Rhinitis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D.  Associate Editor(s)-in-Chief: Fatimo Biobaku M.B.B.S 
Rhinitis is a heterogeneous group of disorders that can significantly impact the quality of life of the affected individual A heightened awareness of the condition and its potential debilitating comorbidities/complications is essential for a timely intervention.
Natural History, Complications, Prognosis
Rhinitis is a very common disease, and it is sometimes erroneously viewed as a trivial disease. Allergic rhinitis rarely occurs in isolation, it is a product of a genetic predisposition, epigenetic events, and environmental exposures, and it is frequently associated with other forms of atopy such as eczema, asthma, and allergic eye disease(allergic rhinoconjunctivitis). The vast majority of individuals with asthma have rhinitis, and allergic eye disease has been reported to affect almost all patients with allergic rhinitis. Nonallergic rhinitis is also associated with asthma. Frequent extension of rhinitis into the sinuses also occur, resulting in rhinosinusitis. Children with nonallergic rhinitis have a higher likelihood of undergoing remission, compared with those with allergic rhinitis, who tend to have a more persistent disease. Remission occurs in up to 73% of four year old children with nonallergic rhinitis by the age of eight years. Rhinitis is a significant cause of lost school and work days, and it constitutes a huge financial burden to the society. Untreated/poorly treated chronic rhinitis is associated with a diminished quality of life, disordered sleep, impaired work performance, and several other co-morbidities.
The complications of rhinitis include the following:
- Chronic cough- One of the commonest causes of chronic cough is posterior rhinorrhoea(postnasal drip)
- Mouth breathing
- Aggravation of adenoidal hypertrophy
- Poor sleep
- Obstructive sleep apnea
- Cognitive impairment
- Eustachian tube dysfunction
- Acute otitis media
- Otitis media with effusion
- Aggravation of asthma
- Hyposmia (usually mild)
Allergic comorbidities associated with Allergic rhinitis include:
- Allergic eye diseases
- Seasonal allergic conjunctivitis
- Perennial allergic conjunctivitis
- Vernal keratoconjunctivitis
- Atopic keratoconjunctivitis
- Asthma: Allergic rhinitis is strongly associated with the risk of developing asthma, and the coexistence of rhinitis with asthma is often associated with an increase in asthma severity.
- Atopic dermatitis
- Oral allergy syndrome
- Eosinophilic gastroenteritis
Resolution of allergic rhinitis occurs in only 10-20% of children within 10 years. A higher likelihood of remission has been documented in children with nonallergic rhinitis compared to the allergic type, with remission occurring within four years in about 73% of four year old children suffering from nonallergic rhinitis. Poorly treated rhinitis is strongly associated with a decreased quality of life and several other co-morbidities.
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Romeo, Jonathan; Dykewicz, Mark (2014). "Chapter 9:Differential Diagnosis of Rhinitis and Rhinosinusitis". Diseases of the Sinuses. Springer New York. pp. 133–152. ISBN 978-1-4939-0265-1.
- ↑ Skoner DP (2001). "Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis". J Allergy Clin Immunol. 108 (1 Suppl): S2–8. PMID 11449200.
- ↑ 3.0 3.1 3.2 Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA; et al. (2008). "The diagnosis and management of rhinitis: an updated practice parameter". J Allergy Clin Immunol. 122 (2 Suppl): S1–84. doi:10.1016/j.jaci.2008.06.003. PMID 18662584.
- ↑ 4.0 4.1 4.2 Shaker M, Salcone E (2016). "An update on ocular allergy". Curr Opin Allergy Clin Immunol. 16 (5): 505–10. doi:10.1097/ACI.0000000000000299. PMID 27490123.
- ↑ 5.0 5.1 Sacre Hazouri JA (2006). "[Allergic rhinitis. Coexistent diseases and complications. A review and analysis]". Rev Alerg Mex. 53 (1): 9–29. PMID 16634358.
- ↑ Mims JW (2014). "Epidemiology of allergic rhinitis". Int Forum Allergy Rhinol. 4 Suppl 2: S18–20. doi:10.1002/alr.21385. PMID 25182349.
- ↑ 7.0 7.1 7.2 7.3 Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A; et al. (2008). "Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen)". Allergy. 63 Suppl 86: 8–160. doi:10.1111/j.1398-9995.2007.01620.x. PMID 18331513.
- ↑ 8.0 8.1 8.2 8.3 Westman M, Stjärne P, Asarnoj A, Kull I, van Hage M, Wickman M; et al. (2012). "Natural course and comorbidities of allergic and nonallergic rhinitis in children". J Allergy Clin Immunol. 129 (2): 403–8. doi:10.1016/j.jaci.2011.09.036. PMID 22056609.
- ↑ Dykewicz MS, Hamilos DL (2010). "Rhinitis and sinusitis". J Allergy Clin Immunol. 125 (2 Suppl 2): S103–15. doi:10.1016/j.jaci.2009.12.989. PMID 20176255.
- ↑ Schoenwetter WF, Dupclay L, Appajosyula S, Botteman MF, Pashos CL (2004). "Economic impact and quality-of-life burden of allergic rhinitis". Curr Med Res Opin. 20 (3): 305–17. doi:10.1185/030079903125003053. PMID 15025839.
- ↑ Blaiss MS (2008). "Pediatric allergic rhinitis: physical and mental complications". Allergy Asthma Proc. 29 (1): 1–6. doi:10.2500/aap2008.29.3072. PMID 18302831.
- ↑ 12.0 12.1 Sih T, Mion O (2010). "Allergic rhinitis in the child and associated comorbidities". Pediatr Allergy Immunol. 21 (1 Pt 2): e107–13. doi:10.1111/j.1399-3038.2009.00933.x. PMID 19664013.
- ↑ Turley R, Cohen SM, Becker A, Ebert CS (2011). "Role of rhinitis in laryngitis: another dimension of the unified airway". Ann Otol Rhinol Laryngol. 120 (8): 505–10. PMID 21922973.
- ↑ Deliu M, Belgrave D, Simpson A, Murray CS, Kerry G, Custovic A (2014). "Impact of rhinitis on asthma severity in school-age children". Allergy. 69 (11): 1515–21. doi:10.1111/all.12467. PMC 4209798. PMID 24958195.
- ↑ Rotiroti, Giuseppina; Scadding, Glenis (July 2016). "Allergic Rhinitis-an overview of a common disease". Paediatrics and Child Health. Volume 26 (Issue 7): 298–303. Retrieved January 20, 2017.
- ↑ Baig MA, Qadir A, Rasheed J (2006). "A review of eosinophilic gastroenteritis". J Natl Med Assoc. 98 (10): 1616–9. PMC 2569760. PMID 17052051 17052051 Check
- ↑ Sly RM (1999). "Changing prevalence of allergic rhinitis and asthma". Ann Allergy Asthma Immunol. 82 (3): 233–48, quiz 248-52. doi:10.1016/S1081-1206(10)62603-8. PMID 10094214.