Materiały źródłowe

• #1 Diagnosing Rhinitis: Allergic vs. Nonallergic | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0501/p1583.html

  Allergic rhinitis, the most common type of rhinitis, generally can be differentiated from the numerous types of nonallergic rhinitis through a thorough history and physical examination. […] Since 1998, three large expert panels have made recommendations for the diagnosis of allergic and nonallergic rhinitis. […] The differential diagnosis of rhinitis is extensive. […] Differentiating allergic rhinitis from other causes of rhinitis can be difficult because the diagnostic criteria for various forms of rhinitis are not always clear-cut. […] Accurate diagnosis is important because therapies that are effective for allergic rhinitis (i.e., antihistamines and nasal corticosteroids) may be less effective for other types of rhinitis. […] Although few studies exist on how to differentiate among types of rhinitis, a thorough and comprehensive history usually suggests the correct diagnosis.

• #2 Chronic Nonallergic Rhinitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0801/p171.html

  Chronic nonallergic rhinitis encompasses a group of rhinitis subtypes without allergic or infectious etiologies. […] Although chronic nonallergic rhinitis represents about one-fourth of rhinitis cases and impacts 20 to 30 million patients in the United States, its pathophysiology is unclear and diagnostic testing is not available. […] A negative result on allergy testing is one unifying characteristic of the chronic nonallergic rhinitis subtypes. […] Diagnosing chronic nonallergic rhinitis can be challenging because nasal congestion and rhinorrhea can also occur with allergic rhinitis and chronic rhinosinusitis. […] Nonallergic rhinitis was previously a diagnosis of exclusion. […] It was diagnosed if a patient with suspected allergic rhinitis tested negative for allergies on skin prick testing or antigen-specific immunoglobulin E testing (formerly called radioallergosorbent testing), or if a patient had mild to no nasal eosinophilia on nasal cytology.

• #3 Patient education: Nonallergic rhinitis (runny or stuffy nose) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/nonallergic-rhinitis-runny-or-stuffy-nose-beyond-the-basics

  WHAT IS NONALLERGIC RHINITIS? […] „Nonallergic rhinitis” is the medical term used to describe the following symptoms when they occur without a known allergic cause for weeks to months at a time for at least one year: […] ●Sneezing […] ●Runny nose […] ●Stuffy nose (congestion) […] ●Postnasal drip […] Symptoms are usually present year-round, although they may be worsened by certain weather conditions (eg, those that accompany changes of season). The condition does not usually develop until adulthood. […] NONALLERGIC RHINITIS TRIGGERS […] The cause of nonallergic rhinitis is not known. However, many triggers of symptoms are known. These include irritants, such as tobacco smoke, traffic fumes, strong odors, and perfumes, as well as weather conditions (such as the arrival of a weather front). People with nonallergic rhinitis are not bothered by pollen or furred animals (the common triggers in allergic rhinitis), unless they also happen to have allergic rhinitis. About one-half of all patients with longstanding nasal symptoms have both allergic and nonallergic rhinitis. (See „Patient education: Allergic rhinitis (Beyond the Basics).”)

• #4 Nonallergic rhinitis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/nonallergic-rhinitis/symptoms-causes/syc-20351229

  Health care providers often first make sure a person’s symptoms aren’t caused by allergies. So you may need skin or blood tests to find out if you have allergic rhinitis. […] The exact cause of nonallergic rhinitis is unknown. […] But experts do know that nonallergic rhinitis happens when blood vessels in the nose expand. These blood vessels fill the tissue that lines the inside of the nose. Many things could cause this. For instance, the nerve endings in the nose might react to triggers too easily. […] Triggers of nonallergic rhinitis can include: […] Some medicines. These include aspirin and ibuprofen (Advil, Motrin IB, others). High blood pressure medicines such as beta blockers also can cause symptoms. […] Using nose sprays or drops for a long time. Don’t use store-bought decongestant drops or sprays oxymetazoline (Afrin, Dristan, others) for more than a few days. A stuffy nose or other symptoms might get worse when the decongestant wears off. This is often called rebound congestion. […] If you’ve tried a medicine that doesn’t help enough, talk to your health care provider. A change to your treatment plan may be needed to prevent or ease your symptoms.

• #5 Nonallergic Rhinitis, With a Focus on Vasomotor Rhinitis Clinical Importance, Differential Diagnosis, and Effective Treatment Recommendations | World Allergy Organization Journal | Full Text

  https://waojournal.biomedcentral.com/articles/10.1097/WAO.0b013e318196ca1e

  The diagnosis of VMR is primarily made by clinical history. […] The diagnosis of VMR is based solely on the patient’s history of symptoms and their triggers, whereas the diagnosis of AR requires an appropriate history and confirmatory allergy testing, either positive prick skin tests or radioallergosorbent tests. […] Nonallergic rhinitis is an underrecognized and inadequately treated condition affecting many subjects. Diagnosis is dependent on a thorough history and exclusion of other underlying conditions, including AR and chronic rhinosinusitis.

