Materiały źródłowe

• #1 Pathogenic Mechanisms of Idiopathic Nonallergic Rhinitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3650978/

  Idiopathic nonallergic rhinitis (iNAR) has been difficult to define because of the long differential diagnosis of rhinopathy in the absence of allergic rhinitis. iNAR has traditionally been a diagnosis of exclusion with no clear unifying pathophysiology. Increased sensitivity to triggers such has climate changes, cold air, tobacco smoke, strong odors, and perfumes have been thought to be characteristic, but recent studies do not support this hypersensitivity hypothesis. […] New investigations of the local nasal environment and systemic „functional” syndromes have offered new insights into this condition. iNAR may be a heterogenous disorder that includes (1) anatomic abnormalities requiring nasal endoscopy for diagnosis, (2) incipient, local atopy (entopy), (3) dysfunction of nociceptive nerve sensor and ion channel proteins, and (4) autonomic dysfunction as found in chronic fatigue syndrome and other functional disorders.

• #2 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. Nonallergic rhinitis can subdivide into numerous different subtypes with vasomotor rhinitis (VMR) being the most common type. […] The pathophysiology of nonallergic rhinitis is complex, with still much to be discovered. It is partly due to an imbalance between parasympathetic and sympathetic inputs on the nasal mucosa. […] Although the etiology of vasomotor rhinitis is not well understood, it is thought to be associated with the dysregulation of sympathetic, parasympathetic, and nociceptive nerves innervating the nasal mucosa. The imbalance among mediators results in increased vascular permeability and mucus secretion from the submucosal nasal glands. Mucous secretion is regulated primarily by the parasympathetic nervous system, whereas the sympathetic nervous system controls vascular tone.

• #2 Pathogenic Mechanisms of Idiopathic Nonallergic Rhinitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3650978/

  Published evidence suggests that iNAR is a heterogenous disorder that includes (1) anatomic abnormalities requiring nasal endoscopy for diagnosis, (2) incipient, „endogenous” atopy (entopy), (3) nociceptive nerve dysfunction, and (4) autonomic dysfunction as found in chronic fatigue syndrome and other systemic „functional” syndromes. […] Hypertrophic turbinate tissue is often used as a „normal” control for studies of nasal polyps. This is inappropriate because turbinate histology depends on the patient pathology. […] The excessive secreted mucus may cause postnasal drip with throat-clearing cough or thick, tenacious anterior discharge. This condition will not respond to vasoconstrictors. The most striking changes were found in „vasomotor rhinitis” where there was a decrease in the size of glands and fibrosis of the lamina propria.

• #3 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 at least 23% of rhinitis cases in the United States and impacts an estimated 20 to 30 million patients, its pathophysiology is unclear. […] The best current evidence supports nociceptor and autonomic nerve dysregulation as components in all forms of nonallergic rhinitis. […] A negative result on allergy testing is one unifying characteristic of the chronic nonallergic rhinitis subtypes. […] Clinically, chronic nonallergic rhinitis is characterized by its nonallergic triggers, including weather changes, tobacco smoke, automotive emission fumes, and irritants such as chemicals with strong odors (e.g., perfumes, chlorine).

• #3 Nonallergic rhinitis: Common problem, chronic symptoms | MDedge

  https://ma1.mdedge.com/content/nonallergic-rhinitis-common-problem-chronic-symptoms

  Mechanisms are mostly unknown. While allergic rhinitis leads to symptoms when airborne allergens bind with specific immunoglobulin E (IgE) in the nose, the etiology of most forms of nonallergic rhinitis is unknown. However, several mechanisms have been proposed. These include entopy (local nasal IgE synthesis with negative skin tests), nocioceptive dysfunction (hyperactive sensory receptors), and autonomic nervous system abnormalities (hypoactive or hyperactive dysfunction of sympathetic or parasympathetic nerves in the nose). […] Patients for whom an allergic cause cannot be found by allergy skin testing or serum specific IgE immunoassay (Immunocap/RAST) for environmental aeroallergens are classified as having nonallergic rhinitis.

• #4 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. […] Nonallergic rhinitis may be diagnosed by means of clinical evaluation or by means of allergen skin testing or radioallergosorbent testing (RAST). […] Depending on its etiology, nonallergic rhinitis may resemble allergic rhinitis in terms of rhinorrhea, sneezing, pruritus, and congestion. […] Inflammation in either type of rhinitis may induce an episode of acute rhinosinusitis in a patient predisposed because of blockages in functionally important intranasal passages. […] The „unified airway” theory applies to nonallergic patients as well; patients with nonallergic rhinitis have been shown to be at a higher risk of asthma, and vice versa. […] 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).

• #4 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. Nonallergic rhinitis can subdivide into numerous different subtypes with vasomotor rhinitis (VMR) being the most common type. […] The pathophysiology of nonallergic rhinitis is complex, with still much to be discovered. It is partly due to an imbalance between parasympathetic and sympathetic inputs on the nasal mucosa. […] Although the etiology of vasomotor rhinitis is not well understood, it is thought to be associated with the dysregulation of sympathetic, parasympathetic, and nociceptive nerves innervating the nasal mucosa. The imbalance among mediators results in increased vascular permeability and mucus secretion from the submucosal nasal glands. Mucous secretion is regulated primarily by the parasympathetic nervous system, whereas the sympathetic nervous system controls vascular tone.

• #5 Pathogenic Mechanisms of Idiopathic Nonallergic Rhinitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3650978/

  Idiopathic nonallergic rhinitis (iNAR) has been difficult to define because of the long differential diagnosis of rhinopathy in the absence of allergic rhinitis. iNAR has traditionally been a diagnosis of exclusion with no clear unifying pathophysiology. Increased sensitivity to triggers such has climate changes, cold air, tobacco smoke, strong odors, and perfumes have been thought to be characteristic, but recent studies do not support this hypersensitivity hypothesis. […] New investigations of the local nasal environment and systemic „functional” syndromes have offered new insights into this condition. iNAR may be a heterogenous disorder that includes (1) anatomic abnormalities requiring nasal endoscopy for diagnosis, (2) incipient, local atopy (entopy), (3) dysfunction of nociceptive nerve sensor and ion channel proteins, and (4) autonomic dysfunction as found in chronic fatigue syndrome and other functional disorders.

• #5 Rhinitis – Wikipedia

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

  Nonallergic rhinitis refers to rhinitis that is not due to an allergy. The category was formerly referred to as vasomotor rhinitis, as the first cause discovered was vasodilation due to an overactive parasympathetic nerve response. […] The diagnosis is made upon excluding allergic causes. It is an umbrella term of rhinitis of multiple causes, such as occupational (chemical), smoking, gustatory, hormonal, senile (rhinitis of the elderly), atrophic, medication-induced (including rhinitis medicamentosa), local allergic rhinitis, non-allergic rhinitis with eosinophilia syndrome (NARES) and idiopathic (vasomotor or non-allergic, non-infectious perennial allergic rhinitis (NANIPER), or non-infectious non-allergic rhinitis (NINAR). […] In vasomotor rhinitis, certain nonspecific stimuli, including changes in environment (temperature, humidity, barometric pressure, or weather), airborne irritants (odors, fumes), dietary factors (spicy food, alcohol), sexual arousal, exercise, and emotional factors trigger rhinitis.

• #6 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. Nonallergic rhinitis can subdivide into numerous different subtypes with vasomotor rhinitis (VMR) being the most common type. […] The pathophysiology of nonallergic rhinitis is complex, with still much to be discovered. It is partly due to an imbalance between parasympathetic and sympathetic inputs on the nasal mucosa. […] Although the etiology of vasomotor rhinitis is not well understood, it is thought to be associated with the dysregulation of sympathetic, parasympathetic, and nociceptive nerves innervating the nasal mucosa. The imbalance among mediators results in increased vascular permeability and mucus secretion from the submucosal nasal glands. Mucous secretion is regulated primarily by the parasympathetic nervous system, whereas the sympathetic nervous system controls vascular tone.

