Rhinitis refers to inflammation of the nasal passages. This inflammation can cause a variety of annoying symptoms, including sneezing, itching, nasal congestion, runny nose, and the sensation that mucus is draining from the nose down the back of the throat

Brief episodes of rhinitis are usually caused by respiratory tract infections with viruses (e.g., the common cold). Chronic rhinitis is usually caused by allergies, but it can also occur from overuse of certain drugs, some medical conditions, and other factors.

For some people, rhinitis can be a lifelong condition that gets relieved and rebounds over time. Fortunately, the symptoms of rhinitis can usually be controlled with a combination of environmental measures, medications.

Allergic rhinitis, also known as hay fever, affects approximately 20 percent of people of all ages. The risk of developing allergic rhinitis is much higher in people with asthma or eczema and in people who have a family history of asthma or rhinitis.

Allergic rhinitis can begin at any age, although most people first develop symptoms in childhood or young adulthood. The symptoms are often at their worst in children and in people in their 30s and 40s. However, the severity of symptoms tends to vary throughout life; many people experience periods when they have no symptoms at all.

The cause of allergic rhinitis

Allergic rhinitis is caused by a nasal reaction to small airborne particles called allergens (substances that provoke an allergic reaction). In some people, these particles also cause reactions in the lungs (asthma) and eyes (allergic conjunctivitis).

There are four major categories of allergens that trigger allergic rhinitis; Pollens (from trees and grass), Insects (house dust mites, cockroaches), Animal allergens (skin, fur, feathers, saliva) and Molds.

The allergic reaction is due to the activation of inflammatory cells in the body upon exposure to these allergens. These cells then produce inflammatory substances, such as histamine, which through a cascade of reactions cause an exaggerated body reaction, causing fluid to build up in the nasal tissues (congestion), itching, sneezing, and runny nose. Over several hours, these substances activate other inflammatory cells that can cause persistent symptoms.

Allergic rhinitis can be seasonal (occurring during specific seasons) or perennial (occurring year round). The allergens that most commonly cause seasonal allergic rhinitis include pollens from trees, grasses, and weeds, as well as spores from fungi and molds. The allergens that most commonly cause perennial allergic rhinitis are dust mites, cockroaches, animal dander, and fungi or molds. Perennial allergic rhinitis tends to be more difficult to deal with.

When an allergen is present year round, the predominant symptoms include post-nasal drip, persistent nasal congestion, and poor-quality sleep.

The symptoms of allergic rhinitis vary from person to person. Although the term "rhinitis” refers only to the nasal symptoms, many patients also experience problems with their eyes, throat, and ears. Common symptoms include; watery nasal discharge, blocked nasal passages, sneezing, nasal itching, post-nasal drip, loss of taste, facial pressure or pain, itchy eyes which turn red most times with feeling of grittiness, sore throat, hoarse voice, congestion or popping of the ears, itching of the throat or ears, disturbed sleep with mouth breathing, frequent awakening, daytime fatigue coupled with difficulty performing work.

Diagnosing allergic rhinitis

The diagnosis of allergic rhinitis is based upon the history of the above symptoms. Physical examination and medical tests can confirm the diagnosis and identify the offending allergens. It is often possible to identify the allergens and other triggers that provoke allergic rhinitis by; recalling the factors that precede symptoms, noting the time at which symptoms begin, Identifying potential allergens in a person’s home, work, and school environments

Skin tests may be performed for people whose symptoms are not well controlled with medications or in whom the offending allergen is not obvious.

Allergic rhinitis management

The treatment of allergic rhinitis includes reducing exposure to allergens and other triggers, in combination with medication therapy. In most people, these measures effectively control the symptoms.

The first step in the treatment of allergic rhinitis is to reduce exposure to allergens. The most common indoor allergens are dust mites and cat and dog dander. However, it is important to know that with indoor allergens, it may take three to six months to see an improvement in symptoms once triggers are removed.

Rinsing the nose with a salt-water (saline) solution, called nasal irrigation or nasal lavage can be done and helps in drainage down the back of the throat, sneezing, nasal dryness, and congestion. This treatment helps by rinsing out allergens and irritants from the nose. Saline rinses also clean the nasal lining and can be used before applying sprays containing medications, to get a better effect from the medication. Nasal lavage with warmed saline can be performed as needed, once per day, or twice daily for increased symptoms

Medical treatment usually includes one or more medications (e.g., nasal glucocorticoid sprays, antihistamines).Antihistamines relieve the itching, sneezing, and runny nose of allergic rhinitis. Combined treatment with nasal steroids or decongestants provides greater symptom relief than use of either alone.

Dr Ian Shyaka is a General Practitioner based in Kigali.