• #6 Nonallergic rhinitis – Wikipedia

  https://en.wikipedia.org/wiki/Nonallergic_rhinitis

  Nonallergic rhinitis is rhinitis inflammation of the inner part of the nose not caused by an allergy. Nonallergic rhinitis displays symptoms including chronic sneezing or having a congested, drippy nose, without an identified allergic reaction with allergy testing being normal. […] Nose examination: The mucosa is usually boggy and edematous with clear mucoid secretions. The turbinates are congested and hypertrophic. […] Absolute eosinophil count, nasal smear, skin and in vitro allergy tests to rule out allergic rhinitis, acoustic rhinometry for measuring nasal patency, smell testing, CT scan in cases of sinus disease and MRI in case of mass lesions.

• #7 Rhinitis – In-Depth Review – Sullivan A, Kushnir NM (Updated 2020)

  https://www.worldallergy.org/component/content/article/rhinitis-in-depth-review-sullivan-a-kushnir-nm-updated-2020?catid=16&Itemid=101

  Non-allergic rhinitis is not one uniform syndrome but instead a collection of disorders that lead to the classic symptoms of rhinitis including rhinorrhea and/or nasal congestion. […] The underlying mechanisms leading to non-allergic rhinitis are quite variable and less well understood. […] To adequately distinguish between allergic, non-allergic, and mixed rhinitis, a thorough history and physical followed by diagnostic testing is a necessity. […] There are also subtle differences on physical examination. Classically, the nasal mucosa in allergic rhinitis is edematous, boggy and often with a blue-white hue. The nasal examination in non-allergic rhinitis is more variable depending on the underlying cause of the disorder. […] The general approach to managing non-allergic rhinitis is to treat any underlying conditions that may be contributing to rhinitis symptoms. This may mean finding alternative medications in patients with medication-induced rhinitis, treating underlying sinus disease or hypothyroidism, or asking patients to experiment with different oral contraceptive preparations. If no underlying cause is found, nasal corticosteroids should be considered as first line therapy.

• #8 Diagnosing Rhinitis: Allergic vs. Nonallergic | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0501/p1583.html

  The diagnosis of nonallergic rhinitis is made after eliminating allergic or IgE-mediated causes. […] The most common cause of nonallergic rhinitis is an acute viral infection. […] Less common chronic causes include vasomotor rhinitis, hormonal rhinitis, non-allergic rhinitis with eosinophilia syndrome, occupational rhinitis (irritant subtype), gustatory rhinitis, rhinitis medicamentosa, and drug-induced rhinitis. […] The main controversy is how to differentiate allergic rhinitis from nonallergic rhinitis. […] Management of allergic and nonallergic rhinitis is slightly different; therefore, as more clinical data become available, determining the difference between the two types will become more important. […] A patient-administered screening tool (Patient Rhinitis Screen) to help physicians identify patients with combination rhinitis is not commonly discussed in the literature.

• #9 Nonallergic rhinopathy: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/001648.htm

  Rhinitis is a condition that includes a runny nose, sneezing, and nasal stuffiness. When environmental allergies (such as hayfever) or a cold are not causing these symptoms, the condition is called nonallergic rhinitis. One type of nonallergic rhinitis is called nonallergic rhinopathy. This condition used to be known as vasomotor rhinitis. […] Your health care provider will ask about your symptoms, when they occur, and what seems to trigger them. […] A skin test may be done to check for specific allergies as a cause of your symptoms. […] If your provider determines you can’t have skin testing, special blood tests may help with the diagnosis. These tests, known as IgE allergen tests, can measure the levels of allergy-related substances. […] A complete blood count (CBC) test can measure eosinophils (allergy-type white blood cells) to get a total eosinophil count. This may also help diagnose allergies. […] Contact your provider if you think you have symptoms of nonallergic rhinopathy.

• #10 Non-allergic rhinitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/231

  For non-allergic rhinitis, traditional triggers such as cat or dog exposure should be absent. […] A diagnosis of NAR requires negative specific IgE responses by skin or serologic testing. […] To establish a definitive diagnosis of NAR, all other chronic rhinitis syndromes should be properly considered and excluded. […] Environmental tobacco smoke, perfumes and fragrances, as well as temperature and barometric changes may aggravate symptoms in NAR, but specific IgE responses by skin or serologic testing are all negative. […] The presence of eosinophils in the nasal mucosa in NARES distinguishes it from other subtypes of NAR. […] Diagnostic tests include allergy skin prick tests and serologic specific IgE testing. […] Tests to consider include nasal eosinophil smear, sinus computed tomography, nasal endoscopy, and nasal provocation test.

• #11 Non-allergic rhinitis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/231

  For non-allergic rhinitis, traditional triggers such as cat or dog exposure should be absent. […] A diagnosis of NAR requires negative specific IgE responses by skin or serological testing. […] To establish a definitive diagnosis of NAR, all other chronic rhinitis syndromes should be properly considered and excluded. […] Environmental tobacco smoke, perfumes and fragrances, as well as temperature and barometric changes may aggravate symptoms in NAR, but specific IgE responses by skin or serological testing are all negative. […] The presence of eosinophils in the nasal mucosa in NARES distinguishes it from other sub-types of NAR. […] Diagnostic investigations include allergy skin prick tests and serological specific IgE testing. […] Investigations to consider include nasal eosinophil smear, sinus computed tomography, nasal endoscopy, and nasal provocation test.

