Acute Rhinitis: A Quick Guide to Symptoms and Treatment

Acute rhinitis is a short-term viral inflammation of the mucous membranes of the nose and nasopharynx, characterized by a runny nose, sneezing, congestion, a sore throat, and often a cough. Commonly referred to as a "cold" or "snot," it is also referred to in medical sources as "acute nasopharyngitis" or "acute viral rhinitis." The disease typically begins suddenly, peaks in symptoms within 2-3 days, and resolves completely in most people within 7-10 days. Its main characteristic is that it is caused by dozens of different respiratory viruses, most commonly rhinoviruses. [1]

Despite its apparent insignificance, acute rhinitis is a leading cause of missed work and school leave. Adults experience an average of 2-4 episodes per year, while young children experience 6-10, especially when attending daycares and schools. The incidence decreases with age as cross-immunity to common viral serotypes develops. Peak incidence occurs during cooler months, but the condition can occur year-round. [2]

The classic "runny nose" is almost always viral, so antibiotics don't speed recovery, don't reduce the risk of complications, and can cause harm due to side effects and increased bacterial resistance. Treatment is symptomatic: rest, fluids, saline irrigation, painkillers for pain or fever, and, in some cases, medications targeted to specific symptoms, such as intranasal ipratropium bromide for severe watery rhinorrhea. [3]

It's important to distinguish acute rhinitis from other upper respiratory tract infections (e.g., influenza, coronavirus infection, acute bacterial sinusitis) and from non-infectious causes of rhinitis. If symptoms persist for more than 10 days, worsen sharply after a brief improvement (a "two-wave" course), or are accompanied by high fever, severe facial pain, decreased vision, or swelling around the eyes, these are reasons to rule out complications and change treatment tactics. [4]

Code according to ICD-10 and ICD-11

In the International Classification of Diseases, Tenth Revision, acute rhinitis is coded as J00 – "Acute nasopharyngitis (common cold)". This code includes synonyms: "acute infectious rhinitis", "acute coryza", "head cold", "viral rhinitis"; in the case of bacterial sinusitis, codes J01.x are used. This approach facilitates the accounting of "common colds" as acute upper respiratory tract infections, distinguishing them from allergic and chronic forms. [5]

The International Classification of Diseases, Eleventh Revision, uses the code CA00 for "Acute nasopharyngitis," which explicitly lists the terms "common cold," "acute infectious rhinitis," and "acute coryza." Chronic rhinitis has a separate block, CA09.0, and other acute upper respiratory tract infections have their own entries, allowing for more precise coding. [6]

Table 1. Codes for "acute rhinitis" (ICD-10 ↔ ICD-11 correspondence)

Clinical situation	ICD-10	ICD-11
Acute rhinitis/acute nasopharyngitis ("cold")	J00	CA00
Acute sinusitis (if present)	J01.x	CA01.x
Chronic rhinitis (not this article)	J31.0	CA09.0

Epidemiology

Acute rhinitis is the most common human disease. In adults, the average number of episodes is 2-4 per year, while in children under 6 years of age, it is 6-10 per year, especially in those attending preschool. Incidence is inversely proportional to age and gradually decreases during adolescence and adulthood. [7]

Seasonality is pronounced in temperate climates: peaks begin in late summer - early fall and continue until spring, but summer episodes are also common. Frequency is influenced by crowding, ventilation quality, and behavior (e.g., attending children's groups, transportation, indoor activities). [8]

The economic burden includes direct costs for medications and visits, and indirect costs such as lost school and work time. Rhinoviruses and other common cold viruses contribute significantly to exacerbations of asthma and chronic obstructive pulmonary disease, hospitalizations of elderly patients, and the burden on primary care. [9]

Spikes in acute respiratory viral infections depend on the circulation of influenza viruses and respiratory syncytial virus, but the "baseline" of rhinoviruses and seasonal coronaviruses ensures year-round circulation of "common colds." Public health monitoring confirms the wave-like activity of respiratory viruses throughout the year. [10]

Table 2. Approximate rates of frequency of acute colds

Group	Episodes per year (average)	Source
Adults	2-4	Eccles 2023, CDC 2024 [11]
Children < 6 years old	6-10	Children's Hospital Boston; Pediatrics Reviews [12]
Peak of activity	Autumn-spring	CDC, observational data [13]

