Pregnancy rhinitis. A clinical study on nasal congestion associated with menstruation and pregnancy

Abstract

Nasal congestion due to menstruation and due to pregnancy are fairly well known clinical phenomena. The aim of this study was to demonstrate these and, after having defined pregnancy rhinitis, to estimate its incidence, possible pathogenetic and risk factors. Daily subjective scores on nasal congestion, and nasal peak expiratory flow (nPEF) alone during the menstrual cycle, combined with oral PEF (giving a blockage index) during pregnancy, were used. On visits 6 months after delivery, acoustic rhinometry and rhinostereometry were performed after histamine challenge, and blood was drawn for in vitro testing of serum regarding sensitisation to 10 airborne allergens. Blood was also drawn on 4 occasions during pregnancy, and levels of 17-ß-estradiol, progesterone, insulinlike growth factor I, placental growth hormone, human growth hormone, and soluble intercellular adhesion molecule-1 in serum were determined by chemiluminescent and radio-immunoassays. Questions on smoking, hayfever, and asthma were asked on entry visits in antenatal care units, and subjective scores on nasal congestion were registered on antenatal care visits throughout and after pregnancy. A standard allergy questionnaire was also used. Repeated nPEF home measurements proved to be a reliable method. There was a relative nasal obstruction during the menstrual days, most pronounced on the 2nd day of menstruation. In the course of pregnancy, blockage could increase, decrease or stay unchanged. We have demonstrated the presence of a nasal congestion, confined to pregnancy, which we call pregnancy rhinitis. Pregnancy rhinitis was defined as nasal congestion in the last 6 or more weeks of pregnancy without other signs of respiratory tract infection and with no known allergic cause, disappearing completely within 2 weeks after delivery . Compared with women without the diagnosis, pregnancy rhinitics had elevated levels of placental growth hormone. No other notable differences were found. The incidence of pregnancy rhinitis in the group we studied was 22%, and it did not appear in any specific gestational week. Pregnancy rhinitis was more frequent in smokers. Sensitisation to house dust mites was more frequent in pregnancy rhinitics, but there was no increased histamine sensitivity, or sensitisation to airborne allergens in general. Hayfever, asthma, month of conception, age, parity, or sex of the child were not important factors.