• #12 Chronic Nonallergic Rhinitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0801/p171.html

  Chronic nonallergic rhinitis encompasses a group of rhinitis subtypes without allergic or infectious etiologies. […] Although chronic nonallergic rhinitis represents about one-fourth of rhinitis cases and impacts 20 to 30 million patients in the United States, its pathophysiology is unclear and diagnostic testing is not available. […] A negative result on allergy testing is one unifying characteristic of the chronic nonallergic rhinitis subtypes. […] Diagnosing chronic nonallergic rhinitis can be challenging because nasal congestion and rhinorrhea can also occur with allergic rhinitis and chronic rhinosinusitis. […] Nonallergic rhinitis was previously a diagnosis of exclusion. […] It was diagnosed if a patient with suspected allergic rhinitis tested negative for allergies on skin prick testing or antigen-specific immunoglobulin E testing (formerly called radioallergosorbent testing), or if a patient had mild to no nasal eosinophilia on nasal cytology.

• #13 Vasomotor Rhinitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK547704/

  Nonallergic rhinitis (NAR) describes a syndrome of chronic symptoms of nasal congestion and rhinorrhea, unrelated to a specific allergen. […] The most critical factor in attaining a proper diagnosis of vasomotor rhinitis is a comprehensive history and physical. […] The workup for vasomotor rhinitis should include skin testing and/or serum-specific IgE antibodies. As a diagnosis of exclusion, vasomotor rhinitis will typically have a negative skin test and serum antibodies for relevant allergens. […] Distinguishing vasomotor rhinitis from allergic rhinitis can be challenging. […] A detailed history will often elucidate an infectious process from an allergic or nonallergic one. […] Upon determining a diagnosis of vasomotor rhinitis, educating the patient on avoiding environmental triggers is critical.

• #14 Allergic and Mixed Rhinitis: Diagnosis and Natural Evolution

  https://www.mdpi.com/2077-0383/8/11/2019

  Chronic rhinitis (CR) is divided into two main categories: allergic rhinitis (AR) and nonallergic rhinitis (NAR). […] However, an additional 30% to 50% of patients with CR might have an overlap of NAR and AR, referred to as mixed rhinitis (MR). […] Progress in elucidating the pathophysiologic mechanisms behind MR and NAR has been made in the past several years, and there are now several guidelines published to assist the clinician in accurately diagnosing AR, NAR, and MR. Clinical history and subjective symptoms can provide clues for differentiating AR from MR and NAR, but allergy testing is recommended to confirm these conditions. […] Establishing the correct diagnosis is the first step toward better medical management. […] Therefore, an accurate diagnosis of allergic and mixed rhinitis (MR) requires a better understanding of the various rhinitis phenotypes and endotypes.

• #15 Nonallergic rhinitis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/nonallergic-rhinitis/diagnosis-treatment/drc-20351235

  Your health care provider will likely give you a physical exam and ask you about your symptoms. You’ll need tests to find out if something other than nonallergic rhinitis is causing your symptoms. […] You may have nonallergic rhinitis if: […] Tests for other health problems don’t find causes such as allergies or a sinus problem. […] Your provider also will want to find out if your symptoms are due to a sinus problem. You might need an imaging test to check your sinuses. […] Your health care provider may suggest surgery to treat other problems that can happen with nonallergic rhinitis. For example, growths in the nose called polyps may need to be removed. Surgery also can fix a problem where the thin wall between the passages in the nose is off-center or crooked. This is called a deviated septum.

• #16 Nonallergic (Vasomotor) Rhinitis: Symptoms, Causes and Treatment

  https://www.webmd.com/allergies/nonallergic-rhinitis

  Nonallergic Rhinitis Diagnosis […] There isnt a certain test that tells you if you have nonallergic rhinitis. Your doctor will give you a physical exam and ask you about your symptoms. The only way to be sure that allergies arent causing your symptoms is with an allergy test. There are two kinds of tests your doctor might order for you: […] Blood test. This measures the amount of immunoglobulin E (IgE) antibodies in your blood to see if your immune system has had a response to certain allergens. […] Skin test. Your doctor will prick your skin with a needle and expose it to a small amount of something that causes allergies in many people, such as mold, pollen, or pet dander. If youre allergic to any of them, youll break out in a bump like an insect bite at that place on your skin. […] Your doctor will also want to be sure that a problem in your sinuses, such as a growth (polyp) or a deviated septum, isnt the cause of your symptoms. To check this, they may order one of two imaging tests to look inside your sinuses. […] Nasal endoscopy. Your doctor will put a narrow fiber-optic tube called an endoscope into your nostrils to look at your sinuses and nasal passages. […] CT scan. This is a computerized X-ray that makes highly detailed pictures of your sinuses.

