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Z Geburtshilfe Neonatol 2017; 221(02): 59-66
DOI: 10.1055/s-0042-110325
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Update Schwangerschaftsrhinitis

Pregnancy Rhinitis – an Update
U. Friebe-Hoffmann
1   Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Ulm, Ulm
,
J. Lindemann
2   Klinik für Hals-Nasen-Ohrenheilkunde und Kopf-Hals-Chirurgie, Universitätsklinikum Ulm, Ulm
› Institutsangaben
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Publikationsverlauf

eingereicht 10. April 2016

akzeptiert nach Überarbeitung 06. Juni 2016

Publikationsdatum:
27. Juli 2016 (online)

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Zusammenfassung

Als sog. Schwangerschaftsrhinitis (SSR) wird eine mehrwöchige, schwangerschaftsbegleitende nasale Obstruktion bezeichnet, die sich durch eine Schwellung der Mukosa sowie vermehrte Sekretion ohne Hinweis auf eine Entzündung, Infektion, Allergie oder Raumforderung auszeichnet und deren Symptome nach der Geburt rasch wieder verschwinden. Die SSR zählt zu den endokrinen nasalen Hyperreaktivitäten. Etwa ein Viertel aller Schwangeren ist von diesem Krankheitsbild betroffen, das zu jedem Zeitpunkt der Schwangerschaft auftreten kann. Pathophysiologisch werden vor allem hormonelle Einflüsse diskutiert, Rauchen sowie eine vorbestehende Hausstaubmilbenallergie gelten als Risikofaktoren. Nachfolgend stellen wir ein stufentherapeutisches Konzept für die Behandlung der SSR vor und diskutieren die aktuelle Literatur.

Abstract

Pregnancy rhinitis (PR), a common condition in pregnant women, is defined as long-lasting nasal congestion due to mucosal swelling and increased secretion without any signs of infection, allergy or tumor, starting at any time during pregnancy and disappearing within 2 weeks of delivery. Smoking and a sensitization to house dust mites are known risk factors. While a definitive pathophysiological concept for PR does not exist, hormonal influences are discussed. We present a stepwise therapeutic strategy for PR and an overview to the latest literature.

