Treatise Index
- 1. The Respiratory Guardian
- 2. Allergic Rhinitis: The IgE Storm
- 3. Sinusitis: When Drainage Fails
- 4. Symptom Comparison Chart
- 5. Environmental Triggers (Mites and Pollution)
- 6. Diagnosis: Clinical vs Imaging
- 7. The Art of Nasal Irrigation
- 8. Medications and Immunotherapy
- 9. Conclusion
- Selected References
The "One Airway"
Rhinitis and asthma are often referred to as "one airway disease." Approximately 80% of asthmatics have rhinitis, and treating nasal inflammation is critical to controlling asthma. The nose is the lung's air conditioner; if it fails (obstruction), the air arrives cold, dry, and dirty to the bronchi, triggering bronchospasm.
1. The Nose as Guardian
The nose is not just a passive channel for air. It is a complex organ responsible for filtering, warming, and humidifying about 10,000 liters of air we breathe daily. When this defense system fails or overreacts, the two most common and frequently confused nasal conditions arise: rhinitis and sinusitis.
Although they share symptoms (stuffy nose), they are distinct pathological entities. Rhinitis is an inflammation of the mucosa lining the nasal cavity, while sinusitis (more correctly called rhinosinusitis) involves inflammation of the paranasal sinuses, the aerated cavities within the facial bones.
2. Allergic Rhinitis: The Inflammatory Storm
Allergic rhinitis is a type I hypersensitivity reaction, mediated by IgE antibodies. It occurs when the immune system mistakenly identifies a harmless substance (allergen, such as pollen or dust mites) as a threat.
Immunological Mechanism
- Sensitization: First contact with the allergen produces specific IgE, which attaches to the surface of mast cells.
- Re-exposure: The allergen binds to IgE, causing mast cell "degranulation."
- Mediator Release: A burst of Histamine, leukotrienes, and prostaglandins is released in seconds.
Histamine causes vasodilation (obstruction), increased vascular permeability (runny nose), and stimulation of nerve endings (itching and sneezing). It is an immediate and explosive reaction.
3. Sinusitis: Drainage Blockage
The sinuses produce mucus that drains into the nose through tiny orifices called ostia. Rhinosinusitis occurs when these ostia are blocked.
The blockage creates a closed, moist, oxygen-free environment, ideal for bacterial proliferation. Causes of blockage include:
- Mucosal edema (due to flu or untreated rhinitis).
- Anatomy (deviated septum, concha bullosa).
- Nasal polyps.
Sinusitis can be Acute (< 12 weeks, usually viral or post-viral) or Chronic (> 12 weeks, complex inflammatory process, often with polyps).
4. Comparison Chart: How to Differentiate?
Clinical distinction is essential for correct treatment:
| Symptom | Allergic Rhinitis | Sinusitis (Acute Bacterial) |
|---|---|---|
| Pruritus (Itching) | Intense (nose, eyes, roof of mouth). | Rare. |
| Sneezing | In bursts (several in a row). | Occasional. |
| Discharge | Watery, clear (hyaline). | Thick, yellow/greenish (purulent). |
| Facial Pain/Pressure | Sensation of heaviness, but pain is rare. | Intense, throbbing pain, worsens when lowering head. |
| Fever | No. | May occur (but not always). |
| Duration | Persistent as long as allergen is present. | Generally > 10 days or "double sickening" (improvement then worsening). |
5. Environmental Triggers: The Invisible Enemy
Environmental control is 50% of the treatment. The main villains are:
- Dust Mites (Dermatophagoides): Live in household dust, mattresses, and pillows. Feed on shed human skin. Their feces are the potent allergen.
- Fungi (Mold): Grow in damp areas (bathrooms, leaks). Airborne spores are universal irritants.
- Animal Dander: The allergenic protein is not in the hair, but in the saliva and skin (dander) of dogs and cats.
- Pollution and Weather Change: Thermal shock and diesel particles (PM2.5) paralyze nasal cilia, facilitating infection and inflammation.
6. Diagnosis: Beyond Clinical History
For Rhinitis, diagnosis is clinical, confirmed by skin tests (Prick Test) or specific IgE blood measurement (RAST) to identify the allergen.
For Sinusitis, the gold standard exam is not X-ray (which has low sensitivity), but Nasofibrolaryngoscopy (camera in the nose) to see pus in the middle meatus, or Computed Tomography (CT) of the sinuses, essential in chronic or pre-surgical cases.
7. Treatment: The Art of Nasal Irrigation
Nasal irrigation with saline solution is the most effective non-pharmacological intervention for both conditions. It:
- Mechanically removes allergens, bacteria, and inflammatory mediators.
- Thins mucus, facilitating expulsion.
- Improves nasal cilia function.
It should be done with high volume (bottles or syringes of 20ml+) and low pressure, daily. It is the "tooth brushing" of the nose.
8. Medications and Immunotherapy
The therapeutic arsenal differs:
Allergic Rhinitis
- Topical Nasal Corticosteroids: The mainstay of treatment. Reduce inflammation and hyper-reactivity. Safe for long-term use (low systemic absorption).
- Antihistamines: Useful for acute attacks (sneezing/itching), but poorly effective for stuffy nose.
- Immunotherapy (Vaccines): The only treatment capable of changing the natural history of the disease, teaching the immune system to tolerate the allergen.
Bacterial Sinusitis
- Antibiotics: Only if there is strong evidence of bacterial infection (symptoms > 10 days, high fever, pus). Amoxicillin-Clavulanate is common.
- Systemic Corticosteroids: May be used for a short period to reduce edema and open ostia.
9. Conclusion
Rhinitis and sinusitis, although affecting the same anatomical region, require distinct approaches. The trivialization of topical decongestants (drops) use must be fought, as they cause rebound medicamentosa rhinitis. The key to superior respiratory health lies in environmental prevention, daily nasal hygiene, and continuous anti-inflammatory treatment, not just symptomatic relief of crises.