• #17 Allergic & Nonallergic Rhinitis NYC | Mount Sinai – New York

  https://www.mountsinai.org/care/ent/services/nasal-sinus-allergy/conditions/rhinitis

  Rhinitis is described as inflammation and irritation of the mucous membrane lining the nose. […] For nonallergic rhinitis, allergy testing as noted above is often performed to rule out any sensitivities. It is important to provide your physician with symptoms, triggers, timing, a full list of current medications (both OTC and prescription)- so that a proper diagnosis can be made. Interestingly, there is no definitive test or exam for diagnosing nonallergic rhinitis. Your physician may order blood work or a CT scan to rule out any other diseases (sinusitis or cerebrospinal brain fluid leak). Your provider may also use a small camera to look into the nasal cavity, back of the nose to determine any other warning signs. The test is painless and can provide a volume of information.

• #18 What Is Nonallergic Rhinitis with Eosinophilia Syndrome?

  https://www.healthline.com/health/non-allergic-rhinitis-with-eosinophilia

  Nonallergic rhinitis with eosinophilia syndrome is a type of rhinitis where you have large numbers of immune cells called eosinophils in your nasal tissue but no symptoms of allergies. […] Nonallergic rhinitis is nasal inflammation that occurs in the absence of an allergic reaction. Nonallergic rhinitis with eosinophilia syndrome (NARES) is a subtype of nonallergic rhinitis. […] People with NARES have high levels of eosinophils in their nasal tissue. However, they have no evidence of an existing allergy or other nasal conditions that could be causing their symptoms. […] Because the symptoms of nonallergic rhinitis like NARES are so similar to allergic rhinitis, your doctor may do allergy testing. This may include skin-prick tests or blood testing. […] People with NARES dont have any evidence of allergies. As such, allergy testing comes back negative.

• #19 What Is Nonallergic Rhinitis with Eosinophilia Syndrome?

  https://www.healthline.com/health/non-allergic-rhinitis-with-eosinophilia

  A doctor may also take a sample of nasal secretions or tissue to check for the presence of certain immune cells. […] People with NARES have increased eosinophils and mast cells. There may also be evidence of mast cell degranulation, which is the process by which mast cells release histamine and other factors. […] Typically, 20% or more of cells in a nasal sample are eosinophils in NARES. However, theres no set cutoff. Researchers from a 2020 study note that the cutoff they found varied quite widely from 5% to 25%. […] A variety of intranasal medications may be used to help manage the symptoms of NARES. These include things like steroids and antihistamines. […] If youve had sneezing, runny nose, or reduced sense of smell for a prolonged period of time, see your doctor. They can do tests to determine what may be causing your symptoms and develop a plan to help you manage them.

• #20 Non-allergic rhinitis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/231

  For non-allergic rhinitis, traditional triggers such as cat or dog exposure should be absent. […] A diagnosis of NAR requires negative specific IgE responses by skin or serological testing. […] To establish a definitive diagnosis of NAR, all other chronic rhinitis syndromes should be properly considered and excluded. […] Environmental tobacco smoke, perfumes and fragrances, as well as temperature and barometric changes may aggravate symptoms in NAR, but specific IgE responses by skin or serological testing are all negative. […] The presence of eosinophils in the nasal mucosa in NARES distinguishes it from other sub-types of NAR. […] Diagnostic investigations include allergy skin prick tests and serological specific IgE testing. […] Investigations to consider include nasal eosinophil smear, sinus computed tomography, nasal endoscopy, and nasal provocation test.

• #21 Allergic and Mixed Rhinitis: Diagnosis and Natural Evolution

  https://www.mdpi.com/2077-0383/8/11/2019

  Although the testing modalities currently available are typically accurate, discrepancies can occur, as in the case of patients with localized AR (LAR) or “entopic” rhinitis. […] A wide number of methods for classifying and diagnosing rhinitis subtypes have been proposed, including nasal cytology, peak nasal inspiratory flow rates, anterior rhinomanometry, acoustic rhinometry, irritant index scales, specific biomarkers, nasal provocation testing with environmental exposure chambers, and nasolaryngoscopy. […] Progress in accurately diagnosing patients with CR will be made as studies incorporate subjective (i.e., validated questionnaires such as the irritant index questionnaire (IIQ), medication responsiveness, and quality-of-life tools) and objective (i.e., nasal cytologic testing, nasal provocation, and biomarkers) methods characterizing rhinitis subtypes.

• #22 Pharmacotherapy for Nonallergic Rhinitis: Overview, Distinguishing Types of Nonallergic Rhinitis, Pharmacotherapy

  https://emedicine.medscape.com/article/874171-overview

  Nonallergic rhinitis is a syndrome resulting from nasal inflammation that encompasses several distinct diagnoses. This syndrome should be distinguished from allergic rhinitis, a syndrome that immunoglobulin E (IgE) is thought to mediate. Nonallergic rhinitis may be diagnosed by means of clinical evaluation or by means of allergen skin testing or radioallergosorbent testing (RAST). […] Nonallergic rhinitis has 7 basic subclassifications, as follows: (1) infectious rhinitis, (2) vasomotor rhinitis, (3) occupational rhinitis, (4) hormonal rhinitis, (5) drug-induced rhinitis, (6) gustatory rhinitis, and (7) nonallergic rhinitis with eosinophilia syndrome (NARES). A thorough history and physical examination aid the clinician in identifying the etiology and help direct the appropriate therapeutic course. […] The diagnosis of nonallergic rhinitis encompasses several individual classifications, including NARES, as well as vasomotor, occupational, hormonal, infectious, drug-induced, and gustatory conditions.