Schlüsselwörter

Schwangerschaft - Rhinitis - Rinopathia gravidarum - Nasale Hyperreaktivität

Key words

Pregnancy - rhinitis - nasal hyperreactivity - rhinopathia gravidarum
 

  • Literatur

  • 1 MacKenzie J. The physiological and pathophysiological relations between the nose and the sexual apparatus of man. Alienist Neurol 1898; 19: 219-239
    PubMedGoogle Scholar
  • 2 Bachert C. Die chronisch verstopfte Nase – Zur Klassifikation der nasalen Hyperreaktivität. Dtsch Arztebl 1996; 93: A-1034-1038
    PubMedGoogle Scholar
  • 3 Caparroz FA, Gregorio LL, Bongiovanni G. et al. Rhinitis and pregnancy: literature review. Braz J Otorhinolaryngol 2016; 82: 105-111
    CrossrefPubMedGoogle Scholar
  • 4 Orban N, Maughan E, Bleach N. Pregnancy-induced rhinitis. Rhinology 2013; 51: 111-1119
    PubMedGoogle Scholar
  • 5 Ellegård E, Hellgren M, Torén K. et al. The incidence of pregnancy rhinitis. Gynecol Obstet Invest 2000; 49: 98-101
    CrossrefPubMedGoogle Scholar
  • 6 Ellegård E, Karlsson G. Nasal congestion during pregnancy. Clin Otolaryngol Allied Sci 1999; 24: 307-311
    CrossrefPubMedGoogle Scholar
  • 7 Ellegård EK. The etiology and management of pregnancy rhinitis. Am J Respir Med Drugs Devices Interv 2003; 2: 469-475
    PubMedGoogle Scholar
  • 8 Ellegård EK. Pregnancy rhinitis. Immunol Allergy Clin North Am 2006; 26: 119-135
    CrossrefPubMedGoogle Scholar
  • 9 Franklin KA, Holmgren PA, Jönsson F. et al. Snoring, pregnancy-induced hypertension, and growth retardation of the fetus. Chest 2000; 117: 137-141
    CrossrefPubMedGoogle Scholar
  • 10 Juniper EF. Measuring health-related quality of life in rhinitis. J Allergy Clin Immunol 1997; 99: S742-S749
    CrossrefPubMedGoogle Scholar
  • 11 Gilbey P, McGruthers L, Morency A-M. et al. Rhinosinusitis-related quality of life during pregnancy. Am J Rhinol Allergy 2012; 26: 283-286
    CrossrefPubMedGoogle Scholar
  • 12 Ayrım A, Keskin EA, Ozol D. et al. Influence of self-reported snoring and witnessed sleep apnea on gestational hypertension and fetal outcome in pregnancy. Arch Gynecol Obstet 2011; 283: 195-199
    CrossrefPubMedGoogle Scholar
  • 13 Sahin FK, Koken G, Cosar E. et al. Obstructive sleep apnea in pregnancy and fetal outcome. Int. J. Gynaecol. Obstet. Off Organ Int Fed Gynaecol Obstet 2008; 100: 141-146
    CrossrefPubMedGoogle Scholar
  • 14 Wolff H, Wolf S, Grace W. 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
    PubMedGoogle Scholar
  • 15 Holmes T, Goodell H, Wolf S. et al. The relation of nasal to sexual function. Nose Exp. Study React. Nose Hum. Subj. Varying Life Exp. Springfield: III Charles C Thomas Publisher; 1950: 89-100
    Google Scholar
  • 16 Philpott CM, Conboy P, Al-Azzawi F. et al. Nasal physiological changes during pregnancy. Clin Otolaryngol Allied Sci 2004; 29: 343-351
    CrossrefPubMedGoogle Scholar
  • 17 Demir UL, Demir BC, Oztosun E. et al. The effects of pregnancy on nasal physiology. Int Forum Allergy Rhinol 2015; 5: 162-166
    CrossrefPubMedGoogle Scholar
  • 18 Mortimer H, Wright RP, Collip JB. The Effect of the Administration of OEstrogenic Hormones on the Nasal Mucosa of the Monkey (Macaca Mulatta). Can Med Assoc J 1936; 35: 503-513
    PubMedGoogle Scholar
  • 19 Taylor M. An experimental study of the influence of the endocrine system on the nasal respiratory mucosa. J Laryngol Otol 1961; 75: 972-977
    CrossrefPubMedGoogle Scholar
  • 20 Toppozada H, Michaels L, Toppozada M. et al. The human respiratory nasal mucosa in pregnancy. An electron microscopic and histochemical study. J Laryngol Otol 1982; 96: 613-626