• #7 Rhinitis – Wikipedia

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

  The pathology of vasomotor rhinitis appears to involve neurogenic inflammation and is as yet not very well understood. The role of transient receptor potential ion channels on the non-neuronal nasal epithelial cells has also been suggested. Overexpression of these receptors have influence the nasal airway hyper-responsiveness to non-allergic irritant environmental stimuli (e.g., extremes of temperature, changes in osmotic or barometric pressure). […] Most prominent pathological changes observed are nasal airway epithelial metaplasia in which goblet cells replace ciliated columnar epithelial cells in the nasal mucous membrane. This results in mucin hypersecretion by goblet cells and decreased mucociliary activity. Nasal secretion are not adequately cleared with clinical manifestation of nasal congestion, sinus pressure, post-nasal dripping, and headache. Over-expression of transient receptor potential (TRP) ion channels, such as TRPA1 and TRPV1, may be involved in the pathogenesis of non-allergic rhinitis. […] Neurogenic inflammation produced by neuropeptides released from sensory nerve endings to the airways is a proposed common mechanism of association between both allergic and non-allergic rhinitis with asthma.

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

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

  Autonomic stimuli have a greater effect on patients with nonallergic rhinitis than on those with allergic rhinitis. […] Autonomic imbalance favoring the parasympathetic system increases nasal blood flow, edema, and secretions, creating an overall presentation of rhinorrhea and nasal obstruction. […] Elevated concentrations of immunoglobulin G subclass 1 (IgG1) and immunoglobulin G subclass 4 (IgG4) anti-IgE autoantibodies have been found in patients with nonallergic rhinitis compared with control subjects. […] Therapy for allergic rhinitis is focused on desensitization and use of decongestants, antihistamines, and mast-cell mediators. […] A wide variety of etiologies are involved in nonallergic rhinitis. […] Therefore, treatment options should not be implemented randomly. […] It is also valuable to distinguish between allergic and nonallergic rhinitis before a treatment method is chosen.

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

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

  Autonomic stimuli have a greater effect on patients with nonallergic rhinitis than on those with allergic rhinitis. […] Autonomic imbalance favoring the parasympathetic system increases nasal blood flow, edema, and secretions, creating an overall presentation of rhinorrhea and nasal obstruction. […] Elevated concentrations of immunoglobulin G subclass 1 (IgG1) and immunoglobulin G subclass 4 (IgG4) anti-IgE autoantibodies have been found in patients with nonallergic rhinitis compared with control subjects. […] Therapy for allergic rhinitis is focused on desensitization and use of decongestants, antihistamines, and mast-cell mediators. […] A wide variety of etiologies are involved in nonallergic rhinitis. […] Therefore, treatment options should not be implemented randomly. […] It is also valuable to distinguish between allergic and nonallergic rhinitis before a treatment method is chosen.

• #10 Vasomotor Rhinitis – StatPearls – NCBI Bookshelf

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

  Sensory neuropeptides and nociceptive type C fibers of the trigeminal nerve contribute to mast cell degranulation as well as the itching/sneezing reflexes. […] The therapeutic transection of the vidian nerve is a well-known surgical option for vasomotor rhinitis. The technique aims to disrupt the autonomic nerve supply of the nasal cavity, thus decreasing nasal secretions. The vidian nerve forms from the confluence of the greater superficial petrosal and deep petrosal nerves. […] Botulinum toxin has also demonstrated a potential role in the treatment of vasomotor rhinitis through its anticholinergic effects. Botulinum toxin (BTX) inhibits acetylcholine release from the presynaptic nerve terminal. Injecting BTX into the inferior and middle turbinates decreases rhinorrhea and nasal mucous gland secretion in patients with vasomotor rhinitis.

• #11 Vasomotor Rhinitis – StatPearls – NCBI Bookshelf

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

  Sensory neuropeptides and nociceptive type C fibers of the trigeminal nerve contribute to mast cell degranulation as well as the itching/sneezing reflexes. […] The therapeutic transection of the vidian nerve is a well-known surgical option for vasomotor rhinitis. The technique aims to disrupt the autonomic nerve supply of the nasal cavity, thus decreasing nasal secretions. The vidian nerve forms from the confluence of the greater superficial petrosal and deep petrosal nerves. […] Botulinum toxin has also demonstrated a potential role in the treatment of vasomotor rhinitis through its anticholinergic effects. Botulinum toxin (BTX) inhibits acetylcholine release from the presynaptic nerve terminal. Injecting BTX into the inferior and middle turbinates decreases rhinorrhea and nasal mucous gland secretion in patients with vasomotor rhinitis.

• #12 Pathogenic Mechanisms of Idiopathic Nonallergic Rhinitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3650978/

  Autonomic dysfunction has long been associated with nonallergic rhinitis. […] The high prevalence of irritable bowel syndrome (IBS) in iNAR is of importance because of correlations of IBS subtypes with specific abnormalities in the enteric serotonin (5-HT) and dopamine systems and central pain, sympathetic autonomic, and parasympathetic autonomic nervous systems. […] The dysautonomia with blunted sympathetic responses to stressors and generalized elevation in parasympathetic influences may be the common denominator.

• #13 Pathogenic Mechanisms of Idiopathic Nonallergic Rhinitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3650978/

  Autonomic dysfunction has long been associated with nonallergic rhinitis. […] The high prevalence of irritable bowel syndrome (IBS) in iNAR is of importance because of correlations of IBS subtypes with specific abnormalities in the enteric serotonin (5-HT) and dopamine systems and central pain, sympathetic autonomic, and parasympathetic autonomic nervous systems. […] The dysautonomia with blunted sympathetic responses to stressors and generalized elevation in parasympathetic influences may be the common denominator.

• #14 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 not a single disease with 1 underlying mechanism but is instead a collection of multiple distinct conditions that cause similar nasal symptoms. […] Nonallergic rhinitis denotes a group of heterogeneous syndromes with distinct underlying pathophysiologies. […] The most frequent form of NAR observed clinically is nonallergic VMR or idiopathic rhinitis, characterized by sporadic or persistent nasal symptoms that are triggered by environmental conditions, such as strong smells; exposure to cold air; changes in temperature, humidity, and barometric pressure; strong emotions; ingesting alcoholic beverages; and changes in hormone levels.

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

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

  Autonomic stimuli have a greater effect on patients with nonallergic rhinitis than on those with allergic rhinitis. […] Autonomic imbalance favoring the parasympathetic system increases nasal blood flow, edema, and secretions, creating an overall presentation of rhinorrhea and nasal obstruction. […] Elevated concentrations of immunoglobulin G subclass 1 (IgG1) and immunoglobulin G subclass 4 (IgG4) anti-IgE autoantibodies have been found in patients with nonallergic rhinitis compared with control subjects. […] Therapy for allergic rhinitis is focused on desensitization and use of decongestants, antihistamines, and mast-cell mediators. […] A wide variety of etiologies are involved in nonallergic rhinitis. […] Therefore, treatment options should not be implemented randomly. […] It is also valuable to distinguish between allergic and nonallergic rhinitis before a treatment method is chosen.

• #16 Pathogenic Mechanisms of Idiopathic Nonallergic Rhinitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3650978/

  Entopy refers to localized nasal allergy without systemic evidence of atopy. […] Evidence of allergic inflammatory cells would support the concept of entopy. […] These studies require follow-up with quantitative reverse transcriptase-polymerase chain reaction, in situ hybridization, and other advanced investigations to determine whether there is a subtle but potentially pathogenic increase in mast cell populations in IR. […] The trigeminal nerve innervates the nasal mucosa through its first ophthalmic and second maxillary branch. […] The collection of sensor proteins on a neuron may be in constant flux depending on the conditions of inhaled air, desensitization, inflammation, and neurotrophins. […] Dysfunction of this system may contribute to dyspnea. More extreme cold activates TRP ankryn 1 ion channels. […] Topical nasal capsaicin is an effective therapy in iNAR. The capsaicin treatment reduced congestion for as long as 6 months. It had no effect in allergic rhinitis. These data suggest that increased nociceptive nerve function plays a role in iNAR, and that specific inactivation of TRPV1 has a role in its treatment.

• #17 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 exact underlying mechanisms causing VMR are not well understood. […] There is evidence that capsaicin-sensitive nociceptors in the nasal mucosa may play a role. […] Some studies have also demonstrated that topical nasal capsaicin treatment of VMR patients can induce prolonged symptom relief. […] The epidemiologic predominance of females experiencing VMR suggests that female hormones might play some role, but there is no research explaining this possibility.