Reasons

The causative agents are predominantly viruses: rhinoviruses rank first, followed by seasonal coronaviruses, adenoviruses, parainfluenza, respiratory syncytial virus, enteroviruses, human metapneumovirus, and others. More than one virus may be involved in a single episode. The proportion of rhinoviruses, according to reviews and molecular diagnostics, varies from approximately 30% to over 50%. [14]

Transmission occurs through airborne droplets, close contact, and contaminated surfaces followed by touching the eyes, nose, or mouth. Outbreaks are more common in crowded conditions and in enclosed spaces with inadequate ventilation. [15]

Behavior and environment play a significant role: poor hand hygiene, sharing utensils, toys, and towels, and infrequent cleaning and ventilation. In children, frequent contact with others and an immature immune system play an additional role. [16]

Antibacterial causes of the “cold” runny nose are not leading: bacterial superinfection develops in a minority and most often manifests as acute bacterial rhinosinusitis with different diagnostic criteria and treatment according to separate recommendations. [17]

Table 3. The most common pathogens causing colds

A group of viruses	Relative contribution (range)	Comments
Rhinoviruses	30-50% and higher	Frequent year-round; leading role in asthma exacerbations. [18]
Seasonal coronaviruses	10-15%	Distinguish from coronavirus disease 2019.
Adenoviruses, enteroviruses	5-10%	They also cause pharyngitis and conjunctivitis.
Parainfluenza, RS virus, metapneumovirus	5-15%	Risk of severe disease in infants and the elderly.

Risk factors

Key behavioral factors include close contact in groups, poor hand hygiene, the habit of touching one's face, and less frequent ventilation of rooms. These factors increase the likelihood of infection and reinfection during the season. [19]

Environmental factors include overcrowding, poorly ventilated offices and classrooms, public transportation during rush hour, and dry indoor air during the heating season, which impairs the mucosal barrier function. Regular ventilation and wet cleaning reduce the risk. [20]

Age is an independent factor: children get sick more often due to their not yet fully developed adaptive immunity and the abundance of contacts, while the elderly get sick more often due to immune aging and comorbid diseases that increase the risk of complications and hospitalizations. [21]

Concomitant respiratory conditions (asthma, chronic obstructive pulmonary disease) increase the risk of severe illness and exacerbations. Controlling basic therapy significantly reduces the consequences of the "common" cold in such patients. [22]

Table 4. Risk factors and what to do about them

Factor	How does it affect	What helps?
Overcrowding, closed spaces	Increases the likelihood of contact with viruses	Ventilation, air filtration, distance
Poor hand hygiene	Transmission through objects and hands	Frequent hand washing, sanitizers
A child in kindergarten/school	More episodes per year	Hygiene, training "not to touch your face"
Asthma, old age	More severe course and complications	Control of chronic diseases, vaccination against influenza and RSV as indicated [23]

Pathogenesis

Rhinoviruses and other "cold" viruses penetrate the epithelium of the nasal and nasopharyngeal mucosa through specific receptors (for example, the intercellular adhesion molecule ICAM-1 for rhinoviruses), replicate better at nasal temperature, and trigger the release of inflammatory mediators. Symptoms are caused not so much by the "destruction" of the mucosa as by the innate immune response: bradykinin and other mediators cause swelling, hypersecretion, and a feeling of "congestion." [24]

Inflammation leads to increased sensitivity of nerve endings, which causes sneezing and itching, as well as dilation of the nasal turbinate vessels, which increases resistance to airflow and makes breathing difficult. Excessive secretion and impaired mucociliary clearance create a "severe" runny nose and postnasal drip. [25]

The nasal mucosa is the first line of defense for the respiratory tract. In response to viruses, interferon pathways and local antiviral mechanisms are activated, often determining the mildness or severity of the illness; in the case of rhinovirus infection, these mechanisms also explain the frequent exacerbations of asthma in those predisposed. [26]

Sinus involvement is common with colds: most adults show signs of viral sinusitis on imaging and CT scans, but it is not the same as bacterial sinusitis and does not require antibiotics unless there are red flags or the condition is persistent.[27]