    CrossrefPubMedGoogle Scholar
  • 21 Mabry RL. The management of nasal obstruction during pregnancy. Ear Nose Throat J 1983; 62: 28-33
    PubMedGoogle Scholar
  • 22 Lekas MD. Rhinitis during pregnancy and rhinitis medicamentosa. Otolaryngol. – Head Neck Surg Off J Am Acad Otolaryngol.-Head Neck Surg 1992; 107: 845-848
    PubMedGoogle Scholar
  • 23 Reynolds SRM, Foster FI. Acetylcholine-equivalent content of the nasal mucosa in rabbits and ctas, before and after administration of estrogen. Am J Physiol.- Leg Content 1940; 131: 422-425
    PubMedGoogle Scholar
  • 24 Kojda G. Weibliche Sexualhormone, Östrogene. Pharmkologie Toxikol
    PubMed
  • 25 Strutz J, Arndt O. editors Hormonelle Rhinitis in Kapitel Nase und Nasennebenhöhlen. Prax. HNO-Heilkd. Kopf- Halschirurgie 275 Tabellen. Stuttgart: Thieme; 2001
    Google Scholar
  • 26 Toppozada H, Toppozada M, El-Ghazzawi I. et al. The human respiratory nasal mucosa in females using contraceptive pills. An ultramicroscopic and histochemical study. J Laryngol Otol 1984; 98: 43-51
    CrossrefPubMedGoogle Scholar
  • 27 Mabry RL. Rhinitis of pregnancy. South Med J 1986; 79: 965-971
    CrossrefPubMedGoogle Scholar
  • 28 Bende M, Hallgårde M, Sjögren U. et al. Nasal congestion during pregnancy. Clin Otolaryngol Allied Sci 1989; 14: 385-387
    CrossrefPubMedGoogle Scholar
  • 29 Ellegård E, Oscarsson J, Bougoussa M. et al. Serum level of placental growth hormone is raised in pregnancy rhinitis. Arch Otolaryngol Head Neck Surg 1998; 124: 439-443
    CrossrefPubMedGoogle Scholar
  • 30 Haeggström A, Ostberg B, Stjerna P. et al. Nasal mucosal swelling and reactivity during a menstrual cycle. ORL J Oto-Rhino-Laryngol Its Relat Spec 2000; 62: 39-42
    PubMedGoogle Scholar
  • 31 Schatz M, Zeiger RS. Diagnosis and management of rhinitis during pregnancy. Allergy Proc Off J Reg State Allergy Soc 1988; 9: 545-554
    PubMedGoogle Scholar
  • 32 Ellegård E, Karlsson G. IgE-mediated reactions and hyperreactivity in pregnancy rhinitis. Arch. Otolaryngol. Head Neck Surg 1999; 125: 1121-1125
    CrossrefPubMedGoogle Scholar
  • 33 Bowser C, Riederer A. [Detection of progesterone receptors in connective tissue cells of the lower nasal turbinates in women]. Laryngorhinootologie 2001; 80: 182-186
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 34 Skinner DW, Richards SH. Acromegaly--the mucosal changes within the nose and paranasal sinuses. J Laryngol Otol 1988; 102: 1107-1110
    CrossrefPubMedGoogle Scholar
  • 35 Zondek B, Bromberg YM. Endocrine allergy; clinical reactions to allergy to endogenous hormones and their treatment. J Obstet Gynaecol Br Emp 1947; 54: 1-19
    CrossrefPubMedGoogle Scholar
  • 36 Milosević D, Janosević D, Dergen R. et al. Pathologic conditions associated with drug-induced rhinitis. Srp Arh Celok Lek 2004; 132: 14-17
    PubMedGoogle Scholar
  • 37 Derkay CS. Eustachian tube and nasal function during pregnancy: a prospective study. Otolaryngol--Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg 1988; 99: 558-566
    PubMedGoogle Scholar
  • 38 Bende M, Gredmark T. Nasal stuffiness during pregnancy. The Laryngoscope 1999; 109: 1108-1110
    CrossrefPubMedGoogle Scholar
  • 39 Hellín Meseguer D, Ruiz Cotorruelo V, Ruiz Franco M. The influence of pregnancy on mucociliary nasal transport. An Otorrinolaringológicos Ibero-Am 1994; 21: 595-601
    PubMedGoogle Scholar
  • 40 Ellegård EK, Karlsson NG. Nasal mucociliary transport in pregnancy. Am J Rhinol 2000; 14: 375-378