• #18 Pathogenic Mechanisms of Idiopathic Nonallergic Rhinitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3650978/

  Entopy refers to localized nasal allergy without systemic evidence of atopy. […] Evidence of allergic inflammatory cells would support the concept of entopy. […] These studies require follow-up with quantitative reverse transcriptase-polymerase chain reaction, in situ hybridization, and other advanced investigations to determine whether there is a subtle but potentially pathogenic increase in mast cell populations in IR. […] The trigeminal nerve innervates the nasal mucosa through its first ophthalmic and second maxillary branch. […] The collection of sensor proteins on a neuron may be in constant flux depending on the conditions of inhaled air, desensitization, inflammation, and neurotrophins. […] Dysfunction of this system may contribute to dyspnea. More extreme cold activates TRP ankryn 1 ion channels. […] Topical nasal capsaicin is an effective therapy in iNAR. The capsaicin treatment reduced congestion for as long as 6 months. It had no effect in allergic rhinitis. These data suggest that increased nociceptive nerve function plays a role in iNAR, and that specific inactivation of TRPV1 has a role in its treatment.

• #19 Pathogenic Mechanisms of Idiopathic Nonallergic Rhinitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3650978/

  Entopy refers to localized nasal allergy without systemic evidence of atopy. […] Evidence of allergic inflammatory cells would support the concept of entopy. […] These studies require follow-up with quantitative reverse transcriptase-polymerase chain reaction, in situ hybridization, and other advanced investigations to determine whether there is a subtle but potentially pathogenic increase in mast cell populations in IR. […] The trigeminal nerve innervates the nasal mucosa through its first ophthalmic and second maxillary branch. […] The collection of sensor proteins on a neuron may be in constant flux depending on the conditions of inhaled air, desensitization, inflammation, and neurotrophins. […] Dysfunction of this system may contribute to dyspnea. More extreme cold activates TRP ankryn 1 ion channels. […] Topical nasal capsaicin is an effective therapy in iNAR. The capsaicin treatment reduced congestion for as long as 6 months. It had no effect in allergic rhinitis. These data suggest that increased nociceptive nerve function plays a role in iNAR, and that specific inactivation of TRPV1 has a role in its treatment.

• #20

  https://link.springer.com/article/10.1007/s11882-016-0638-1

  Non-allergic rhinitis is characterized by rhinitis symptoms without systemic sensitization of infectious etiology. […] Based on endotypes, we can categorize non-allergic rhinitis into an inflammatory endotype with usually eosinophilic inflammation encompassing at least NARES and LAR and part of the drug induced rhinitis (e.g., aspirin intolerance) and a neurogenic endotype encompassing idiopathic rhinitis, gustatory rhinitis, and rhinitis of the elderly. […] Patients with idiopathic rhinitis have a higher baseline TRPV1 expression in the nasal mucosa than healthy controls. […] Activation of nasal afferent nerves by aspecific factors results in defensive efferent responses, such as sneezing, and glandular and/or vascular activation, leading to rhinorrhea and nasal congestion. […] Both transient receptor potential ankyrin 1 (TRPA1) and vanilloid 1 (TRPV1) receptors are abundantly expressed in these C-fiber sensory nerves and can be activated by a number of endogenous inflammatory mediators.

• #21

  https://link.springer.com/article/10.1007/s11882-016-0638-1

  Non-allergic rhinitis is characterized by rhinitis symptoms without systemic sensitization of infectious etiology. […] Based on endotypes, we can categorize non-allergic rhinitis into an inflammatory endotype with usually eosinophilic inflammation encompassing at least NARES and LAR and part of the drug induced rhinitis (e.g., aspirin intolerance) and a neurogenic endotype encompassing idiopathic rhinitis, gustatory rhinitis, and rhinitis of the elderly. […] Patients with idiopathic rhinitis have a higher baseline TRPV1 expression in the nasal mucosa than healthy controls. […] Activation of nasal afferent nerves by aspecific factors results in defensive efferent responses, such as sneezing, and glandular and/or vascular activation, leading to rhinorrhea and nasal congestion. […] Both transient receptor potential ankyrin 1 (TRPA1) and vanilloid 1 (TRPV1) receptors are abundantly expressed in these C-fiber sensory nerves and can be activated by a number of endogenous inflammatory mediators.

• #22 Rhinitis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Rhinitis_pathophysiology

  Rhinitis can occur via the following mechanism: Exposure to nonallergic triggers result in the activation of Transient Receptor Potential cation channels (TRPV1, TRPA1) on nasal mucosal nerve fibers. […] This results in the release of neuropetides such as Calcitonin Gene-Related Peptide (CGRP) and substance P from sensory nerve endings. […] These neuropeptides facilitate vasodilation and plasma extravasation, resulting in edema and glandular hypersecretion. […] It is important to note that the evidence for substance P involvement was extrapolated following the beneficial effect of treatment with capsaicin (known to deplete substance P from sensory nerve endings) in affected patients. […] These pathophysiologic mechanisms have not been extensively investigated.

• #23

  https://link.springer.com/article/10.1007/s11882-016-0638-1

  Non-allergic rhinitis is characterized by rhinitis symptoms without systemic sensitization of infectious etiology. […] Based on endotypes, we can categorize non-allergic rhinitis into an inflammatory endotype with usually eosinophilic inflammation encompassing at least NARES and LAR and part of the drug induced rhinitis (e.g., aspirin intolerance) and a neurogenic endotype encompassing idiopathic rhinitis, gustatory rhinitis, and rhinitis of the elderly. […] Patients with idiopathic rhinitis have a higher baseline TRPV1 expression in the nasal mucosa than healthy controls. […] Activation of nasal afferent nerves by aspecific factors results in defensive efferent responses, such as sneezing, and glandular and/or vascular activation, leading to rhinorrhea and nasal congestion. […] Both transient receptor potential ankyrin 1 (TRPA1) and vanilloid 1 (TRPV1) receptors are abundantly expressed in these C-fiber sensory nerves and can be activated by a number of endogenous inflammatory mediators.

• #24 Rhinitis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Rhinitis_pathophysiology

  Rhinitis can occur via the following mechanism: Exposure to nonallergic triggers result in the activation of Transient Receptor Potential cation channels (TRPV1, TRPA1) on nasal mucosal nerve fibers. […] This results in the release of neuropetides such as Calcitonin Gene-Related Peptide (CGRP) and substance P from sensory nerve endings. […] These neuropeptides facilitate vasodilation and plasma extravasation, resulting in edema and glandular hypersecretion. […] It is important to note that the evidence for substance P involvement was extrapolated following the beneficial effect of treatment with capsaicin (known to deplete substance P from sensory nerve endings) in affected patients. […] These pathophysiologic mechanisms have not been extensively investigated.

• #25

  https://link.springer.com/article/10.1007/s11882-016-0638-1

  Patients with idiopathic rhinitis compared to healthy controls have been shown to overexpress TRPV1 in the nasal mucosa, and they have increased SP levels in nasal secretions. […] An imbalance of these components leads to glandular hypersecretion and plays an important role, e.g., in rhinitis of the elderly. […] Capsaicin is unique among naturally occurring irritant compounds because the initial neuronal excitation evoked by it is followed by a long-lasting refractory period, during which the previously excited neurons are no longer responsive to a broad range of stimuli. […] The therapeutic effect of intranasal capsaicin application is thought to be induced by the abovementioned defunctionalization and/or degeneration of nerve terminals by the massive Ca2+ influx. […] Expression of TRPV1, transient receptor potential cation channel subfamily M, receptor 8 (TRPM8), and protein gene product 9.5 (PGP 9.5) was reduced in patients with IR after capsaicin treatment.

• #26 Rhinitis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Rhinitis_pathophysiology

  Rhinitis can occur via the following mechanism: Exposure to nonallergic triggers result in the activation of Transient Receptor Potential cation channels (TRPV1, TRPA1) on nasal mucosal nerve fibers. […] This results in the release of neuropetides such as Calcitonin Gene-Related Peptide (CGRP) and substance P from sensory nerve endings. […] These neuropeptides facilitate vasodilation and plasma extravasation, resulting in edema and glandular hypersecretion. […] It is important to note that the evidence for substance P involvement was extrapolated following the beneficial effect of treatment with capsaicin (known to deplete substance P from sensory nerve endings) in affected patients. […] These pathophysiologic mechanisms have not been extensively investigated.