Symptoms

Typical symptoms include nasal congestion, watery or mucous rhinorrhea, sneezing, a scratchy or sore throat, headache, and fatigue. Temperature may be normal or moderately elevated, especially in children. Symptoms worsen over 1-2 days, peak on days 2-3, and gradually subside. [28]

Cough and postnasal drip are often present, due to irritation of the back of the throat. In young children, loss of appetite, irritability, and restless sleep are possible; in adults, decreased concentration and performance. [29]

The color of the discharge (including "green snot") does not differentiate a viral from a bacterial infection and is not an indication for antibiotics. The dynamics of symptoms are more important: sustained improvement by days 7-10 is normal; persistent symptoms for >10 days without improvement or a "double worsening" after a brief improvement are a reason to suspect bacterial sinusitis. [30]

In a "cold," the sense of smell is reduced due to swelling and impaired airflow; persistent anosmia, severe myalgias, and high fever more often indicate influenza or other infections and require a different approach and targeted testing. [31]

Classification, forms and stages

Clinicians typically differentiate between uncomplicated acute rhinitis (the vast majority of episodes) and complicated forms that progress to acute rhinosinusitis, otitis media, or exacerbations of chronic respiratory diseases. This approach is important for deciding when to limit self-care to a more thorough approach and when to pursue other forms of examination and treatment. [32]

Based on the dominant symptom, a distinction is made between the "rhinorrheal" variant (profuse watery discharge), the "congestive" variant (predominantly congestion), and the "pharyngeal" variant (sore throat is the primary symptom). This helps select symptom-based therapy. [33]

The course of the disease is often described in stages as an incubation period (usually 1-2 days), a period of increasing symptoms (up to 48 hours), a peak (2-3 days), and a gradual decline (another 4-7 days). In some children, symptoms can last up to 14 days even without a bacterial superinfection. [34]

Risk groups for complications are assessed separately: young children, the elderly, pregnant women, patients with asthma and chronic obstructive pulmonary disease, and the immunocompromised - their threshold for seeking medical attention and examinations is lower. [35]

Complications and consequences

The most common complications in children are acute otitis media; in adults, post-viral acute rhinosinusitis, which in a minority of cases becomes bacterial. In predisposed individuals, acute rhinitis can trigger exacerbations of asthma and chronic obstructive pulmonary disease. [36]

Severe orbital and intracranial complications are rare and are usually associated with acute bacterial sinusitis of the frontal or maxillary sinus. These complications are indicated by severe facial-orbital pain, eyelid swelling, double vision, and decreased vision, which warrant urgent evaluation. [37]

In older adults and patients with comorbid conditions, colds are more likely to cause general malaise, dehydration, sleep disturbances, and appetite loss, which may increase the risk of hospitalization. Supportive care and chronic disease management reduce these risks. [38]

Economic consequences include reduced productivity and the need to care for sick children; preventive measures (hygiene, ventilation, influenza and respiratory syncytial virus vaccinations when indicated) reduce indirect losses. [39]

Table 5. Red flags for a cold

Sign	What to suspect	Action
Fever ≥ 39 °C for > 3 days, severe facial-orbital pain	Acute bacterial sinusitis	See a doctor immediately; review antibiotics according to guidelines [40]
Swelling of the eyelids, double vision, decreased vision	Orbital complications	Emergency care, visualization
"Two-wave" course (worsening after improvement) > 5-10 days	Postviral → bacterial sinusitis	Face-to-face assessment, change of tactics [41]
Severe shortness of breath, wheezing	Exacerbation of asthma/bronchitis	Exacerbation plan, inhalation therapy
In infants - refusal to drink/lethargy	Risk of dehydration	Pediatric emergency care

When to see a doctor

If symptoms persist for more than 10 days without obvious improvement or worsen sharply after a short “clear window,” this is a typical situation for postviral rhinosinusitis and possible bacterial superinfection - an in-person assessment is needed. [42]

Seek immediate medical attention if you experience any of the following "red flags": high fever with severe facial pain, swelling around the eyes, double vision or decreased vision, severe one-sided pain in the upper jaw area, severe weakness, and dehydration. These are signs of potential complications. [43]

