SELECTED ARTICLES FROM THE RECENT LITERATURE 2004
12/3/04
Characteristics of pregnancy rhinitis
Summary
Background - A common condition during pregnancy has been called "pregnancy rhinitis" (PR), characterized by nasal congestion present for at least the last 6 weeks of pregnancy without evidence for infection or allergic causes and remitting within 2 weeks after delivery. The mechanisms underlying PR are not clearly defined but placental growth hormone effects may be involved. The quality of life is frequently affected significantly during PR.
Findings - PR and its treatment were reviewed by Ellegard of the Kungsbacka Hospital in Sweden . He commented that one must distinguish PR from chronic sinusitis which may be manifested in pregnancy only by chronic nasal congestion. The treatment of prominent PR is sometimes not effectual. Antihistamines and nasal corticosteroids are usually not very effective. Topical nasal decongestant sprays are therefore used frequently initially with benefit but often leading to rebound congestion when the vasoconstricting effect wanes. Rhinitis medicamentosa may result from overuse/prolonged use of such vasconstrictor nasal sprays.
Reference
Clin Rev Allergy Immunology 2004;26:149-59
Editor's Comments
This review highlights a common and poorly understood problem. I have always considered PR as a manifestation of hormonal effects. Because histamine release and eosinophil-rich inflammation is not present in PR, it is not surprising that treatment with antihistamines or nasal corticosteroids is not really effectual. One of the unanswered questions is why not all pregnant women get PR. Perhaps differences in the secretion of the offending hormone and/or different end-organ responsiveness are determinants of PR. Not mentioned in this report is whether PR occurring in a pregnancy will be followed by a consistent recurrence of PR in subsequent pregnancies in the same individual.
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