• #27 Rhinitis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Rhinitis_pathophysiology

  Rhinitis can occur via the following mechanism: Exposure to nonallergic triggers result in the activation of Transient Receptor Potential cation channels (TRPV1, TRPA1) on nasal mucosal nerve fibers. […] This results in the release of neuropetides such as Calcitonin Gene-Related Peptide (CGRP) and substance P from sensory nerve endings. […] These neuropeptides facilitate vasodilation and plasma extravasation, resulting in edema and glandular hypersecretion. […] It is important to note that the evidence for substance P involvement was extrapolated following the beneficial effect of treatment with capsaicin (known to deplete substance P from sensory nerve endings) in affected patients. […] These pathophysiologic mechanisms have not been extensively investigated.

• #28 Rhinitis – Wikipedia

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

  The pathology of vasomotor rhinitis appears to involve neurogenic inflammation and is as yet not very well understood. The role of transient receptor potential ion channels on the non-neuronal nasal epithelial cells has also been suggested. Overexpression of these receptors have influence the nasal airway hyper-responsiveness to non-allergic irritant environmental stimuli (e.g., extremes of temperature, changes in osmotic or barometric pressure). […] Most prominent pathological changes observed are nasal airway epithelial metaplasia in which goblet cells replace ciliated columnar epithelial cells in the nasal mucous membrane. This results in mucin hypersecretion by goblet cells and decreased mucociliary activity. Nasal secretion are not adequately cleared with clinical manifestation of nasal congestion, sinus pressure, post-nasal dripping, and headache. Over-expression of transient receptor potential (TRP) ion channels, such as TRPA1 and TRPV1, may be involved in the pathogenesis of non-allergic rhinitis. […] Neurogenic inflammation produced by neuropeptides released from sensory nerve endings to the airways is a proposed common mechanism of association between both allergic and non-allergic rhinitis with asthma.

• #29 Rhinitis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Rhinitis_pathophysiology

  Rhinitis can occur via the following mechanism: Exposure to nonallergic triggers result in the activation of Transient Receptor Potential cation channels (TRPV1, TRPA1) on nasal mucosal nerve fibers. […] This results in the release of neuropetides such as Calcitonin Gene-Related Peptide (CGRP) and substance P from sensory nerve endings. […] These neuropeptides facilitate vasodilation and plasma extravasation, resulting in edema and glandular hypersecretion. […] It is important to note that the evidence for substance P involvement was extrapolated following the beneficial effect of treatment with capsaicin (known to deplete substance P from sensory nerve endings) in affected patients. […] These pathophysiologic mechanisms have not been extensively investigated.

• #30 Pathogenic Mechanisms of Idiopathic Nonallergic Rhinitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3650978/

  Entopy refers to localized nasal allergy without systemic evidence of atopy. […] Evidence of allergic inflammatory cells would support the concept of entopy. […] These studies require follow-up with quantitative reverse transcriptase-polymerase chain reaction, in situ hybridization, and other advanced investigations to determine whether there is a subtle but potentially pathogenic increase in mast cell populations in IR. […] The trigeminal nerve innervates the nasal mucosa through its first ophthalmic and second maxillary branch. […] The collection of sensor proteins on a neuron may be in constant flux depending on the conditions of inhaled air, desensitization, inflammation, and neurotrophins. […] Dysfunction of this system may contribute to dyspnea. More extreme cold activates TRP ankryn 1 ion channels. […] Topical nasal capsaicin is an effective therapy in iNAR. The capsaicin treatment reduced congestion for as long as 6 months. It had no effect in allergic rhinitis. These data suggest that increased nociceptive nerve function plays a role in iNAR, and that specific inactivation of TRPV1 has a role in its treatment.

• #31 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 exact underlying mechanisms causing VMR are not well understood. […] There is evidence that capsaicin-sensitive nociceptors in the nasal mucosa may play a role. […] Some studies have also demonstrated that topical nasal capsaicin treatment of VMR patients can induce prolonged symptom relief. […] The epidemiologic predominance of females experiencing VMR suggests that female hormones might play some role, but there is no research explaining this possibility.

• #32

  https://link.springer.com/article/10.1007/s11882-016-0638-1

  Patients with idiopathic rhinitis compared to healthy controls have been shown to overexpress TRPV1 in the nasal mucosa, and they have increased SP levels in nasal secretions. […] An imbalance of these components leads to glandular hypersecretion and plays an important role, e.g., in rhinitis of the elderly. […] Capsaicin is unique among naturally occurring irritant compounds because the initial neuronal excitation evoked by it is followed by a long-lasting refractory period, during which the previously excited neurons are no longer responsive to a broad range of stimuli. […] The therapeutic effect of intranasal capsaicin application is thought to be induced by the abovementioned defunctionalization and/or degeneration of nerve terminals by the massive Ca2+ influx. […] Expression of TRPV1, transient receptor potential cation channel subfamily M, receptor 8 (TRPM8), and protein gene product 9.5 (PGP 9.5) was reduced in patients with IR after capsaicin treatment.

• #33

  https://link.springer.com/article/10.1007/s11882-016-0638-1

  Patients with idiopathic rhinitis compared to healthy controls have been shown to overexpress TRPV1 in the nasal mucosa, and they have increased SP levels in nasal secretions. […] An imbalance of these components leads to glandular hypersecretion and plays an important role, e.g., in rhinitis of the elderly. […] Capsaicin is unique among naturally occurring irritant compounds because the initial neuronal excitation evoked by it is followed by a long-lasting refractory period, during which the previously excited neurons are no longer responsive to a broad range of stimuli. […] The therapeutic effect of intranasal capsaicin application is thought to be induced by the abovementioned defunctionalization and/or degeneration of nerve terminals by the massive Ca2+ influx. […] Expression of TRPV1, transient receptor potential cation channel subfamily M, receptor 8 (TRPM8), and protein gene product 9.5 (PGP 9.5) was reduced in patients with IR after capsaicin treatment.

• #34 Pathogenic Mechanisms of Idiopathic Nonallergic Rhinitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3650978/

  Entopy refers to localized nasal allergy without systemic evidence of atopy. […] Evidence of allergic inflammatory cells would support the concept of entopy. […] These studies require follow-up with quantitative reverse transcriptase-polymerase chain reaction, in situ hybridization, and other advanced investigations to determine whether there is a subtle but potentially pathogenic increase in mast cell populations in IR. […] The trigeminal nerve innervates the nasal mucosa through its first ophthalmic and second maxillary branch. […] The collection of sensor proteins on a neuron may be in constant flux depending on the conditions of inhaled air, desensitization, inflammation, and neurotrophins. […] Dysfunction of this system may contribute to dyspnea. More extreme cold activates TRP ankryn 1 ion channels. […] Topical nasal capsaicin is an effective therapy in iNAR. The capsaicin treatment reduced congestion for as long as 6 months. It had no effect in allergic rhinitis. These data suggest that increased nociceptive nerve function plays a role in iNAR, and that specific inactivation of TRPV1 has a role in its treatment.

• #35 Pathogenic Mechanisms of Idiopathic Nonallergic Rhinitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3650978/

  Entopy refers to localized nasal allergy without systemic evidence of atopy. […] Evidence of allergic inflammatory cells would support the concept of entopy. […] These studies require follow-up with quantitative reverse transcriptase-polymerase chain reaction, in situ hybridization, and other advanced investigations to determine whether there is a subtle but potentially pathogenic increase in mast cell populations in IR. […] The trigeminal nerve innervates the nasal mucosa through its first ophthalmic and second maxillary branch. […] The collection of sensor proteins on a neuron may be in constant flux depending on the conditions of inhaled air, desensitization, inflammation, and neurotrophins. […] Dysfunction of this system may contribute to dyspnea. More extreme cold activates TRP ankryn 1 ion channels. […] Topical nasal capsaicin is an effective therapy in iNAR. The capsaicin treatment reduced congestion for as long as 6 months. It had no effect in allergic rhinitis. These data suggest that increased nociceptive nerve function plays a role in iNAR, and that specific inactivation of TRPV1 has a role in its treatment.

