Treatment of Chronic Rhinitis

Treatment

In cases of infectious rhinitis, a cure can usually be expected with appropriate antibiotic administration for a sufficient period of time. If complications are present, surgical treatment may be considered. However, in children, drug treatment is the standard rather than surgical treatment.

In chronic hypertrophic rhinitis, oral decongestants, topical steroid sprays, and local steroid injections are used. Surgical treatment may also reduce the enlarged nasal mucosa.

For vasomotor rhinitis, topical nasal steroids are used as treatment. They are effective for nasal obstruction and rhinorrhea, and antihistamines can be used together depending on the symptoms. If surgical treatment such as septal correction surgery or turbinate plasty is also performed, the effect of drug treatment may be better.

Allergic rhinitis is a chronic inflammation of the nasal cavity, so long-term treatment and attention are required. Avoidance of the causative allergen and appropriate drug therapy are essential, and when these two treatments are not effective, immunotherapy and surgical treatment are considered.

1. Avoidance therapy Allergy does not occur if the patient is not exposed to the causative allergen at all. Therefore, the first step is to avoid exposure to the causative allergen and irritants; this is called avoidance therapy.

However, it is very difficult to relieve symptoms with avoidance therapy alone, because each patient’s living conditions make exposure to allergens easy, it is difficult to change these conditions, and in some cases the exact cause is not identified.

Still, reducing exposure to allergens by making the greatest possible efforts within practical limits can lessen the severity of symptoms and reduce the amount of medication needed in drug therapy. Common allergens such as house dust mites should be removed, and exposure to allergens such as pollen should be avoided. In addition, people who are sensitive to pet hair should not keep pets.

2. Drug therapy Drug therapy mainly uses oral antihistamines and decongestants such as nasal sprays. Antihistamines block the action of histamine on the blood vessels and sensory nerves of the nasal mucosa, preventing a range of symptoms.

Using topical nasal steroids is effective. Their advantage is that they act locally and have almost no systemic side effects, and they are effective for chronic rhinitis, including allergic rhinitis. This spray should be used regularly once or twice a day, and spraying it only when the nose is blocked reduces its effectiveness. It can improve most of the main symptoms, such as sneezing, runny nose, nasal congestion, and itching.

However, if vasoconstrictive drugs among the sprays, called decongestants, are used continuously, the nasal mucosa can be damaged and drug-induced rhinitis, described above, may occur, so caution is needed.

3. Surgical treatment Surgical treatment is performed with the aim of fundamentally resolving allergic rhinitis that does not improve well with drug therapy alone. It is also performed to alleviate accompanying problems when there is a nasal structural abnormality that worsens severe nasal congestion or symptoms, or when sinusitis is present. Methods include laser cauterization of the nasal mucosa, which is overly sensitive to foreign substances, to reduce mucosal reactivity, and vidian neurectomy.

4. Immunotherapy Depending on the patient’s age and the degree of allergic reaction, the causative allergen is administered to induce changes in the body’s immune response. It is highly effective in children, and although the treatment period is long at 3 to 5 years, it is effective in 70 to 80% of cases.

This is a desensitization method in which the causative allergen is gradually increased from a low concentration and administered by subcutaneous injection so that an allergic reaction does not occur when the allergen enters the body from outside. However, because there are many serious side effects, it should be avoided in patients with heart disease, pregnant women, and patients with severe asthma.

So far, I have explained the treatment of chronic rhinitis. In the next installment, we will look at diffuse large B-cell lymphoma.

Source: Korea Disease Control and Prevention Agency, National Health Information Portal