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Non-Allergic Rhinitis (Vasomotor)

Non-Allergic Rhinitis (Vasomotor)

Non-allergic rhinitis is a chronic condition that can occur at any age but is more common in adults. The most common symptoms are nasal congestion, post-nasal drainage, and headache, although runny nose, sneezing and itching of the nose may occur in some non-allergic individuals. Many non-allergic patients have recurrent sinusitis and middle ear infections or middle ear fluid collection.

Initial evaluation requires that surgical conditions (growths in the nose, crooked nasal septum, etc.) and general medical conditions (thyroid disease, pregnancy, etc.) are not responsible for the chronic symptoms. We recommend that ever patient have a family practitioner, internist, or pediatrician to follow them for their general medical care. If the history and physical examination are not positive for surgical or general medical problems, the patient most likely has the most common nasal problem of non-allergic or allergic nasal disease.

Non-allergic rhinitis is a very difficult topic to fully understand. The actual defect resulting in the symptoms commonly found is not known. We do know that the difficulty arises in the inability to correctly change the size of blood vessels and the quantity of mucus produced by mucus glands in the nose. Under normal circumstances the nose warms or cools the air entering the nose to 98 degrees F., increases the humidity to at least 80%, and filters unwanted substances resulting in relatively clean air at 98 degrees F. and 80% humidity entering the lungs regardless of current environmental conditions. These changes occur almost instantly with each breath. The non-allergic individual has lost the ability to make the necessary changes either from an ineffective blood vessel and mucus gland controlling mechanism, temperature and humidity sensing mechanism, or both. The end result is inappropriate blood vessel size and/or excess mucus production which can result in nasal congestion, post-nasal drainage, and headaches.

Many individuals with non-allergic nasal disease will have a significant amount of irritation, inflammation, and hyperreactivity in the nose contributing to the persistent, chronic nature of the disease.

Nasal allergy on the other hand usually presents with runny nose, sneezing, and itching but some patients can also have nasal congestion, post-nasal drainage, and headaches. With nasal allergy we usually see definite problems at certain seasons of the year or a correlation with exposures to dust, animal dander, mold or mildew exposures and in some patients’ extreme reactions to certain foods. Allergy symptoms also involving the eyes usually are redness, itching and watering of the eyes.

It is possible for an individual to have problems with both non-allergic rhinitis and allergic rhinitis, and this makes the problems at times more difficult to clearly diagnose and treat.

Several tests can be used to differentiate non-allergic rhinitis from allergic rhinitis. Skin testing, as one might expect, displays positivity in patients with allergic rhinitis, whereas a negative skin test will be obtained in patients with non-allergic rhinitis. In addition, the blood IgE levels and eosinophils (the allergy cell) are elevated in patients with allergic rhinitis but not in non-allergic rhinitis.

Non-allergic rhinitis often is triggered by drafts, temperature changes (especially cold air), by scented cosmetics (both men’s and women’s cosmetics), by cigarette and tobacco smoke, as well as fireplace smoke, scented or perfumed soaps. Many types of aerosol sprays, even scented deodorants can cause problems. Paint fumes, insecticides, bug sprays,
varnishes, and even the odor from new clothing, carpeting or furniture can cause problems. Kerosene, lighter fluids, oil and gas fumes can cause problems. House dust may act as an irritant, and should be avoided.

Do not overuse over-the-counter decongestant sprays or nose drops because these can cause “rebound” nasal congestion. All nasal decongestant sprays should be discontinued following 3 days of continuous use. Medications will be prescribed to help with this problem. A good part of the treatment is avoiding known problems and exposures, and working by trial and error to find medications that work best in your case. Medications that may be tried include: Astelin© nasal spray, decongestants, decongestant-antihistamine combinations, intranasal steroid sprays, and possibly an atropine-derivative nasal spray (Atrovent©).

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AAAAI News: Sinusitis’s Impact on Asthma, Shot Brings 4-Season Relief

Chronic Sinusitis’s Impact on Asthma

Asthmatics can add chronic rhinosinusitis (CRS) as a related condition, and one that has a significant health impact, according to new research.

