What Is Perennial Rhinitis?

Perennial rhinitis, also known as perennial allergic rhinitis, is a type of allergic rhinitis. Allergic rhinitis refers to non-infectious nasal mucosa that is released by specific individuals after exposure to allergens, which are mainly released by IgE-mediated media (mainly histamine) and have a variety of immune-active cells and cytokines disease. The typical symptoms of allergic rhinitis are paroxysmal sneeze, watery snot, nasal congestion, and itchy nose, and some are accompanied by hyposmia. The traditional classification is divided into seasonal allergic rhinitis and perennial allergic rhinitis according to the seasonality of the patient's onset. Perennial rhinitis refers to the symptoms of allergic rhinitis in more than half of the days in a year. Allergen skin test positives are mainly indoor allergens (mites, indoor dust, etc.). Perennial rhinitis can occur at any age, both men and women, and is easy to see in young people.

Basic Information

nickname: Perennial allergic rhinitis
English name: perennial rhinitis
Visiting department: Otorhinolaryngology-Head and Neck Surgery

Common locations: Nasal mucosa
Common causes: 1. inhaled allergens 2. food allergens 3. contact
Common symptoms: Nasal itching, continuous episodes of paroxysmal sneezing, massive watery nose and stuffy nose, etc.

Causes of perennial rhinitis

Inhalant allergen

Such as indoor and outdoor dust, dust mites, fungi, animal fur, feathers, cotton wool, etc., cause perennial seizures. Plant pollen causes are mostly seasonal.

2. Food Allergens

Such as fish and shrimp, eggs, milk, flour, peanuts, soybeans, etc., especially certain medicines, such as sulfa drugs, quinine, antibiotics, etc. can cause disease.

3. Contact

Such as cosmetics, gasoline, paint, alcohol, etc. Others may be caused by certain bacteria and their toxins, physical factors (such as changes in hot and cold, temperature irregularities), endocrine disorders, or humoral acid-base balance disorders. It can also exist simultaneously or sequentially due to multiple factors.

Clinical manifestations of perennial rhinitis

Symptoms can vary depending on the length and amount of exposure to the stimulus and the patient's response to the body. Perennial allergic rhinitis can occur at any time, sometimes lightly and severely, or gradually relieved after getting up every morning. Generally susceptible to the onset of winter, often coexist with other allergic diseases throughout the body. Seasonal allergic rhinitis, with seasonal onset, usually develops in spring and autumn, with rapid onset of symptoms. The onset time ranges from hours, days to weeks, and the interval between attacks is completely normal.

Typical symptoms are itchy nose, continuous episodes of paroxysmal sneezing, large watery snot and stuffy nose. The specific performance is as follows:

1. Itchy nose and continuous sneezing

There are several paroxysmal episodes every day, with more than 3 sneezes each time, followed by nasal congestion and runny nose, especially in the morning and night. Nasal itching is seen in most patients, and sometimes itching of the outer nose, soft palate, face and external ear canal. Seasonal rhinitis is more obvious with itchy eyes.

2. A lot of watery nose

Sometimes it can drip from the nostrils unconsciously, but when the acute response tends to weaken or disappear, it can be reduced or thickened, and if the infection is secondary, it can become mucopurulent secretions.

3. Nasal congestion

The degree varies, unilaterally or bilaterally, intermittently or continuously, or alternately.

4. Smell disorder

Caused by mucosal edema and nasal congestion are mostly temporary. It is caused by atrophy of the olfactory nerve caused by persistent mucosal edema, which is mostly persistent.

Perennial rhinitis examination

1. Ask for a detailed history

Search for the cause of past medical history and family history, especially allergic diseases.

2. Anterior Rhinoscopy

It can be seen that the nasal mucosa is pale and edema with a lot of water-like secretions. Nasal polyps or polyp-like degeneration can occur if persistent edema occurs.

3. Nasal secretion smear test

During the onset of allergies, increased eosinophils and more mast cells can be seen in nasal secretions.