If there are symptoms similar to flu or coronavirus infection (high temperature, severe myalgia, sudden malaise, loss of smell), it makes sense to get tested - there are antiviral drugs against flu and coronavirus infection that work better when started early. [44]

For children under 4-6 years of age, do not use "combination" cold and cough remedies without consulting a doctor: the US Food and Drug Administration warns of lack of benefit and the risk of serious side effects, and manufacturers label such products as "not for children under 4 years of age." Honey drink is only suitable for children over 1 year of age. [45]

Diagnostics

Step 1. Clinical assessment. The diagnosis of acute rhinitis is clinical: runny nose, sneezing, congestion, sore throat, cough in the first 48 hours, peaking on days 2-3. Examination of the nose and oropharynx, temperature measurement, and assessment of the general condition. Special laboratory tests are not required in typical cases. [46]

Step 2. Distinguishing a cold from influenza and coronavirus infection. If you have a high fever, myalgia, sudden onset, or contact with someone with influenza or coronavirus infection, consider testing, especially in those at risk for complications: antivirals are effective when started early. This is not a "cold treatment," but a tactic for other infections. [47]

Step 3. Screening for complications. If symptoms persist for >10 days without improvement, or if there is a "double worsening" or severe facial pain, post-viral or bacterial rhinosinusitis is likely. For the bacterial variant, a triad is used: duration of >10 days without improvement, severe onset with high fever >39°C and purulent discharge for >3-4 days, or a "double worsening" after improvement. Imaging is not necessary for uncomplicated sinusitis. [48]

Step 4. Additional tests are only indicated. Complete blood counts, C-reactive protein levels, and nasal cultures are not informative for a common cold. Computed tomography of the paranasal sinuses, endoscopy, and bacteriological culture of the middle nasal passage are performed if complications are suspected, in immunocompromised patients, or in cases of atypical progression. [49]

Table 6. Minimum required diagnostics

Situation	What to do	For what
A typical cold lasts 7-10 days	Clinical assessment only	Avoid unnecessary tests
Suspected influenza/coronavirus	Tests according to indications	Access to antiviral agents [50]
Symptoms >10 days, "double worsening"	Sinusitis assessment	Antibiotic decision [51]
Heavy "red flags"	Urgently see a specialist, visualization	Exclusion of orbital and intracranial complications [52]

Differential diagnosis

Allergic rhinitis produces recurring seasonal or year-round symptoms with itchy, watery eyes and profuse sneezing; temperature is usually normal and symptoms improve with antihistamines and resolve without exposure to allergens.[53]

Influenza is characterized by a sudden onset, high fever, severe myalgia, and fatigue; a runny nose and cough are not always present within the first 24 hours. Antiviral medications are available for influenza and coronavirus infections, so it's important to distinguish them from the common cold. [54]

Acute bacterial rhinosinusitis is not defined by "green snot," but rather by a duration of ≥10 days without improvement, a severe onset, or "double aggravation"; facial and dental pain, purulent discharge, and sinus pressure raise suspicion. The decision to administer antibiotics is based on clinical findings, not the color of the discharge. [55]

Structural causes of nasal congestion (deviated septum, turbinate hypertrophy, nasal valve dysfunction) can mimic a "chronic cold," but these cases typically have fewer cycles and flare-ups, and symptoms recur consistently outside of flu seasons. In doubtful cases, an examination by an ENT specialist is helpful.

Table 7. How a “cold” differs from other conditions

State	"For" the diagnosis	"Against"
Allergic rhinitis	Itchy eyes, seasonality, response to antihistamines	High temperature, myalgia
Flu/coronavirus infection	High fever, myalgia, sudden onset	Mild course, improvement by day 7-10
Bacterial sinusitis	Duration ≥10 days, "double worsening", facial pain	Steady improvement by day 7-10
Structural obstruction	Persistence of symptoms outside of seasonality	Clear viral prodrome

Treatment

The first pillar is self-care and routine. Drink plenty of fluids, rest, humidify the air, and ventilate your room. Moderate physical activity is safe, but strenuous activity should be postponed until symptoms peak. For fever, headache, and muscle aches, use over-the-counter pain relievers and antipyretics as directed. [56]