• #23 Vasomotor Rhinitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK547704/

  Nonallergic rhinitis (NAR) describes a syndrome of chronic symptoms of nasal congestion and rhinorrhea, unrelated to a specific allergen. […] The most critical factor in attaining a proper diagnosis of vasomotor rhinitis is a comprehensive history and physical. […] The workup for vasomotor rhinitis should include skin testing and/or serum-specific IgE antibodies. As a diagnosis of exclusion, vasomotor rhinitis will typically have a negative skin test and serum antibodies for relevant allergens. […] Distinguishing vasomotor rhinitis from allergic rhinitis can be challenging. […] A detailed history will often elucidate an infectious process from an allergic or nonallergic one. […] Upon determining a diagnosis of vasomotor rhinitis, educating the patient on avoiding environmental triggers is critical.

• #24 What Is Nonallergic Rhinitis with Eosinophilia Syndrome?

  https://www.healthline.com/health/non-allergic-rhinitis-with-eosinophilia

  A doctor may also take a sample of nasal secretions or tissue to check for the presence of certain immune cells. […] People with NARES have increased eosinophils and mast cells. There may also be evidence of mast cell degranulation, which is the process by which mast cells release histamine and other factors. […] Typically, 20% or more of cells in a nasal sample are eosinophils in NARES. However, theres no set cutoff. Researchers from a 2020 study note that the cutoff they found varied quite widely from 5% to 25%. […] A variety of intranasal medications may be used to help manage the symptoms of NARES. These include things like steroids and antihistamines. […] If youve had sneezing, runny nose, or reduced sense of smell for a prolonged period of time, see your doctor. They can do tests to determine what may be causing your symptoms and develop a plan to help you manage them.

• #25 Diagnosing Rhinitis: Allergic vs. Nonallergic | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0501/p1583.html

  Vasomotor rhinitis is diagnosed through exclusion; patients should have normal serum IgE levels, negative skin testing or RAST, and no inflammation on nasal cytology. […] Hormonal causes of rhinitis include pregnancy, oral contraceptive use, and hypothyroidism. […] Numerous medications have been associated with rhinitis; these include angiotensin-converting enzyme inhibitors, reserpine, guanethidine, phentolamine, methyldopa, prazosin, beta blockers, chlorpromazine, topical nasal decongestants, aspirin, and nonsteroidal anti-inflammatory drugs. […] Repetitive use of topical alpha-adrenergic decongestant sprays (for five to seven consecutive days) may induce rebound nasal congestion after withdrawal (rhinitis medicamentosa). […] Nonallergic rhinitis with eosinophilia syndrome presents as congestion and nasal eosinophilia with no obvious allergic source detected on skin testing or RAST. […] A number of conditions can produce the same signs and symptoms as rhinitis.

• #26 Patient education: Nonallergic rhinitis (runny or stuffy nose) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/nonallergic-rhinitis-runny-or-stuffy-nose-beyond-the-basics

  Rhinitis medicamentosa — Rhinitis medicamentosa is a type of rhinitis that develops as a result of overuse of over-the-counter decongestant nasal sprays or from snorting cocaine (this does not happen with use of nasal glucocorticoid [steroid] sprays). Oral medications can also cause rhinitis medicamentosa. (See 'Medications that worsen symptoms’ above.) […] Rhinitis medicamentosa is treated by discontinuing the drug that is causing the condition. Steroid nasal sprays can speed the recovery from this condition. […] WHERE TO GET MORE INFORMATION […] Your health care provider is the best source of information for questions and concerns related to your medical problem. […] This article will be updated as needed on our website (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below.

• #27 Diagnosing Rhinitis: Allergic vs. Nonallergic | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0501/p1583.html

  Vasomotor rhinitis is diagnosed through exclusion; patients should have normal serum IgE levels, negative skin testing or RAST, and no inflammation on nasal cytology. […] Hormonal causes of rhinitis include pregnancy, oral contraceptive use, and hypothyroidism. […] Numerous medications have been associated with rhinitis; these include angiotensin-converting enzyme inhibitors, reserpine, guanethidine, phentolamine, methyldopa, prazosin, beta blockers, chlorpromazine, topical nasal decongestants, aspirin, and nonsteroidal anti-inflammatory drugs. […] Repetitive use of topical alpha-adrenergic decongestant sprays (for five to seven consecutive days) may induce rebound nasal congestion after withdrawal (rhinitis medicamentosa). […] Nonallergic rhinitis with eosinophilia syndrome presents as congestion and nasal eosinophilia with no obvious allergic source detected on skin testing or RAST. […] A number of conditions can produce the same signs and symptoms as rhinitis.