• #36 Non-allergic rhinitis in children: Epidemiological aspects, pathological features, diagnostic methodology and clinical management

  https://www.wjgnet.com/2222-0682/full/v6/i4/200.htm

  The local production of IgE in the nasal mucosa has been largely demonstrated in patients with AR, where the allergen exposure directly drives the antibody class switch recombination. […] Poor SPT technique and/or quality of allergen preparations or a cover allergy, namely the sensitivity to not tested allergens, have been suggested to explain some cases of apparent entopy. […] Epidemiologically, LAR might affect more than 40% people diagnosed with NAR. […] Importantly, in addition to highlighting the epidemiological importance of LAR among CR, this study noticed that 36% of patients with LAR had rhinitis since childhood. […] However, such a hypothesis upon LAR as an initial stage of AR needs to be tested adequately and immune processes might differ according to allergens. […] Non IgE-mediated immune mechanisms could take place in several classified forms of NAR.

• #37 Non-Allergic Rhinitis | IntechOpen

  https://www.intechopen.com/chapters/74261

  Metabolic (Acromegaly, Pregnancy, Hypothyroidism), Autoimmune (Sjogrens syndrome SLE Relapsing polychondritis Churg-Straus), Granulomatous diseases (Sarcoidosis and Wegeners granulomatosis), Other (Cystic fibrosis, Cilia dyskinesia syndromes, Immunodeficiency, Amyloidosis, Chronic fatigue syndrome) are the most common causes of NAR. […] Non-allergic rhinitis with eosinophilia syndrome (NARES) is a type of non-allergic rhinitis characterized by negative skin test and normal IgE levels. […] Eosinophilia is observed in patients.

• #38 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. […] Nonallergic rhinitis may be diagnosed by means of clinical evaluation or by means of allergen skin testing or radioallergosorbent testing (RAST). […] Depending on its etiology, nonallergic rhinitis may resemble allergic rhinitis in terms of rhinorrhea, sneezing, pruritus, and congestion. […] Inflammation in either type of rhinitis may induce an episode of acute rhinosinusitis in a patient predisposed because of blockages in functionally important intranasal passages. […] The „unified airway” theory applies to nonallergic patients as well; patients with nonallergic rhinitis have been shown to be at a higher risk of asthma, and vice versa. […] 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).

• #39 Chronic Nonallergic Rhinitis | AAFP

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

  Chronic nonallergic rhinitis is more common in women, with a female-to-male ratio of 2:1 to 3:1. […] Nonallergic rhinitis with nasal eosinophilia syndrome is an inflammatory type of rhinitis with increased eosinophils in the secretions and on nasal biopsy, with increased mast cells and evidence of mast cell degranulation but without positive findings on allergy testing. […] Atrophic rhinitis involves atrophy of the nasal mucosa that can lead to nasal crusting and drying. […] Senile or geriatric rhinitis is distinguished by its late onset, occurring primarily in older patients. […] Gustatory rhinitis represents a nasal response to consuming specific foods (e.g., spicy foods) or liquids (e.g., alcohol). […] Drug-induced rhinitis can occur with use of various medications and illicit drugs, including antihypertensives, nonsteroidal anti-inflammatory drugs, phosphodiesterase-5 inhibitors, and cocaine.

• #40 Non-allergic rhinitis in children: Epidemiological aspects, pathological features, diagnostic methodology and clinical management

  https://www.wjgnet.com/2222-0682/full/v6/i4/200.htm

  The local production of IgE in the nasal mucosa has been largely demonstrated in patients with AR, where the allergen exposure directly drives the antibody class switch recombination. […] Poor SPT technique and/or quality of allergen preparations or a cover allergy, namely the sensitivity to not tested allergens, have been suggested to explain some cases of apparent entopy. […] Epidemiologically, LAR might affect more than 40% people diagnosed with NAR. […] Importantly, in addition to highlighting the epidemiological importance of LAR among CR, this study noticed that 36% of patients with LAR had rhinitis since childhood. […] However, such a hypothesis upon LAR as an initial stage of AR needs to be tested adequately and immune processes might differ according to allergens. […] Non IgE-mediated immune mechanisms could take place in several classified forms of NAR.

• #41 Non-allergic rhinitis in children: Epidemiological aspects, pathological features, diagnostic methodology and clinical management

  https://www.wjgnet.com/2222-0682/full/v6/i4/200.htm

  The local production of IgE in the nasal mucosa has been largely demonstrated in patients with AR, where the allergen exposure directly drives the antibody class switch recombination. […] Poor SPT technique and/or quality of allergen preparations or a cover allergy, namely the sensitivity to not tested allergens, have been suggested to explain some cases of apparent entopy. […] Epidemiologically, LAR might affect more than 40% people diagnosed with NAR. […] Importantly, in addition to highlighting the epidemiological importance of LAR among CR, this study noticed that 36% of patients with LAR had rhinitis since childhood. […] However, such a hypothesis upon LAR as an initial stage of AR needs to be tested adequately and immune processes might differ according to allergens. […] Non IgE-mediated immune mechanisms could take place in several classified forms of NAR.

• #42 Non-allergic rhinitis in children: Epidemiological aspects, pathological features, diagnostic methodology and clinical management

  https://www.wjgnet.com/2222-0682/full/v6/i4/200.htm

  The local production of IgE in the nasal mucosa has been largely demonstrated in patients with AR, where the allergen exposure directly drives the antibody class switch recombination. […] Poor SPT technique and/or quality of allergen preparations or a cover allergy, namely the sensitivity to not tested allergens, have been suggested to explain some cases of apparent entopy. […] Epidemiologically, LAR might affect more than 40% people diagnosed with NAR. […] Importantly, in addition to highlighting the epidemiological importance of LAR among CR, this study noticed that 36% of patients with LAR had rhinitis since childhood. […] However, such a hypothesis upon LAR as an initial stage of AR needs to be tested adequately and immune processes might differ according to allergens. […] Non IgE-mediated immune mechanisms could take place in several classified forms of NAR.

• #43 Non-allergic rhinitis in children: Epidemiological aspects, pathological features, diagnostic methodology and clinical management

  https://www.wjgnet.com/2222-0682/full/v6/i4/200.htm

  The local production of IgE in the nasal mucosa has been largely demonstrated in patients with AR, where the allergen exposure directly drives the antibody class switch recombination. […] Poor SPT technique and/or quality of allergen preparations or a cover allergy, namely the sensitivity to not tested allergens, have been suggested to explain some cases of apparent entopy. […] Epidemiologically, LAR might affect more than 40% people diagnosed with NAR. […] Importantly, in addition to highlighting the epidemiological importance of LAR among CR, this study noticed that 36% of patients with LAR had rhinitis since childhood. […] However, such a hypothesis upon LAR as an initial stage of AR needs to be tested adequately and immune processes might differ according to allergens. […] Non IgE-mediated immune mechanisms could take place in several classified forms of NAR.

• #44 Nonallergic Rhinitis | IntechOpen

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

  Non-allergic rhinitis (NAR) is a heterogeneous nasal disease with high global prevalence. While the specific factors contributing to the origin of NAR remain uncertain, there is indication that neurogenic factors play a significant role in the development of NAR. […] The inflammatory pathway is present in a subset of NAR individuals. A Th2 cytokine inflammatory pattern, observed in patients with Allergic Rhinitis (AR) and those with work-related allergic rhinitis triggered by high molecular weight (HMW) allergens, characterizes this subgroup. […] Nevertheless, a portion of Non-Allergic Rhinitis (NAR) patients does not exhibit an infiltration of inflammatory cells in the nasal mucosa, suggesting involvement of a neurogenic mechanism. This includes conditions such as rhinitis of the elderly, gustatory rhinitis, certain types of occupational rhinitis, certain drug-induced rhinitis, and Idiopathic Rhinitis (IR).

• #45 Non-Allergic Rhinitis | IntechOpen

  https://www.intechopen.com/chapters/74261

  Non-allergic rhinitis is a term used for situations where no allergen can be detected as the cause of rhinitis. […] The pathophysiology of nonallergic rhinitis (NAR) is heterogeneous. […] It was determined that the patients showed more neurogenic abnormalities in the pathophysiology. […] Non-Allergic rhinitis occurs due to non-IgE mediated mechanisms. Prostaglandins, leukotrienes are found in both the upper and lower airways. These cause mast cell secretion, eosinophils, after exposure to the allergen in rhinitis. Prostaglandins and leukotrienes released from mast cells cause vasodilatation and hypersecretion from the gland, leading to rhinitis symptoms. Although this mechanism is not fully active in non-allergic rhinitis, symptoms occur with a similar effect. […] Vasomotor rhinitis; It constitutes the most important part of rhinitis in the definition of non-allergic rhinitis. Its other name is known as non-allergic rhinopathy. It occurs as a result of impaired vasomotor balance in the nose.