Saline irrigations and washes (isotonic or hypertonic solutions) reduce the viscosity of secretions, moisturize the mucosa, and subjectively relieve symptoms. Data are mixed, but randomized trials and pilot projects have shown benefit in some adults and children, especially with proper technique. Solutions of 0.9-3% are used 1-2 times daily; hypertonic solutions may sting, so adjust according to tolerance. For preschool-aged children, drops/sprays with gentle technique are preferable. [57]

Intranasal ipratropium bromide is one of the few medications proven to reduce runny nose associated with colds (reducing nasal congestion), while having little effect on congestion. The medication is used as directed several times a day until symptoms subside. Side effects are usually local (dryness, crusting), and serious adverse events are rare. This is a good option when the main complaint is a runny nose. [58]

Oral decongestants (such as pseudoephedrine, available over the counter) temporarily relieve congestion in adults. However, oral phenylephrine has been found to be ineffective: in 2023, a US regulatory advisory committee unanimously found it to be clinically ineffective, and in 2024, a proposal was published to remove it from the list of ingredients in over-the-counter decongestant medications; a final decision is expected after the review process is completed. Oral decongestants should be used with caution or avoided in children and pregnant women. [59]

Topical vasoconstrictor sprays provide rapid relief from congestion, but they should be used for no more than 3-5 days at a time due to the risk of rebound rhinotomy (drug-induced rhinitis). Short courses are acceptable in adults without contraindications; in children, non-drug methods are preferred and prolonged use should be avoided whenever possible. If you become addicted to drops, a weaning program and support with saline solutions are needed. [60]

Antihistamines alone are of little help against viral rhinitis and can cause drowsiness and dry mouth. Their role is limited to cases with severe itching and sneezing, especially when combined with allergies. Antihistamine-decongestant combinations in adults can provide short-term relief, but the effect is moderate and does not affect the duration of the illness. Such combinations should not be given to children without a doctor's prescription. [61]

Intranasal corticosteroids do not demonstrate a clinically significant effect for the common cold and are not recommended for routine use. They are the drugs of choice for allergic rhinitis, but not for acute viral rhinitis. An exception is made for concomitant conditions with specific indications. [62]

Zinc has been studied for decades: a recent Cochrane review from 2024 concluded that there is insufficient evidence to confidently recommend zinc for the prevention or treatment of colds, although some meta-analyses suggest a possible modest reduction in the severity and duration of symptoms with early onset. If a patient chooses zinc, the dose, form (acetate, gluconate), and early initiation within the first 24 hours are important, but no guarantee of effectiveness can be made. [63]

Vitamin C, when taken regularly, does not prevent colds in the general population, but in some studies it modestly reduces the duration and severity of symptoms; starting it "after you get sick" does not produce a significant effect. Therefore, routinely prescribing vitamin C for colds is not advisable, but if a person is already taking it, a slight reduction in severity can be expected. [64]

Pediatric practice requires special caution. Regulators and pediatric societies do not recommend over-the-counter "cold and cough remedies" for children under 4-6 years of age due to the lack of proven benefit and potential harm; exceptions include saline humidifiers and antipyretics, according to indications and age-appropriate dosages. Honey as a cough remedy is only acceptable after 1 year of age. [65]

Antibiotics are not indicated for colds. They are not effective against viruses and do not shorten the duration of the illness. An exception is the development of clinical criteria for acute bacterial rhinosinusitis, when national guidelines are used and the need for a "watchful waiting" approach or delayed prescription is assessed. [66]

Table 8. Symptom-based treatment of the common cold (adults)

Dominant complaint	What helps?	Comment
Congestion	Short courses of topical vasoconstrictors; oral pseudoephedrine	Oral phenylephrine is ineffective; topical application is not effective for more than 3-5 days. [67]
Watery rhinorrhea	Ipratropium bromide intranasally	Reduces flow, has almost no effect on congestion. [68]
Pain/temperature	Paracetamol, ibuprofen	According to the instructions, comorbidity should be taken into account.
General relief	Salt irrigation	Gentle technique is more important than “super concentration.” [69]