• #28 Patient education: Nonallergic rhinitis (runny or stuffy nose) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/nonallergic-rhinitis-runny-or-stuffy-nose-beyond-the-basics

  How long will I need treatment? — The dose or frequency of medications can be reduced in some patients over time. However, in most patients, symptoms are lifelong, and some medication is usually needed on a daily and long-term basis. […] OTHER TYPES OF NONALLERGIC RHINITIS […] Gustatory rhinitis — „Gustatory rhinitis” is the term used to describe the sudden onset of watery nasal discharge with eating, especially foods that are spicy or heated (such as soup). […] Cold air rhinitis — Cold air rhinitis, which is also called „Skier’s nose,” is the term applied to patients whose nose runs, producing a watery discharge in cold temperatures. […] Senile rhinitis — Senile rhinitis, which is also called „dry nose syndrome” or „atrophic rhinitis,” occurs when the nasal glands that produce moisture fail to function adequately. This most often occurs with aging but can also be due to certain types of nasal surgery.

• #29 Patient education: Nonallergic rhinitis (runny or stuffy nose) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/nonallergic-rhinitis-runny-or-stuffy-nose-beyond-the-basics

  How long will I need treatment? — The dose or frequency of medications can be reduced in some patients over time. However, in most patients, symptoms are lifelong, and some medication is usually needed on a daily and long-term basis. […] OTHER TYPES OF NONALLERGIC RHINITIS […] Gustatory rhinitis — „Gustatory rhinitis” is the term used to describe the sudden onset of watery nasal discharge with eating, especially foods that are spicy or heated (such as soup). […] Cold air rhinitis — Cold air rhinitis, which is also called „Skier’s nose,” is the term applied to patients whose nose runs, producing a watery discharge in cold temperatures. […] Senile rhinitis — Senile rhinitis, which is also called „dry nose syndrome” or „atrophic rhinitis,” occurs when the nasal glands that produce moisture fail to function adequately. This most often occurs with aging but can also be due to certain types of nasal surgery.

• #30 Nonallergic Rhinitis, With a Focus on Vasomotor Rhinitis Clinical Importance, Differential Diagnosis, and Effective Treatment Recommendations | World Allergy Organization Journal | Full Text

  https://waojournal.biomedcentral.com/articles/10.1097/WAO.0b013e318196ca1e

  The term „rhinitis” denotes nasal inflammation causing a combination of rhinorrhea, sneezing, congestion, nasal itch, and/or postnasal drainage. […] Nonallergic rhinitis (NAR) is also very common, affecting millions of people. […] Nonallergic rhinitis denotes a group of heterogeneous syndromes with distinct underlying pathophysiologies. […] Most patients with chronic nasal symptoms appear at the physician’s office assuming that they have AR. […] In the presence of negative allergy skin tests and a history of rhinitis symptoms, most patients will have some form of NAR or rhinosinusitis. […] Nonallergic rhinitis can be classified into 9 subtypes: drug-induced rhinitis, gustatory rhinitis (rhinorrhea associated with eating), hormonal-induced rhinitis, infectious rhinitis, NARES, occupational rhinitis, senile rhinitis, atrophic rhinitis, and VMR.

• #31 Diagnosing Rhinitis: Allergic vs. Nonallergic | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0501/p1583.html

  Allergic rhinitis, the most common type of rhinitis, generally can be differentiated from the numerous types of nonallergic rhinitis through a thorough history and physical examination. […] Since 1998, three large expert panels have made recommendations for the diagnosis of allergic and nonallergic rhinitis. […] The differential diagnosis of rhinitis is extensive. […] Differentiating allergic rhinitis from other causes of rhinitis can be difficult because the diagnostic criteria for various forms of rhinitis are not always clear-cut. […] Accurate diagnosis is important because therapies that are effective for allergic rhinitis (i.e., antihistamines and nasal corticosteroids) may be less effective for other types of rhinitis. […] Although few studies exist on how to differentiate among types of rhinitis, a thorough and comprehensive history usually suggests the correct diagnosis.

• #32 Vasomotor Rhinitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK547704/

  Vasomotor rhinitis is a diagnosis of exclusion after performing an exhaustive investigation into a patients history. […] Patients with negative systemic allergy assessments and negative imaging are often categorized into a nonallergic rhinitis subtype but have a clinical picture congruent with local allergic rhinitis.

• #33 Non-allergic rhinitis: a case report and review | Clinical and Molecular Allergy | Full Text

  https://clinicalmolecularallergy.biomedcentral.com/articles/10.1186/1476-7961-8-1

  Rhinitis is characterized by rhinorrhea, sneezing, nasal congestion, nasal itch and/or postnasal drip. […] Often the first step in arriving at a diagnosis is to exclude or diagnose sensitivity to inhalant allergens. Non-allergic rhinitis (NAR) comprises multiple distinct conditions that may even co-exist with allergic rhinitis (AR). […] The following case presentation is an example of a patient with typical NAR symptoms who fits the epidemiological profile, but who presented atypically, failed to respond to standard therapy and was subsequently found to have a much more serious underlying condition. […] The diagnosis starts with identification of the rhinorrhea as CSF. The fluid is analyzed for beta-2 transferrin, which is formed by the conversion of beta-1 transferrin into beta-2 transferrin by cerebral neuraminidase.

