Klinik und Therapie der Schwangerschafts-Rhinopathie

Zusammenfassung

Als Schwangerschafts-Rhinopathie oder Rhinopathia gravidarum bezeichnet man eine mehrwöchige, schwangerschaftsbegleitende Behinderung der Nasenluftpassage ohne Hinweis auf eine Raumforderung, Infektion oder Allergie und das rasche Verschwinden der Symptome nach der Geburt. Das Krankheitsbild betrifft etwa 20 bis 30 % aller Schwangeren und kann zu jedem Zeitpunkt der Gravidität auftreten. Pathophysiologisch werden vor allem hormonelle Einflüsse verantwortlich gemacht. Raucherinnen sowie Patientinnen mit vorbestehender Milbenallergie und chronischer Sinusitis besitzen ein erhöhtes Risiko daran zu erkranken. Im Folgenden wird ein stufentherapeutisches Konzept für die Behandlung der Rhinopathia gravidarum vorgestellt.

Abstract

Pregnancy rhinitis is a common condition with long-lasting nasal congestion without signs of infection, allergy or tumor, starting at any time during pregnancy and disappearing completely within 2 weeks of delivery. Risk factors are smoking, sensitisation to house dust mites and chronic sinusitis. Hormonal influences are most likely; however, a definitive pathophysiological concept does not exist. Various treatment options are presented and a stepwise therapeutic strategy for pregnancy rhinitis is developed.

