Pregnancy-induced rhinitis

Abstract

Background: Pregnancy-induced rhinitis (PIR) is often misclassified and under-diagnosed. There is currently no cure or optimum symptomatic treatment. Objective: To summarize current knowledge of PIR and assess evidence supporting treatment options. Type of review: Structured literature search. SEARCH STRATEGY AND EVALUATION METHOD: Review of English-language articles addressing evidence for aetiology, classification, differential diagnosis or treatment options for PIR. Comparisons to management of other types of rhinitis in pregnancy are also considered. Results: Incidence and prevalence of PIR vary widely between studies. Hormonal changes have a presumed aetiological role, although present evidence is scanty. Smoking appears to be the only agreed identifiable risk factor. Distinction between PIR and other types of rhinitis in pregnancy, especially allergic rhinitis, is important as effective treatments differ. Management of PIR focuses on minimal intervention required for symptom relief. Conclusions: Although PIR is temporary, its impact on patients` quality of life can be profound. Advice and conservative treatment provide the mainstay of clinical management. None of the currently available medical options offer an ideal solution. Any potential benefit gained should be balanced against risks to the foetus. Clarifying the definition of this separate category of rhinitis will lead to better recognition, with prompt and appropriate treatment.

Rhinitis and pregnancy: literature review

“…Regarding risk factors for the development of gestational rhinitis, smoking was the only one identified with significant evidence. 7 , 16 The same study found that the specific IgE to house dust mites was a predisposing factor for the development of the disease. 16 There is no association between gestational rhinitis and pre-existing asthma.…”

“… 8 Also, no association was observed with maternal age, gestational age, child's gender, and parity. 1 , 7 , 17 In relation to the actual allergic rhinitis, it was observed that the electron microscopy findings in pregnant women with nasal symptoms were identical to those with allergic rhinitis. 18 …”

“… 9 Population studies with relatively small samples often do not differentiate gestational rhinitis from other types of rhinitis, showing a prevalence ranging between 18% and 30% (for all types of rhinitis during pregnancy). 7 The largest population study on prevalence was performed in Sweden through questionnaires and included 599 patients, excluding those who already had signs of rhinitis before pregnancy, revealing a prevalence of gestational rhinitis of 22%. 10 …”

“…Although many etiological factors have been proposed, the current knowledge about the physiopathology of gestational rhinitis is still scarce. 7 , 9 It is presupposed that the placental trophoblastic hormone can stimulate hypertrophy of the nasal mucosa during pregnancy. 9 Moreover, estrogen may contribute to this effect by increasing histamine receptors in epithelial cells and the microvasculature.…”

“… 6 Gestational rhinitis, in turn, is defined as nasal obstruction that is not present before pregnancy, typically occurs in the second or third trimesters, with a duration equal to or greater than six weeks, shows no allergic cause or upper airway infection signs and symptoms resolve completely within two weeks after delivery. 1 , 7 , 8 …”