Non-allergic rhinitis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

For non-allergic rhinitis, traditional triggers such as cat or dog exposure should be absent.
Symptoms and exam findings can overlap between perennial allergic rhinitis and non-allergic rhinitis (NAR), with nasal turbinates swollen and beefy red, scant mucus, cobblestoning of posterior pharynx from chronic postnasal drainage, and retraction of tympanic membranes indicating congestion.
A diagnosis of NAR requires negative specific IgE responses by skin or serologic testing.
Differentiation between non-allergic rhinitis with eosinophilia syndrome and other subtypes of NAR is determined by the presence or absence of eosinophilia in the nasal passage.
Treatment is based on symptoms, and all patients should be counseled on avoidance of triggers. Symptom control in NAR requires a balance between the control of excess secretions and over-suppression. First-line treatments include intranasal corticosteroids, intranasal antihistamines, and intranasal ipratropium.

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Citations

Key Articles

Nassef M, Shapiro G, Casale TB. Identifying and managing rhinitis and its subtypes: allergic and non-allergic components - a consensus report and materials from the Respiratory Allergic Disease Foundation. Curr Med Res Opin. 2006 Dec;22(12):2541-8.[Abstract]
Dykewicz MS, Wallace DV, Amrol DJ, et al. Rhinitis 2020: a practice parameter update. J Allergy Clin Immunol. 2020 Oct;146(4):721-67.[Abstract][Full Text]
Bernstein JA, Levin LS, Al-Shuik E, et al. Clinical characteristics of chronic rhinitis patients with high vs low irritant trigger burdens. Ann Allergy Asthma Immunol. 2012 Sep;109(3):173-8.[Abstract]
Sur DKC, Plesa ML. Chronic nonallergic rhinitis. Am Fam Physician. 2018 Aug 1;98(3):171-6.[Abstract][Full Text]

Referenced Articles

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