Schlüsselwörter

Schwangerschafts-Rhinopathie - Rhinopathia gravidarum - Schwangerenrhinitis

Key words

Pregnancy rhinitis - treatment

• 1 MacKenzie J N. The physiological and pathophysiological relations between the nose and the sexual apparatus of man.  Alienist Neurol. 1898;  19 219-239
• 2 Mabry R L. Intranasal steroid injection during pregnancy.  South Med J. 1980;  73 1176-1179
• 3 Mabry R L. Rhinitis of pregnancy.  South Med J. 1986;  79 965-971
• 4 Ellegård E, Hellgren M, Toren K, Karlsson G. The incidence of pregnancy rhinitis.  Gyn Obstet Invest. 2000;  49 98-101
• 5 Ellegård E, Karlsson G. Nasal congestion during pregnancy.  Clin Otolaryngol. 1999;  24 307-311
• 6 Derkay C S. Eustachian tube and nasal function during pregnancy: a prospective study.  Otolaryngol Head Neck Surg. 1988;  99 558-566
• 7 Ellegård E, Karlsson G. IgE-mediated reactions and hyperreactivity in pregnancy rhinitis.  Arch Otolaryngol Head Neck Surg. 1999;  125 121-1125
• 8 Juniper E F. Measuring health-related quality of life in rhinitis.  J Allergy Clin Immunol. 1997;  99 S742-749
• 9 Franklin K A, Holmgren P A, Jonsson F, Poromaa N, Stenlund H, Svanborg E. Snoring, pregnancy-induced hypertension, and growth retardation of the fetus.  Chest. 2000;  117 137-141
• 10 Wolff H G, Wolf S, Grace W J. et al . Changes in form and function of mucous membranes occurring as part of protective reaction patterns in man during periods of life stress and emotional conflict.  Trans Assoc Am Physicians. 1948;  61 313-334
• 11 Holmes T H, Goodell H, Wolf S, Wolff H G. The relation of nasal to sexual function.  In: The nose: An experimental study on reactions within the nose in human subjects during varying life experiences. Springfield; III Charles C Thomas Publisher 1950: 89-100
• 12 Mortimer H, Wright R P, Collip J B. The effect of the administration of oestrogenic hormones on the nasal mucosa of the monkey (Macaca mulatta).  Can Med Assoc J. 1936;  35 503-512
• 13 Taylor M. An experimental study of the influence of the endocrine system on the nasal respiratory mucosa.  J Laryngol Otol. 1961;  75 972-977
• 14 Toppozada H, Michaels L, Toppozada M, El-Ghazzawi I, Talaat M, Elwany S. The human respiratory nasal mucosa in pregnancy.  J Laryngol Otol. 1982;  96 613-626
• 15 Mabry R L. The management of nasal obstruction during pregnancy.  ENT journal. 1983;  62 16-19
• 16 Lekas M D. Rhinitis during pregnancy and rhinitis medicamentosa.  Otolaryngol Head Neck Surg. 1992;  107 845-849
• 17 Reynolds S RM, Foster F I. Acetylcholine-equivalent content of the nasal mucosa in rabbits and cats, before and after administration of estrogen.  Am J Physiol. 1940;  131 422-425
• 18 Kojda G. Weibliche Sexualhormone, Östrogene. In Kojda. G Pharmakologie Toxikologie Systematisch. 2. Auflage 2002 Uni-Med Verlag Bremen; pp.: 363-369
• 19 Kühnel T. Hormonelle Rhinitis in Kapitel Nase und Nasennebenhöhlen. Praxis der HNO-Heilkunde, Kopf- und Halschirurgie (Hrsg. Strutz J und Mann W). Thieme Stuttgart; 2001
• 20 Toppozada H, Toppozada M, El-Ghazzawi I, Elwany S. The human respiratory nasal mucosa in females using contraceptive pills.  J Laryngol Otol. 1984;  98 43-51
• 21 Bende M, Hallgarde U, Sjögren C, Uvnäs-Moberg K. Nasal congestion during pregnancy.  Clin Otolaryngol. 1989;  14 385-387
• 22 Ellegård E, Oscarsson J, Bougoussa M, Igout A, Hennen G, Eden S, Karlsson G. Serum level of placental growth hormone is raised in pregnancy rhinitis.  Arch Otolaryngol Head Neck Surg. 1998;  124 439-443
• 23 Haeggstrom A, Ostberg B, Stjerna P, Graf P, Hallen H. Nasal mucosal swelling and reactivity during a menstrual cycle.  ORL J Otorhinolaryngol Relat Spec. 2000;  62 39-42
• 24 Bowser C, Riederer A. Detection of progesterone receptors in connective tissue cells of the lower nasal turbinates in women.  Laryngorhinoontologie. 2001;  80 182-186
• 25 Schatz M, Zeiger R S. Diagnosis and management of rhinitis during pregnancy.  Allergy Proc. 1988;  9 545-554
• 26 Skinner D W, Richards S H. Acromegaly: the mucosal changes within the nose and paranasal sinuses.  J Laryngol Otol. 1988;  102 1107-1110
• 27 Zondeck B, Bromberg Y M. Endocrine allergy - clinical reactions of allergy to endogenous hormones and their treatment.  J Obstet Gynecol Br Emp. 1947;  54 1-19
• 28 Sorri M, Harikainen-Sorri A, Kärja J. Rhinitis during pregnancy.  Rhinology. 1980;  18 83-86
• 29 Hellin M, Ruiz C V, Ruiz F M. The influence of pregnancy on mucociliary nasal transport.  An Otorrinolaringol Ibero Am. 1994;  21 595-601
• 30 Ellegård E, Karlsson G. Nasal mucociliary transport in pregnancy.  Am J Rhin. 2000;  14 375-378
• 31 Turnbull G L, Rundell O H, Rayburn W F, Jones R K, Pearman C S. Managing pregnancy-related nocturnal nasal congestion. The external nasal dilator.  J Reprod Med. 1996;  41 897-902
• 32 Graf P, Hallén H. Effect of the nasal mucosa of long-term treatment with oxymetazoline, benzalkonium chloride and placebo nasal sprays.  Laryngoscope. 1996;  106 605-609
• 33 Schaefer C h, Spielmann H. Arzeneiverordnung in Schwangerschaft und Stillzeit. 6. Auflage Urban & Fischer Verlag München und Jena; 2001
• 34 Scadding G K, Lund V J, Jacques L A, Richards D H. A placebo-controlled study of fluticasone propionate aqueous nasal spray and beclomethasone dipropionate in perennial Rhinitis: efficacy in allergic and non-allergic perennial Rhinitis.  Clin Exp Allergy. 1995;  25 737-775
• 35 Mygind N. Effects of corticosteroid therapy in non-allergic rhinosinusitis.  Acta Otolaryngol. 1996;  116 164-166
• 36 Mabry R L. Evaluation of systemic absorption of intraturbinally injected triamcinolone.  Otolaryngol Head Neck Surg. 1981;  89 268-270
• 37 Van As A, Bronsky E, Grossman J, Meltzer E, Ratner P, Reed C. Dose tolerance study of fluticasone propionate aqueous nasal spray in patients with seasonal allergic rhinitis.  Ann Allerg. 1991;  67 156-162
• 38 Wilson A M, Sims E J, McFarlane L C, Lipworth B J. Effects of intranasal corticosteroids on adrenal, bone, and blood markers of systemic activity in allergic rhinitis.  J Allerg Clin Immunol. 1998;  102 598-604
• 39 Allen D B. Systemic effects of intranasal steroids: an endocrinologist's perspective.  J Allergy Clin Immunol. 2000;  106 S179-190
• 40 Ellegård E, Hellgren M, Karlsson N G. Fluticasone propionate aqueous nasal spray in pregnancy rhinitis.  Clin Otolaryngol. 2001;  26 394-400
• 41 O'Connell M, Welsch G. Unbound plasma cortisol during pregnancy.  J Clin Endocrinol. 1969;  29 563-568
• 42 Hager G, Heise G. A severe complication with permanent practical blindness of one eye following an intranasal injection.  HNO. 1962;  10 325-328
• 43 McCleve D E, Goldstein J, Silver S. Corticosteroid injections of the nasal turbinates: past experience and precautions.  Otolaryngology. 1978;  86 851-857
• 44 Onrust S V, Lamb H M. Mometasone furoate. A review of its intranasal use in allergic rhinitis.  Drugs. 1998;  56 725-745
• 45 Storms W W. Risk-benefit assessment of fluticasone propionate in the treatment of asthma and allergic Rhinitis.  J Asthma. 1998;  35 313-336
• 46 Hallen H, Enerdal J, Graf P. Fluticasone propionate nasal spray is more effective and has a faster onset of action than placebo in treatment of rhinitis medicamentosa.  Clin Exp Allergy. 1997;  27 552-558
• 47 Naclerio R M. Optimizing treatment options.  Clin Exp Allergy. 1998;  28 Suppl 6 54-59