis Acute sinusitis is a clinical diagnosis. However, the evaluation might include the following laboratory tests [ ] : Nasal cytology Nasal-sinus biopsy Tests for immunodeficiency, cystic fibrosis, or ciliary dysfunction Nasal cytology examinations may be useful to elucidate the following entities: Allergic rhinitis [ ] Eosinophilia Nasal polyposis Aspirin sensitivity Tests for immunodeficiency are indicated if history findings indicate recurrent infection; they include the following (...) , intracranial), and associated factors (nasal polyposis, immunosuppression, anatomic variants). (See , , and .) Acute sinusitis is a clinical diagnosis; thus, an understanding of its presentation is of paramount importance in differentiating this entity from allergic or vasomotor rhinitis and common upper respiratory infections. No specific clinical symptom or sign is sensitive or specific for acute sinusitis, so the overall clinical impression should be used to guide management. (See .) The primary goals

2014 eMedicine Pediatrics

119. Sinusitis (Diagnosis)

detail. Diagnosis Acute sinusitis is a clinical diagnosis. However, the evaluation might include the following laboratory tests [ ] : Nasal cytology Nasal-sinus biopsy Tests for immunodeficiency, cystic fibrosis, or ciliary dysfunction Nasal cytology examinations may be useful to elucidate the following entities: Allergic rhinitis [ ] Eosinophilia Nasal polyposis Aspirin sensitivity Tests for immunodeficiency are indicated if history findings indicate recurrent infection; they include the following (...) , intracranial), and associated factors (nasal polyposis, immunosuppression, anatomic variants). (See , , and .) Acute sinusitis is a clinical diagnosis; thus, an understanding of its presentation is of paramount importance in differentiating this entity from allergic or vasomotor rhinitis and common upper respiratory infections. No specific clinical symptom or sign is sensitive or specific for acute sinusitis, so the overall clinical impression should be used to guide management. (See .) The primary goals

2014 eMedicine Pediatrics

120. Nasal Polyps (Diagnosis)

. The following conditions are associated with multiple benign polyps: Bronchial asthma - In 20-50% of patients with polyps CF - Polyps in 6-44% of patients with CF [ ] Allergic rhinitis AFS - Polyps in 85% of patients with AFS Chronic rhinosinusitis Aspirin intolerance - In 8-26% of patients with polyps Alcohol intolerance - In 50% of patients with nasal polyps Churg-Strauss syndrome - Nasal polyps in 50% of patients with Churg-Strauss syndrome Young syndrome (ie, chronic sinusitis, nasal polyposis (...) , azoospermia) Nonallergic rhinitis with eosinophilia syndrome (NARES) - Nasal polyps in 20% of patients with NARES Most studies suggest that polyps are associated more strongly with nonallergic disease than with allergic disease. Statistically, nasal polyps are more common in patients with nonallergic asthma (13%) than with allergic asthma (5%), and only 0.5% of 3000 atopic individuals have nasal polyps. Several theories have been postulated to explain the pathogenesis of nasal polyps, although none seems

2014 eMedicine Pediatrics

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