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

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

  Autonomic stimuli have a greater effect on patients with nonallergic rhinitis than on those with allergic rhinitis. […] Autonomic imbalance favoring the parasympathetic system increases nasal blood flow, edema, and secretions, creating an overall presentation of rhinorrhea and nasal obstruction. […] Elevated concentrations of immunoglobulin G subclass 1 (IgG1) and immunoglobulin G subclass 4 (IgG4) anti-IgE autoantibodies have been found in patients with nonallergic rhinitis compared with control subjects. […] Therapy for allergic rhinitis is focused on desensitization and use of decongestants, antihistamines, and mast-cell mediators. […] A wide variety of etiologies are involved in nonallergic rhinitis. […] Therefore, treatment options should not be implemented randomly. […] It is also valuable to distinguish between allergic and nonallergic rhinitis before a treatment method is chosen.

• #47 Frontiers | Microbial characterization of the nasal cavity in patients with allergic rhinitis and non-allergic rhinitis

  https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2023.1166389/full

  Introduction: Although recent studies have shown that the human microbiome is involved in the pathogenesis of allergic diseases, the impact of microbiota on allergic rhinitis (AR) and non-allergic rhinitis (nAR) has not been elucidated. The aim of this study was to investigate the differences in the composition of the nasal flora in patients with AR and nAR and their role in the pathogenesis. […] In conclusion, patients with AR and nAR had significantly different microbiota profiles compared to healthy controls. The results suggest that the nasal microbiota may play a key role in the pathogenesis and symptoms of AR and nAR, providing us with new ideas for the treatment of AR and nAR. […] The average relative abundance of vibrio vulnificus and Acinetobacter baumanni increased significantly in the AR group.

• #48 Frontiers | Microbial characterization of the nasal cavity in patients with allergic rhinitis and non-allergic rhinitis

  https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2023.1166389/full

  Introduction: Although recent studies have shown that the human microbiome is involved in the pathogenesis of allergic diseases, the impact of microbiota on allergic rhinitis (AR) and non-allergic rhinitis (nAR) has not been elucidated. The aim of this study was to investigate the differences in the composition of the nasal flora in patients with AR and nAR and their role in the pathogenesis. […] In conclusion, patients with AR and nAR had significantly different microbiota profiles compared to healthy controls. The results suggest that the nasal microbiota may play a key role in the pathogenesis and symptoms of AR and nAR, providing us with new ideas for the treatment of AR and nAR. […] The average relative abundance of vibrio vulnificus and Acinetobacter baumanni increased significantly in the AR group.

• #49 Frontiers | Microbial characterization of the nasal cavity in patients with allergic rhinitis and non-allergic rhinitis

  https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2023.1166389/full

  Introduction: Although recent studies have shown that the human microbiome is involved in the pathogenesis of allergic diseases, the impact of microbiota on allergic rhinitis (AR) and non-allergic rhinitis (nAR) has not been elucidated. The aim of this study was to investigate the differences in the composition of the nasal flora in patients with AR and nAR and their role in the pathogenesis. […] In conclusion, patients with AR and nAR had significantly different microbiota profiles compared to healthy controls. The results suggest that the nasal microbiota may play a key role in the pathogenesis and symptoms of AR and nAR, providing us with new ideas for the treatment of AR and nAR. […] The average relative abundance of vibrio vulnificus and Acinetobacter baumanni increased significantly in the AR group.

• #50 Frontiers | Microbial characterization of the nasal cavity in patients with allergic rhinitis and non-allergic rhinitis

  https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2023.1166389/full

  According to the KEGG database, ICMT is a unique enzyme in the microbiota of AR patients. […] This suggests that we could use ICMT inhibitors to block Ras methylation and thus prevent the occurrence of AR, which will be the goal of our next investigation. […] Therefore, we believe that glycan biosynthesis and metabolism play a role in the pathogenesis of AR. […] The joint detection of microbiota based on random forest results may also provide us with new ideas for future AR and nAR diagnosis.

• #51 New insights into the pathogenesis of non-allergic rhinitis | Clinical and Translational Allergy | Full Text

  https://ctajournal.biomedcentral.com/articles/10.1186/2045-7022-5-S4-P1

  Effective treatment requires a correct diagnosis, however for different subgroups of chronic rhinitis patients differentiation on a clinical level is complicated. […] In the case of non-allergic rhinitis (NAR) that represents a wide spectrum of diseases, we are also faced with a missing mechanistic or molecular diagnosis. […] Comparing subgroups of NAR patients with healthy controls three significant differences were observed related to the activation state of genes. […] Two classes of genes were significantly up-regulated in non-allergic rhinitis. […] The first class is related to interferon (INF) signalling and the second class is related to epithelial growth factor receptor (EGFR) signalling pathway. […] Finally there was a significant difference in cold-induced RNA binding protein (CIRBP) that was activated in NAR and de-activated in healthy.

• #52 New insights into the pathogenesis of non-allergic rhinitis | Clinical and Translational Allergy | Full Text

  https://ctajournal.biomedcentral.com/articles/10.1186/2045-7022-5-S4-P1

  Effective treatment requires a correct diagnosis, however for different subgroups of chronic rhinitis patients differentiation on a clinical level is complicated. […] In the case of non-allergic rhinitis (NAR) that represents a wide spectrum of diseases, we are also faced with a missing mechanistic or molecular diagnosis. […] Comparing subgroups of NAR patients with healthy controls three significant differences were observed related to the activation state of genes. […] Two classes of genes were significantly up-regulated in non-allergic rhinitis. […] The first class is related to interferon (INF) signalling and the second class is related to epithelial growth factor receptor (EGFR) signalling pathway. […] Finally there was a significant difference in cold-induced RNA binding protein (CIRBP) that was activated in NAR and de-activated in healthy.

• #53 New insights into the pathogenesis of non-allergic rhinitis | Clinical and Translational Allergy | Full Text

  https://ctajournal.biomedcentral.com/articles/10.1186/2045-7022-5-S4-P1

  These three path could well be related as CIRBP is able to affect ERK activity downstream of EGFR resulting in increased IFN-levels. […] Assessing differences between chronic rhinitis subgroups using a completely unbiased approach has revealed a novel profile in non-allergic rhinitis. […] The increased activity of the EGFR and INF-pathways in turn might well explain the symptomatology in these patients.

• #54 New insights into the pathogenesis of non-allergic rhinitis | Clinical and Translational Allergy | Full Text

  https://ctajournal.biomedcentral.com/articles/10.1186/2045-7022-5-S4-P1

  These three path could well be related as CIRBP is able to affect ERK activity downstream of EGFR resulting in increased IFN-levels. […] Assessing differences between chronic rhinitis subgroups using a completely unbiased approach has revealed a novel profile in non-allergic rhinitis. […] The increased activity of the EGFR and INF-pathways in turn might well explain the symptomatology in these patients.

• #55 Pathogenic Mechanisms of Idiopathic Nonallergic Rhinitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3650978/

  Published evidence suggests that iNAR is a heterogenous disorder that includes (1) anatomic abnormalities requiring nasal endoscopy for diagnosis, (2) incipient, „endogenous” atopy (entopy), (3) nociceptive nerve dysfunction, and (4) autonomic dysfunction as found in chronic fatigue syndrome and other systemic „functional” syndromes. […] Hypertrophic turbinate tissue is often used as a „normal” control for studies of nasal polyps. This is inappropriate because turbinate histology depends on the patient pathology. […] The excessive secreted mucus may cause postnasal drip with throat-clearing cough or thick, tenacious anterior discharge. This condition will not respond to vasoconstrictors. The most striking changes were found in „vasomotor rhinitis” where there was a decrease in the size of glands and fibrosis of the lamina propria.

• #56 Pathogenic Mechanisms of Idiopathic Nonallergic Rhinitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3650978/

  Published evidence suggests that iNAR is a heterogenous disorder that includes (1) anatomic abnormalities requiring nasal endoscopy for diagnosis, (2) incipient, „endogenous” atopy (entopy), (3) nociceptive nerve dysfunction, and (4) autonomic dysfunction as found in chronic fatigue syndrome and other systemic „functional” syndromes. […] Hypertrophic turbinate tissue is often used as a „normal” control for studies of nasal polyps. This is inappropriate because turbinate histology depends on the patient pathology. […] The excessive secreted mucus may cause postnasal drip with throat-clearing cough or thick, tenacious anterior discharge. This condition will not respond to vasoconstrictors. The most striking changes were found in „vasomotor rhinitis” where there was a decrease in the size of glands and fibrosis of the lamina propria.