    CrossrefPubMedGoogle Scholar
  • 41 Eccles R. Nasal airflow in health and disease. Acta Otolaryngol (Stockh.) 2000; 120: 580-595
    CrossrefPubMedGoogle Scholar
  • 42 Stroud RH, Wright ST, Calhoun KH. Nocturnal nasal congestion and nasal resistance. The Laryngoscope 1999; 109: 1450-1453
    CrossrefPubMedGoogle Scholar
  • 43 Rambur B. Pregnancy rhinitis and rhinitis medicamentosa. J Am Acad Nurse Pract 2002; 14: 527-530
    CrossrefPubMedGoogle Scholar
  • 44 Turnbull GL, Rundell OH, Rayburn WF. et al. Managing pregnancy-related nocturnal nasal congestion. The external nasal dilator. J Reprod Med 1996; 41: 897-902
    PubMedGoogle Scholar
  • 45 Roush SF, Bell L. Obstructive sleep apnea in pregnancy. Am Board Fam Pract 2004; 17: 292-294
    PubMedGoogle Scholar
  • 46 Graf P, Hallén H. Effect on the nasal mucosa of long-term treatment with oxymetazoline, benzalkonium chloride, and placebo nasal sprays. The Laryngoscope 1996; 106: 605-609
    CrossrefPubMedGoogle Scholar
  • 47 Graf P. Rhinitis medicamentosa: a review of causes and treatment. Treat Respir Med 2005; 4: 21-29
    CrossrefPubMedGoogle Scholar
  • 48 Schaefer C, Spielmann H, Vetter K. et al. Arzneimittel in Schwangerschaft und Stillzeit. 8., vollständig überarbeitete Aufl. München: Elsevier, Urban; Fischer; 2012
    Google Scholar
  • 49 Yau W-P, Mitchell AA, Lin KJ. et al. Use of Decongestants During Pregnancy and the Risk of Birth Defects. Am J Epidemiol 2013; 178: 198-208
    CrossrefPubMedGoogle Scholar
  • 50 Scadding GK, Lund VJ, Jacques LA. et al. 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 J Br Soc Allergy Clin Immunol 1995; 25: 737-743
    PubMedGoogle Scholar
  • 51 Mygind N. Effects of corticosteroid therapy in non-allergic rhinosinusitis. Acta Otolaryngol (Stockh.) 1996; 116: 164-166
    CrossrefPubMedGoogle Scholar
  • 52 Mabry RL. Evaluation of systemic absorption of intraturbinally injected triamcinolone. Otolaryngol--Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg 1981; 89: 268-270
    PubMedGoogle Scholar
  • 53 van As A, Bronsky E, Grossman J. et al. Dose tolerance study of fluticasone propionate aqueous nasal spray in patients with seasonal allergic rhinitis. Ann Allergy 1991; 67: 156-162
    PubMedGoogle Scholar
  • 54 Wilson AM, Sims EJ, McFarlane LC. et al. Effects of intranasal corticosteroids on adrenal, bone, and blood markers of systemic activity in allergic rhinitis. J Allergy Clin Immunol 1998; 102: 598-604
    CrossrefPubMedGoogle Scholar
  • 55 Allen DB. Systemic effects of intranasal steroids: an endocrinologist’s perspective. J Allergy Clin Immunol 2000; 106: S 179-190
    CrossrefPubMedGoogle Scholar
  • 56 Ellegård EK, Hellgren M, Karlsson NG. Fluticasone propionate aqueous nasal spray in pregnancy rhinitis. Clin Otolaryngol Allied Sci 2001; 26: 394-400
    CrossrefPubMedGoogle Scholar
  • 57 O’Connell M, Welsh GW. Unbound plasma cortisol in pregnant and Enovid-E treated women as determined by ultrafiltration. J Clin Endocrinol Metab 1969; 29: 563-568
    CrossrefPubMedGoogle Scholar
  • 58 Onrust SV, Lamb HM. Mometasone furoate. A review of its intranasal use in allergic rhinitis. Drugs 1998; 56: 725-745
    CrossrefPubMedGoogle Scholar
  • 59 Storms WW. Risk-benefit assessment of fluticasone propionate in the treatment of asthma and allergic rhinitis. J Asthma Off J Assoc Care Asthma 1998; 35: 313-336
    PubMedGoogle Scholar
  • 60 Hallén 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 J Br Soc Allergy Clin Immunol 1997; 27: 552-558
    PubMedGoogle Scholar