• #34 Chronic Nonallergic Rhinitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0801/p171.html

  Chronic nonallergic rhinitis encompasses a group of rhinitis subtypes without allergic or infectious etiologies. […] Although chronic nonallergic rhinitis represents about one-fourth of rhinitis cases and impacts 20 to 30 million patients in the United States, its pathophysiology is unclear and diagnostic testing is not available. […] A negative result on allergy testing is one unifying characteristic of the chronic nonallergic rhinitis subtypes. […] Diagnosing chronic nonallergic rhinitis can be challenging because nasal congestion and rhinorrhea can also occur with allergic rhinitis and chronic rhinosinusitis. […] Nonallergic rhinitis was previously a diagnosis of exclusion. […] It was diagnosed if a patient with suspected allergic rhinitis tested negative for allergies on skin prick testing or antigen-specific immunoglobulin E testing (formerly called radioallergosorbent testing), or if a patient had mild to no nasal eosinophilia on nasal cytology.

• #35 Allergic and Mixed Rhinitis: Diagnosis and Natural Evolution

  https://www.mdpi.com/2077-0383/8/11/2019

  Chronic rhinitis (CR) is divided into two main categories: allergic rhinitis (AR) and nonallergic rhinitis (NAR). […] However, an additional 30% to 50% of patients with CR might have an overlap of NAR and AR, referred to as mixed rhinitis (MR). […] Progress in elucidating the pathophysiologic mechanisms behind MR and NAR has been made in the past several years, and there are now several guidelines published to assist the clinician in accurately diagnosing AR, NAR, and MR. Clinical history and subjective symptoms can provide clues for differentiating AR from MR and NAR, but allergy testing is recommended to confirm these conditions. […] Establishing the correct diagnosis is the first step toward better medical management. […] Therefore, an accurate diagnosis of allergic and mixed rhinitis (MR) requires a better understanding of the various rhinitis phenotypes and endotypes.

• #36 Non-allergic rhinitis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/231

  For non-allergic rhinitis, traditional triggers such as cat or dog exposure should be absent. […] A diagnosis of NAR requires negative specific IgE responses by skin or serological testing. […] To establish a definitive diagnosis of NAR, all other chronic rhinitis syndromes should be properly considered and excluded. […] Environmental tobacco smoke, perfumes and fragrances, as well as temperature and barometric changes may aggravate symptoms in NAR, but specific IgE responses by skin or serological testing are all negative. […] The presence of eosinophils in the nasal mucosa in NARES distinguishes it from other sub-types of NAR. […] Diagnostic investigations include allergy skin prick tests and serological specific IgE testing. […] Investigations to consider include nasal eosinophil smear, sinus computed tomography, nasal endoscopy, and nasal provocation test.

• #37 Nonallergic Rhinitis – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/nose-and-paranasal-sinus-disorders/nonallergic-rhinitis

  Rhinitis is classified as allergic or nonallergic. Diagnosis is usually clinical. […] The different forms of rhinitis are diagnosed clinically. Testing is unnecessary. […] Vasomotor rhinitis is differentiated from specific viral and bacterial infections of the nose by the lack of purulent exudate and crusting. It is differentiated from allergic rhinitis by the absence of an identifiable allergen.

• #38 Nonallergic Rhinitis | IntechOpen

  https://www.intechopen.com/chapters/1180286

  Nonallergic rhinitis is a chronic condition that starts later in life which is defined as inflammation or dysfunction of the nasal mucosa present for at least 12 weeks per year without any indications of allergic sensitization. […] To establish a diagnosis of chronic rhinitis, it is necessary for two nasal symptoms to be consistently present for at least 1 hour each day. These symptoms include rhinorrhea (anterior or posterior), nasal obstruction or congestion, sneezing or nasal itch, cough, hyposmia, facial pressure, and eustachian tube dysfunction. […] The diagnosis of NAR relies on a comprehensive medical history, which includes the exclusion of clinically relevant sensitization to airborne allergens and the absence of clinical signs of rhinosinusitis. […] Nasal endoscopy is strongly recommended, as it enables a comprehensive evaluation of the entire endonasal cavity, including the ostiomeatal complex. Emphasizing the significance of nasal endoscopy in diagnosing prolonged cases of rhinitis is crucial, as it can unveil the presence of chronic rhinosinusitis without nasal polyps (CRSsNP) or with nasal polyps (CRSwNP).

• #39 Nonallergic Rhinitis, With a Focus on Vasomotor Rhinitis Clinical Importance, Differential Diagnosis, and Effective Treatment Recommendations | World Allergy Organization Journal | Full Text

  https://waojournal.biomedcentral.com/articles/10.1097/WAO.0b013e318196ca1e

  The diagnosis of VMR is primarily made by clinical history. […] The diagnosis of VMR is based solely on the patient’s history of symptoms and their triggers, whereas the diagnosis of AR requires an appropriate history and confirmatory allergy testing, either positive prick skin tests or radioallergosorbent tests. […] Nonallergic rhinitis is an underrecognized and inadequately treated condition affecting many subjects. Diagnosis is dependent on a thorough history and exclusion of other underlying conditions, including AR and chronic rhinosinusitis.