• #57 Vasomotor rhinitis – wikidoc

  https://www.wikidoc.org/index.php/Vasomotor_rhinitis

  Rhinitis can occur following exposure to nonallergic triggers, via activation of Transient Receptor Potential cation channels(TRPV1, TRPA1) on nasal mucosal nerve fibers, which result in the release of neuropetides such as Calcitonin Gene-Related Peptide (CGRP)and substance P from sensory nerve endings. […] These neuropeptides facilitate vasodilation and plasma extravasation, resulting in edema and glandular hypersecretion. […] It is important to note that the evidence for substance P involvement was extrapolated following the beneficial effect of treatment with capsaicin(known to deplete substance P from sensory nerve endings) in affected patients. […] These pathophysiologic mechanisms have not been extensively investigated. […] Subtypes of nonallergic rhinitis include: […] Vasomotor/idiopathic rhinitis – This is also sometimes referred to as nonallergic rhinopathy because there is a lack of nasal mucosal inflammation.

• #58 Vasomotor rhinitis – wikidoc

  https://www.wikidoc.org/index.php/Vasomotor_rhinitis

  Rhinitis can occur following exposure to nonallergic triggers, via activation of Transient Receptor Potential cation channels(TRPV1, TRPA1) on nasal mucosal nerve fibers, which result in the release of neuropetides such as Calcitonin Gene-Related Peptide (CGRP)and substance P from sensory nerve endings. […] These neuropeptides facilitate vasodilation and plasma extravasation, resulting in edema and glandular hypersecretion. […] It is important to note that the evidence for substance P involvement was extrapolated following the beneficial effect of treatment with capsaicin(known to deplete substance P from sensory nerve endings) in affected patients. […] These pathophysiologic mechanisms have not been extensively investigated. […] Subtypes of nonallergic rhinitis include: […] Vasomotor/idiopathic rhinitis – This is also sometimes referred to as nonallergic rhinopathy because there is a lack of nasal mucosal inflammation.

• #59 Vasomotor rhinitis – wikidoc

  https://www.wikidoc.org/index.php/Vasomotor_rhinitis

  Rhinitis can occur following exposure to nonallergic triggers, via activation of Transient Receptor Potential cation channels(TRPV1, TRPA1) on nasal mucosal nerve fibers, which result in the release of neuropetides such as Calcitonin Gene-Related Peptide (CGRP)and substance P from sensory nerve endings. […] These neuropeptides facilitate vasodilation and plasma extravasation, resulting in edema and glandular hypersecretion. […] It is important to note that the evidence for substance P involvement was extrapolated following the beneficial effect of treatment with capsaicin(known to deplete substance P from sensory nerve endings) in affected patients. […] These pathophysiologic mechanisms have not been extensively investigated. […] Subtypes of nonallergic rhinitis include: […] Vasomotor/idiopathic rhinitis – This is also sometimes referred to as nonallergic rhinopathy because there is a lack of nasal mucosal inflammation.

• #60 Nonallergic Rhinitis – Clinical Tree

  https://clinicalpub.com/nonallergic-rhinitis/

  In a subset of patients with idiopathic NAR, there is no evidence of inflammation and the nasal mucosa is similar to that of normal control subjects. […] These sensory C fibers in the nasal mucosa react to pain, changes in temperature, and environmental irritants by releasing neuropeptides, including substance P, calcitonin gene-related peptide, and neurokinins A and B. […] Another potential mechanism of NAR may implicate dysregulation of the autonomic system.

• #61 Non-allergic rhinitis in children: Epidemiological aspects, pathological features, diagnostic methodology and clinical management

  https://www.wjgnet.com/2222-0682/full/v6/i4/200.htm

  Therefore, in addition to pure immunologic mechanisms, actually a complex series of neuroendocrine pathways have been proposed to explain the pathophysiology of several forms of NAR and, in some extent, those could be involved in AR, too. […] The neural regulation of upper airways relies upon sympathetic (adrenergic) and parasympathetic (cholinergic) fibers, which regulate the activity and the trophism of epithelial, vascular and glandular components of the nasal mucosa. […] The activation of these unmyelinated sensory C-fibers leads to the release of several neuropeptides in the human nasal mucosa, through an antidromic conduction, in response to a large variety of stimuli. […] Thus, this neurogenic reactivity seems to be dominant in those forms of NAR where the cellular inflammation resulted to be poorly expressed.

• #62 Non-allergic rhinitis in children: Epidemiological aspects, pathological features, diagnostic methodology and clinical management

  https://www.wjgnet.com/2222-0682/full/v6/i4/200.htm

  Indeed, several inflammatory mediators have been demonstrated to interact with sensory nerve endings in the nasal mucosa, which resulted to release several neurotrophins, in addition to the aforementioned neuropeptides. […] The presence of eosinophils in the nasal mucosa resulted to be the most important determinant for the severity of the clinical disease. […] The other prevalent form of NAR in children resulted to be NARNE, as described above. […] A significant difference of inflammatory changes in the nasal cytology specimens was observed between people living in highly polluted urban areas and rural residents. […] Environmental pollution could exacerbate allergic inflammation and/or promote the development of new allergic sensitization at the respiratory level, especially in children, leading to mixed patterns of allergic and non allergic rhinitis in some cases.

• #63 Non-allergic rhinitis in children: Epidemiological aspects, pathological features, diagnostic methodology and clinical management

  https://www.wjgnet.com/2222-0682/full/v6/i4/200.htm

  Indeed, several inflammatory mediators have been demonstrated to interact with sensory nerve endings in the nasal mucosa, which resulted to release several neurotrophins, in addition to the aforementioned neuropeptides. […] The presence of eosinophils in the nasal mucosa resulted to be the most important determinant for the severity of the clinical disease. […] The other prevalent form of NAR in children resulted to be NARNE, as described above. […] A significant difference of inflammatory changes in the nasal cytology specimens was observed between people living in highly polluted urban areas and rural residents. […] Environmental pollution could exacerbate allergic inflammation and/or promote the development of new allergic sensitization at the respiratory level, especially in children, leading to mixed patterns of allergic and non allergic rhinitis in some cases.

• #64 Non-allergic rhinitis in children: Epidemiological aspects, pathological features, diagnostic methodology and clinical management

  https://www.wjgnet.com/2222-0682/full/v6/i4/200.htm

  Indeed, several inflammatory mediators have been demonstrated to interact with sensory nerve endings in the nasal mucosa, which resulted to release several neurotrophins, in addition to the aforementioned neuropeptides. […] The presence of eosinophils in the nasal mucosa resulted to be the most important determinant for the severity of the clinical disease. […] The other prevalent form of NAR in children resulted to be NARNE, as described above. […] A significant difference of inflammatory changes in the nasal cytology specimens was observed between people living in highly polluted urban areas and rural residents. […] Environmental pollution could exacerbate allergic inflammation and/or promote the development of new allergic sensitization at the respiratory level, especially in children, leading to mixed patterns of allergic and non allergic rhinitis in some cases.

• #65 Pathogenic Mechanisms of Idiopathic Nonallergic Rhinitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3650978/

  Idiopathic nonallergic rhinitis (iNAR) has been difficult to define because of the long differential diagnosis of rhinopathy in the absence of allergic rhinitis. iNAR has traditionally been a diagnosis of exclusion with no clear unifying pathophysiology. Increased sensitivity to triggers such has climate changes, cold air, tobacco smoke, strong odors, and perfumes have been thought to be characteristic, but recent studies do not support this hypersensitivity hypothesis. […] New investigations of the local nasal environment and systemic „functional” syndromes have offered new insights into this condition. iNAR may be a heterogenous disorder that includes (1) anatomic abnormalities requiring nasal endoscopy for diagnosis, (2) incipient, local atopy (entopy), (3) dysfunction of nociceptive nerve sensor and ion channel proteins, and (4) autonomic dysfunction as found in chronic fatigue syndrome and other functional disorders.