4. Skin prick test

Use a standardized allergen reagent to puncture the skin on the palm of the forearm and observe the results 20 minutes later. Each test should be carried out with positive and negative controls, the positive control using histamine, the negative control using allergen vehicle. Determine the results according to the corresponding standardized allergen reagent instructions. Skin prick tests should be performed at least 7 days after discontinuation of antihistamines. Allergic challenge test: skin test (scratch, intradermal and contact method, etc.) is generally used. The principle is that there are a variety of hypothetical allergic substances. After contact with the body, depending on whether there is a reaction, it can assist diagnosis. After allergen diagnosis is clear, this allergen can also be used for desensitization treatment.

5. Serum-specific IgE detection

The patient's venous blood is drawn for immunological testing, and is not affected by drugs and skin conditions.

Diagnosis of perennial rhinitis

Clinical symptoms Symptoms such as sneezing, watery snot, nasal congestion, and itchy nose appear more than two (including 2), and the symptoms last or accumulate for more than 1 hour per day. Perennial rhinitis has allergic rhinitis for more than half of the days in 1 year Symptoms. Signs are usually pale nasal mucosa, edema, and nasal watery secretions. Allergen skin puncture test is positive, and / or serum-specific IgE is positive. Nasal challenge test may be performed if necessary.

Differential diagnosis of perennial rhinitis

Seasonal allergic rhinitis

Seasonal allergic rhinitis occurs only in certain seasons each year and is caused by flowers, grass, trees, etc. Therefore, seasonal rhinitis, also known as hay fever or hay fever, has a distinct seasonal incidence, which occurs mostly in the spring and autumn, and mostly in the fall.

2. Angiomotor rhinitis

It is generally believed to be related to autonomic dysfunction, which can be induced by changes in ambient temperature, mood swings, mental stress, fatigue, and endocrine disorders. Clinical manifestations are similar to allergic rhinitis, but tests for specific allergens are usually negative.

Perennial rhinitis treatment

1. Avoid contact with allergens

(1) Reduce the number of indoor dust mites, and clean bedding and curtains. Mite allergens are soluble in water. Washing textiles can remove most of these allergens. Use air purifiers and vacuum cleaners with filters.

(2) Patients who are allergic to animal fur should avoid allergens.

2. Drug treatment

(1) Antihistamines Oral or nasal second-generation or new H1 antihistamines can effectively alleviate symptoms such as nasal itching, sneezing and runny nose.

(2) Glucocorticoid Nasal glucocorticoid can effectively alleviate symptoms such as nasal congestion, runny nose and sneezing. Oral glucocorticoids can be used for short-term treatment of severe patients who do not respond to other medications or cannot tolerate nasal medications.

(3) Anti-leukotriene drugs are effective for allergic rhinitis and asthma.

(4) Mast cell stabilizer has a certain effect on alleviating nasal symptoms, and eye drops are effective in alleviating ocular symptoms.

(5) Intranasal decongestant can relieve the symptoms of nasal congestion caused by nasal congestion, and the treatment course should be controlled within 7 days.

(6) Intranasal anticholinergic drugs can effectively inhibit runny nose and have limited clinical application value.

3. Immunotherapy

Including non-specific immunotherapy and specific immunotherapy. Specific immunotherapy is commonly used subcutaneously and sublingually. The course of treatment is divided into a dose accumulation stage and a dose maintenance stage, and the total course of treatment is not less than 2 years.

4. Surgical treatment

Indications: The symptoms of nasal congestion are not improved by drugs or immunotherapy, and there are obvious signs that affect the quality of life. There are obvious anatomical variations in the nasal cavity, accompanied by dysfunction. Complicated with chronic sinusitis and nasal polyps, drug treatment was ineffective. Surgical treatment is not a routine treatment for allergic rhinitis. Intranasal nerves such as the pterygoid nerve and anterior ethmoidomy have been discontinued because of inaccurate curative effect and many side effects.