• #40 Diagnosing Rhinitis: Allergic vs. Nonallergic | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0501/p1583.html

  Allergic rhinitis, the most common type of rhinitis, generally can be differentiated from the numerous types of nonallergic rhinitis through a thorough history and physical examination. […] Since 1998, three large expert panels have made recommendations for the diagnosis of allergic and nonallergic rhinitis. […] The differential diagnosis of rhinitis is extensive. […] Differentiating allergic rhinitis from other causes of rhinitis can be difficult because the diagnostic criteria for various forms of rhinitis are not always clear-cut. […] Accurate diagnosis is important because therapies that are effective for allergic rhinitis (i.e., antihistamines and nasal corticosteroids) may be less effective for other types of rhinitis. […] Although few studies exist on how to differentiate among types of rhinitis, a thorough and comprehensive history usually suggests the correct diagnosis.

• #41 Allergic and Mixed Rhinitis: Diagnosis and Natural Evolution

  https://www.mdpi.com/2077-0383/8/11/2019

  Although the testing modalities currently available are typically accurate, discrepancies can occur, as in the case of patients with localized AR (LAR) or “entopic” rhinitis. […] A wide number of methods for classifying and diagnosing rhinitis subtypes have been proposed, including nasal cytology, peak nasal inspiratory flow rates, anterior rhinomanometry, acoustic rhinometry, irritant index scales, specific biomarkers, nasal provocation testing with environmental exposure chambers, and nasolaryngoscopy. […] Progress in accurately diagnosing patients with CR will be made as studies incorporate subjective (i.e., validated questionnaires such as the irritant index questionnaire (IIQ), medication responsiveness, and quality-of-life tools) and objective (i.e., nasal cytologic testing, nasal provocation, and biomarkers) methods characterizing rhinitis subtypes.

• #42

  https://journals.lww.com/co-allergy/fulltext/2001/02000/non_allergic_rhinitis__diagnosis_and_management.4.aspx

  Patients in the rhinitis clinic with negative skin prick tests present a challenge. Non-allergic rhinitis consists of a variety of conditions including infection, hormonal changes, drugs and autonomic dysfunction. […] A detailed accurate history needs to be taken followed by relevant investigations which may include allergen challenge, because skin prick and RAST-negative allergic rhinitis is now recognised. Nitric oxide levels may prove helpful: elevated levels suggest inflammation, very low levels indicate the possibility of primary ciliary dyskinesia or cystic fibrosis. Treatment is of the underlying cause when found: for those without obvious pathology a trial of combined therapy with topical corticosteroids plus antihistamine or plus anti-cholinergic may be worth while. […] A complex inter-relationship between allergic and infectious rhinitis is becoming apparent.

• #43 Allergic and Mixed Rhinitis: Diagnosis and Natural Evolution

  https://www.mdpi.com/2077-0383/8/11/2019

  Although the testing modalities currently available are typically accurate, discrepancies can occur, as in the case of patients with localized AR (LAR) or “entopic” rhinitis. […] A wide number of methods for classifying and diagnosing rhinitis subtypes have been proposed, including nasal cytology, peak nasal inspiratory flow rates, anterior rhinomanometry, acoustic rhinometry, irritant index scales, specific biomarkers, nasal provocation testing with environmental exposure chambers, and nasolaryngoscopy. […] Progress in accurately diagnosing patients with CR will be made as studies incorporate subjective (i.e., validated questionnaires such as the irritant index questionnaire (IIQ), medication responsiveness, and quality-of-life tools) and objective (i.e., nasal cytologic testing, nasal provocation, and biomarkers) methods characterizing rhinitis subtypes.

• #44 Nonallergic Rhinitis | IntechOpen

  https://www.intechopen.com/chapters/1180286

  The following diagnostic tests are not recommended in NAR: allergen provocation testing, microbiological analysis of the nasal content, nasal cytology or biopsies, measurement of total IgE or allergen-specific IgE in nasal secretions, CT scans of the sinonasal cavities, measurement of nasal hyperreactivity, measurement of markers of cerebrospinal fluid leakage (b2- transferrin or b-trace).

• #45 Allergic and Mixed Rhinitis: Diagnosis and Natural Evolution

  https://www.mdpi.com/2077-0383/8/11/2019

  Distinguishing between the various rhinitis phenotypes can be confusing as the clinical presentation for each can be similar. […] Understanding the subtle differences between these conditions allows for a more accurate diagnostic approach, leading to better symptom control and improvement of quality of life. […] A comprehensive past medical history and focused physical exam serves as the cornerstone for a complete workup that can provide clues for what rhinitis phenotype the patient may have. […] However, relying solely on clinical characteristics for an accurate diagnosis can be confusing due to overlapping characteristics of rhinitis subtypes and therefore, as discussed below, testing to determine sensitization to aeroallergens is necessary for an accurate diagnosis of AR, MR, or NAR.

Zobacz więcej