Table 9. Child safety during a cold

Age	What is possible?	What to avoid
< 1 year	Saline drops/spray, humidification, antipyretics as indicated	Honey taken internally (risk of botulism), any "combo syrups"
1-4 years	Saline preparations, antipyretics	Most over-the-counter "cold and cough" medications are available without a doctor's prescription.
≥ 6 years	Symptom-oriented; ipratropium is possible according to the instructions	Self-medication with antihistamine plus decongestant combinations

Source: US regulatory and pediatric guidelines.[70]

Prevention

The most effective measures include hand hygiene, avoiding touching your face, and ventilating rooms. Teaching children cough and sneeze etiquette, regular cleaning, and avoiding sharing bottles, utensils, and towels are also helpful. These measures are simple and reduce the transmission of viruses. [71]

When in contact with vulnerable individuals (infants, the elderly, and those with compromised immune systems), it makes sense to stay home during the first few days of symptoms, use disposable tissues and masks during close contact, and pay close attention to surface cleanliness. This reduces family and household transmission. [72]

There is no vaccine against the "common cold" as a syndrome, but vaccination against influenza and respiratory syncytial virus in appropriate groups reduces severe outcomes and diagnostic confusion during respiratory infection season. Plan your vaccinations before the season begins. [73]

Rational expectations and proper use of medications are also preventative: avoiding unnecessary antibiotics and oral phenylephrine, limiting the duration of topical vasoconstrictors, and emphasizing safe methods reduce the risk of drug-induced problems. [74]

Forecast

In most people, acute rhinitis is a mild and self-limited condition: symptoms subside within 7-10 days, and in some children, up to 14 days, with no signs of bacterial infection. The peak phase is usually short and tolerable with symptom-focused treatment. [75]

Complications develop in a minority of cases and are most often associated with the sinuses and middle ear; early recognition of "red flags" and referral to a doctor prevents serious outcomes. Most patients do not require tests or x-rays, and proper self-care and training in spray technique are more effective. [76]

In vulnerable groups, the prognosis depends on comorbidities and the availability of supportive care. Control of chronic diseases, vaccination against influenza and respiratory syncytial virus when indicated, and early intervention in case of deterioration reduce the risk of hospitalization. [77]

The economic losses from the common cold are significant, but they can be reduced by simple measures: staying home during peak symptoms, hygiene, ventilation, wise choice of medications, and mindful behavior during the respiratory virus season. [78]

Table 10. Expected dynamics for uncomplicated “cold”

Day of illness	What usually happens
1-2	Prodrome: sore throat, sneezing, rhinorrhea begins to intensify
2-3	Peak: maximum runny nose, congestion, sometimes low-grade fever
4-7	Gradual subsidence of symptoms, "wet tail"
7-10	Return to normal activity for most
Up to 14 (more common in children)	Mild residual runny nose/cough is acceptable

FAQ

Do I need to get tested for a common cold?
No. The diagnosis is clinical. Tests and X-rays are not necessary unless there are red flags. [79]

What medications actually help?
Painkillers for pain and fever, saline irrigations, and selected symptom-based treatments are helpful: intranasal ipratropium bromide for watery rhinorrhea, short courses of nasal decongestants for congestion in adults. Antibiotics and intranasal steroids are ineffective for "colds." [80]

Does phenylephrine tablets help with congestion?
No. The US FDA has initiated the removal of oral phenylephrine from the list of approved medications due to its ineffectiveness; the final decision is pending. Alternatives include pseudoephedrine (over the counter) and short courses of nasal sprays. [81]

Should you take zinc and vitamin C?
Zinc is controversial: the latest Cochrane 2024 review finds the evidence insufficient for routine recommendation; vitamin C does not prevent colds, but may only slightly shorten their duration and severity with regular use. The decision is individual; don't expect "miracles." [82]

When exactly do you need to see a doctor?
If symptoms persist for more than 10 days without improvement, if they worsen after a brief improvement, if there is a high fever and severe facial pain, if there is swelling around the eyes, double vision or decreased vision, severe weakness, dehydration, or severe shortness of breath. In children and the elderly, if there is any alarming worsening of symptoms. [83]