Rinite mista: um novo fenótipo?
Mixed rhinitis: a new phenotype?
Isabella Burla Manhães; Fausto Yoshio Matsumoto; Dirceu Solé; Gustavo Falbo Wandalsen
Resumo
A rinite não é uma condição homogênea e pode se manifestar por diferentes subtipos, segundo os mecanismos fisiopatológicos subjacentes (endotipos) e manifestações clínicas (fenótipos). A rinite idiopática (RI) é o subtipo mais prevalente dentro do grupo das rinites não alérgicas e requer a exclusão da rinite alérgica (RA) como diagnóstico. A rinite mista (RM) pode ser considerada em pacientes que apresentam sintomas após exposição a alérgenos e estímulos inespecíficos, uma combinação de RI e RA. Os autores realizaram revisão narrativa de artigos publicados em inglês, português, francês e espanhol, na última década nas bases de dados PubMed, Google Scholar, EMBASE e SciELO. As palavras-chaves usadas nessa busca foram: mixed rhinitis OR allergic rhinitis OR nonallergic rhinitis OR chronic rhinitis OR nasal irritants AND children OR adults. A prevalência de rinite crônica na população geral está estimada entre 10% e 40%; entre adultos, a prevalência de RM corresponde entre 30% e 50% desses pacientes. Em crianças com RA, 42,9% delas foram classificadas como tendo RM. Clinicamente, a RM manifesta-se por quadros mais graves de rinite, com pior controle e maior necessidade de associação de medicamentos. O emprego de instrumento padronizado e validado para a cultura da população em estudo é primordial para a identificação de pacientes com RM, além de permitir o melhor entendimento desse fenótipo de rinite com relação à evolução e controle medicamentoso.
Palavras-chave
Abstract
Rhinitis is not a homogeneous condition and can manifest in different subtypes, depending on the underlying pathophysiological mechanisms (endotypes) and clinical manifestations (phenotypes). Vasomotor rhinitis (VR) is the most prevalent subtype within the group of nonallergic rhinitis and requires the exclusion of allergic rhinitis (AR) as a diagnosis. Mixed rhinitis (MR) can be considered in patients who present symptoms after exposure to allergens and nonspecific stimuli, representing a combination of Nonallergic rhinitis (NAR) and AR. The PubMed, Google Scholar, EMBASE, and SciELO databases were searched for articles published in English, Portuguese, French, or Spanish in the last decade. The following search strategy was used: mixed rhinitis OR allergic rhinitis OR nonallergic rhinitis OR chronic rhinitis OR nasal irritants AND children OR adults. The prevalence of chronic rhinitis in the general population is estimated to be between 10% and 40%. Among adults, the prevalence of MR corresponds to 30% to 50% of these patients. In children with AR, 42.9% were classified as having MR. Clinically, MR manifests itself in more severe conditions, with worse control and a greater need for medication combinations. The use of a standardized and culturally validated instrument for the study population is essential for the identification of patients with MR, as well as for improving the understanding of this rhinitis endotype in terms of disease progression and pharmacological management.
Keywords
References
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Submitted date:
09/13/2024
Accepted date:
12/21/2024
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