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Rhinitis: Nonallergic Rhinitis
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Rhinitis is a nonspecific term that covers infections, allergies, and other disorders whose common feature is the location of their symptoms. In rhinitis, the mucous membranes become infected or irritated, producing a discharge, congestion, and swelling of the tissues. The most widespread form of infectious rhinitis is the common cold. Doctors sometimes designate two different forms of rhinitis. These are allergic rhinitis and nonallergic rhinitis. Allergic rhinitis is cause by allergies, and nonallergic rhinitis is caused by other conditions such as the common cold.
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Nonallergic rhinitis of all types is rare in children. Even children presenting with NARES account for less than 2% of children with nasal eosinophilia. Second-generation oral antihistamines may be used to control symptoms of rhinitis. If possible, first-generation oral antihistamines should be avoided to prevent adverse reactions, particularly paroxysmal hyperactivity. Nasal corticosteroids may be beneficial in pediatric patients presenting with rhinorrhea, sneezing, pruritus, and congestion. Although growth delay has not been observed in long-term studies, the FDA recommends routine monitoring of height in children treated with corticosteroids.
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Vasomotor rhinitis affects millions of Americans and results in significant symptomatology. Characterized by a combination of symptoms that includes nasal obstruction and rhinorrhea, vasomotor rhinitis is a diagnosis of exclusion reached after taking a careful history, performing a physical examination, and, in select cases, testing the patient with known allergens. According to a 2002 evidence report published by the Agency for Healthcare Research and Quality (AHRQ), there is insufficient evidence to reliably differentiate between allergic and nonallergic rhinitis based on signs and symptoms alone. The minimum level of diagnostic testing needed to differentiate between the two types of rhinitis ... has not been established. An algorithm is presented that is based on a targeted history and physical examination and a stepwise approach to management that reflects the AHRQ evidence report and U.S. Food and Drug Administration approvals. Specific approaches to the management of rhinitis in children, athletes, pregnant women, and older adults are discussed.
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There is no cure for viral nonallergic rhinitis; treatment is given for symptom relief. Medications include aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) for headache and muscle pain, and decongestants to relieve stuffiness or runny nose. Patients should be warned against overusing decongestants, because they can cause a rebound effect. Over-the-counter (OTC) antihistamines are ... available; however, most anti-histamines carry warnings of drowsiness and the inability to do some tasks while medicated. Claritin is a prescription-strength OTC non-drowsy antihistamine that helps relieve symptoms of rhinitis. Antibiotics are not given for viral nonallergic rhinitis because they do not kill viruses.
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Three types of nonallergic rhinitis commonly occur in older patients. The first, vasomotor rhinitis, is thought to be caused by increased cholinergic activity and is similar to that occurring in younger patients. The second type, gustatory rhinitis, is associated with profuse, watery rhinorrhea that may be exacerbated by eating. The third form is believed to arise from alpha-adrenergic hyperactivity, stimulated by the regular use of antihypertensives.
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Nonallergic rhinitis is a distinct disease classification, separate from allergic rhinitis, which is characterized by an IgE-mediated response. The diagnosis of nonallergic rhinitis encompasses several individual classifications, including NARES, as well as vasomotor, occupational, hormonal, infectious, drug-induced, and gustatory conditions. A wide variety of medications are available for the treatment of associated symptoms. However, no individual class of medications or single medication is ideal for managing the entire spectrum of symptoms. Surgical therapy may be warranted in particular patients which nonallergic rhinitis refractory to proper medical management. Patients are best treated to manage their unique symptoms and to correct the causes.
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Nonallergic Rhinitis