In the study, patients with asthma who also had a chronic bronchial condition were the most likely to have CRS – and to feel the effects of this disease combination. The new findings will be presented at the 2022 annual meeting of the AAAAI (American Academy of Allergy Asthma & Immunology) in Phoenix in late February.

To conduct the study, researchers from Northwestern and Johns Hopkins universities analyzed medical records from 1988 to 2021 on those with asthma, who had CRS and/or bronchiectasis. In the latter chronic condition, the airway walls become thick and damaged. The patient experiences mucus buildup, coughing, and lung infections.

The sinus condition CRS lasts for more than 12 weeks, even with medication, and includes symptoms such as nasal congestion, facial pressure and thick nasal discharge.  

The team studied records spanning more than three decades to capture as many patients as possible, and to follow patients with asthma who did not initially have bronchiectasis, says study author Dr. Margaret Kim.

To measure the impact of CRS on patients with asthma and bronchiectasis, the researchers examined the use of medication, such as antibiotics and oral corticosteroids, along with the need for urgent health care. Of the 5,038 patients identified with asthma, 19 percent had bronchiectasis, 39 percent had CRS, and 10 percent had both conditions.

The study found that 51 percent of asthmatics who had bronchiectasis were more likely to have CRS than patients without it (36 percent).

Need for Medical Attention

The findings point to greater use of health-care resources among that 51 percent of asthma patients. The use of medications and the rate of hospital admissions and emergency room visits were all higher. The researchers conclude that CRS is an important to be aware of, especially in asthma patients with bronchiectasis.

The study is important as more patients are being diagnosed with bronchiectasis, which is associated with high health-care costs and requirements, said Kim, a clinical fellow in allergy and immunology at Northwestern University’s Feinberg School of Medicine.

“This knowledge helps identify patients who need more medical attention,” she said.

To help the identification process, providers can routinely ask about symptoms of CRS in patients who have asthma and bronchiectasis, and patients with CRS. Kim says patients with CRS should also be screened for bronchiectasis if they have symptoms that could suggest the condition, such as a cough with phlegm and difficulty controlling asthma.

Asthma Relief for All Seasons

Patients taking the biologic drug tezepelumab experienced fewer asthma exacerbations during all seasons throughout the year than those taking the placebo as part of a Phase 3 clinical trial, according to results to be presented at the 2022 AAAAI meeting.

Researchers focused on asthma exacerbations based on each season when they analyzed the results of the study called Navigator. That trial divided more than 1,000 teen and adult patients with poorly controlled asthma and frequent exacerbations into two groups. Participants received by injection either tezepelumab or placebo every four weeks for a year (but did not know which, as the trial was “blinded”). The participants also remained on their standard asthma regimens of inhaled corticosteroid inhalers, plus at least one additional controller medication. 

Tezepelumab reduced the annualized asthma exacerbation rate in the 528 patients taking the drug by 63 percent in winter, 46 percent in spring, 62 percent in summer, and 54 percent in fall, according to the study. Compared to those taking the placebo, patients taking tezepelumab had fewer exacerbations in winter (81.7 percent vs. 66.6 percent), spring (84.3 percent vs 76.3 percent), summer (86.8 percent vs 73.1 percent) and fall (79.4 percent vs. 66.6 percent), the study found.

Tezepelumab is a monoclonal antibody designed to work at an early stage of immune system response in the airways, blocking TSLP (thymic stromal lymphopoietin). TSLP is a type of cytokine, or signaling molecule, that triggers immune defenses. In response to a trigger, TSLP cytokines set off a cascade of airway inflammation that leads to asthma symptoms.

In December 2021, the FDA approved Tezspire (tezepelumab-ekko) injection as an add-on maintenance treatment to improve severe asthma symptoms when used with a patient’s current asthma medicine.

To read the entire article online, visit https://www.allergicliving.com/2022/02/03/aaaai-news-sinusitiss-impact-on-asthma-shot-brings-4-season-relief/

The post AAAAI News: Sinusitis’s Impact on Asthma, Shot Brings 4-Season Relief appeared first on Oklahoma Allergy and Asthma Clinic.

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