rhinitis%20-%20nonallergic%20(pediatric)
RHINITIS - NONALLERGIC (PEDIATRIC)
Rhinitis is the inflammation of the nasal lining membranes.
Nonallergic rhinitis is a diagnosis of rhinitis without any immunoglobulin E (IgE) mediation, as documented by allergen skin testing.
Signs & symptoms are nasal itching, rhinorrhea, nasal congestion with or without obstruction and sneezing.

Principles of Therapy

  • If possible, treatment should be aimed at the underlying causative physiology of nonallergic rhinitis
  • Treatment response may be less effective than in allergic rhinitis
  • Predominantly aimed at symptomatic treatment
  • Medications may be administered on an “as-required” basis or as a long-term therapy

Pharmacotherapy

Anticholinergics
  • Action: Inhibit the parasympathetic nervous system that innervates the serous & seromucous glands
  • Ideal for patients who present only with rhinorrhea, especially in gustatory rhinitis
  • Have no activity against sneezing, itching or nasal congestion
Antihistamines
  • Less effective in nasal congestion but some have anti-inflammatory properties
Nasal Antihistamines
  • Effect: Have been shown to control rhinorrhea
  • Effective for vasomotor rhinitis
Oral Antihistamines
  • 1st generation antihistamines may be useful in controlling rhinorrhea
  • Generally less effective for nonallergic rhinitis but may be used as an adjuvant to nasal corticosteroids in the treatment of NARES
Corticosteroids (Nasal)
  • Effect: Decrease nasal obstruction
  • Onset of action is relatively slow (up to 4 weeks) with maximum efficacy after a few days, thus more recommended for patients with chronic symptoms
  • Patient should be maintained on the lowest effective dose
  • Caution is needed due to the possible effect on growth
  • Regular height measurements are advised
Decongestants
  • Preparations containing Ephedrine, Oxymetazoline & Xylometazoline should not be used in patients <2 years of age
Nasal Decongestants
  • Relieves nasal obstruction & postnasal drainage
Oral Decongestants
  • Effects: Relieve nasal obstruction & postnasal drainage
  • Ideal for long-term use & for patients with sporadic symptoms
  • Do not cause rebound nasal congestion
  • May be used in combination with nasal corticosteroids
  • May cause CNS stimulation, hypertension & cardiac arrhythmias
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