• #66 Non-allergic rhinitis in children: Epidemiological aspects, pathological features, diagnostic methodology and clinical management

  https://www.wjgnet.com/2222-0682/full/v6/i4/200.htm

  The possibility to unveil an overlapped rhinitis through nasal cytology might ameliorate the clinical and therapeutic management of these patients and also could have implications in the epidemiological analysis of pediatric CR and complications. […] Indeed, AR and NAR could be overlapping conditions in a greater number of cases than previously thought. […] However, in order to achieve a better correlation between cyto-pathological patterns and clinical features of CR, a systematic application of nasal cytology and further studies are needed, both in adults and children.

• #67 Non-allergic rhinitis in children: Epidemiological aspects, pathological features, diagnostic methodology and clinical management

  https://www.wjgnet.com/2222-0682/full/v6/i4/200.htm

  The possibility to unveil an overlapped rhinitis through nasal cytology might ameliorate the clinical and therapeutic management of these patients and also could have implications in the epidemiological analysis of pediatric CR and complications. […] Indeed, AR and NAR could be overlapping conditions in a greater number of cases than previously thought. […] However, in order to achieve a better correlation between cyto-pathological patterns and clinical features of CR, a systematic application of nasal cytology and further studies are needed, both in adults and children.

• #68 Non-allergic rhinitis in children: Epidemiological aspects, pathological features, diagnostic methodology and clinical management

  https://www.wjgnet.com/2222-0682/full/v6/i4/200.htm

  The possibility to unveil an overlapped rhinitis through nasal cytology might ameliorate the clinical and therapeutic management of these patients and also could have implications in the epidemiological analysis of pediatric CR and complications. […] Indeed, AR and NAR could be overlapping conditions in a greater number of cases than previously thought. […] However, in order to achieve a better correlation between cyto-pathological patterns and clinical features of CR, a systematic application of nasal cytology and further studies are needed, both in adults and children.

• #69 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 not a single disease with 1 underlying mechanism but is instead a collection of multiple distinct conditions that cause similar nasal symptoms. […] Nonallergic rhinitis denotes a group of heterogeneous syndromes with distinct underlying pathophysiologies. […] The most frequent form of NAR observed clinically is nonallergic VMR or idiopathic rhinitis, characterized by sporadic or persistent nasal symptoms that are triggered by environmental conditions, such as strong smells; exposure to cold air; changes in temperature, humidity, and barometric pressure; strong emotions; ingesting alcoholic beverages; and changes in hormone levels.

• #70 AAIR :: Allergy, Asthma & Immunology Research

  https://e-aair.org/DOIx.php?id=10.4168/aair.2011.3.3.148

  Nonallergic rhinitis (NAR) is generally described as chronic nasal symptoms, such as obstruction and rhinorrhea that occur in relation to nonallergic, noninfectious triggers such as change in the weather, exposure to caustic odors or cigarette smoke, barometric pressure differences, etc. […] The term vasomotor is often used which suggests involvement of neural, glandular, and vascular pathways; however, this term is misleading because it implies a true understanding of the underlying pathophysiology of the disease when this has not been definitively established. […] Nonallergic rhinopathy (formerly known as vasomotor rhinitis) accounts for the majority of NAR. It is a diverse group of patients that have chronic nasal symptoms with a lack of nasal eosinophilia and an etiology that is neither immunologic nor due to infection.

• #71 Chronic Nonallergic Rhinitis | AAFP

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

  Chronic nonallergic rhinitis is more common in women, with a female-to-male ratio of 2:1 to 3:1. […] Nonallergic rhinitis with nasal eosinophilia syndrome is an inflammatory type of rhinitis with increased eosinophils in the secretions and on nasal biopsy, with increased mast cells and evidence of mast cell degranulation but without positive findings on allergy testing. […] Atrophic rhinitis involves atrophy of the nasal mucosa that can lead to nasal crusting and drying. […] Senile or geriatric rhinitis is distinguished by its late onset, occurring primarily in older patients. […] Gustatory rhinitis represents a nasal response to consuming specific foods (e.g., spicy foods) or liquids (e.g., alcohol). […] Drug-induced rhinitis can occur with use of various medications and illicit drugs, including antihypertensives, nonsteroidal anti-inflammatory drugs, phosphodiesterase-5 inhibitors, and cocaine.

• #72 AAIR :: Allergy, Asthma & Immunology Research

  https://e-aair.org/DOIx.php?id=10.4168/aair.2011.3.3.148

  NAR with eosinophilia is characterized by patients who have year-round nasal symptoms but eosinophils are found on nasal smear though they lack positive skin tests and/or specific IgE antibodies in the serum. […] Atrophic rhinitis, as the name implies, refers to a chronic condition in which there is progressive atrophy of the nasal mucosa with crusting and dryness as the most prominent features. It is typically not inflammatory mediated. […] Senile rhinitis occurs most commonly in the elderly, presents mostly with watery rhinorrhea that may worsen after certain foods or environmental irritants. […] Gustatory rhinitis occurs after eating, especially hot or spicy foods. […] Rhinitis medicamentosa is included in drug-induced rhinitis, though a variety of medications have been implicated in causing chronic nasal congestion.

• #73 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 exact underlying mechanisms causing VMR are not well understood. […] There is evidence that capsaicin-sensitive nociceptors in the nasal mucosa may play a role. […] Some studies have also demonstrated that topical nasal capsaicin treatment of VMR patients can induce prolonged symptom relief. […] The epidemiologic predominance of females experiencing VMR suggests that female hormones might play some role, but there is no research explaining this possibility.

• #74 Chronic Nonallergic Rhinitis | AAFP

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

  Chronic nonallergic rhinitis is more common in women, with a female-to-male ratio of 2:1 to 3:1. […] Nonallergic rhinitis with nasal eosinophilia syndrome is an inflammatory type of rhinitis with increased eosinophils in the secretions and on nasal biopsy, with increased mast cells and evidence of mast cell degranulation but without positive findings on allergy testing. […] Atrophic rhinitis involves atrophy of the nasal mucosa that can lead to nasal crusting and drying. […] Senile or geriatric rhinitis is distinguished by its late onset, occurring primarily in older patients. […] Gustatory rhinitis represents a nasal response to consuming specific foods (e.g., spicy foods) or liquids (e.g., alcohol). […] Drug-induced rhinitis can occur with use of various medications and illicit drugs, including antihypertensives, nonsteroidal anti-inflammatory drugs, phosphodiesterase-5 inhibitors, and cocaine.

• #75 Chronic nonallergic rhinitis – UpToDate

  https://www.uptodate.com/contents/chronic-nonallergic-rhinitis

  Chronic nonallergic rhinitis (NAR) is not a specific disease but rather a syndrome diagnosed by excluding other specific types of rhinitis. The pathogenesis, incidence, clinical manifestations, diagnosis, and treatment of chronic NAR are presented in this topic review. […] Theories of pathogenesis include noninflammatory and inflammatory mechanisms.

• #76 Pathogenic Mechanisms of Idiopathic Nonallergic Rhinitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3650978/

  Idiopathic nonallergic rhinitis (iNAR) has been difficult to define because of the long differential diagnosis of rhinopathy in the absence of allergic rhinitis. iNAR has traditionally been a diagnosis of exclusion with no clear unifying pathophysiology. Increased sensitivity to triggers such has climate changes, cold air, tobacco smoke, strong odors, and perfumes have been thought to be characteristic, but recent studies do not support this hypersensitivity hypothesis. […] New investigations of the local nasal environment and systemic „functional” syndromes have offered new insights into this condition. iNAR may be a heterogenous disorder that includes (1) anatomic abnormalities requiring nasal endoscopy for diagnosis, (2) incipient, local atopy (entopy), (3) dysfunction of nociceptive nerve sensor and ion channel proteins, and (4) autonomic dysfunction as found in chronic fatigue syndrome and other functional disorders.

• #77 Nonallergic rhinitis: Common problem, chronic symptoms | MDedge

  https://ma1.mdedge.com/content/nonallergic-rhinitis-common-problem-chronic-symptoms

  Mechanisms are mostly unknown. While allergic rhinitis leads to symptoms when airborne allergens bind with specific immunoglobulin E (IgE) in the nose, the etiology of most forms of nonallergic rhinitis is unknown. However, several mechanisms have been proposed. These include entopy (local nasal IgE synthesis with negative skin tests), nocioceptive dysfunction (hyperactive sensory receptors), and autonomic nervous system abnormalities (hypoactive or hyperactive dysfunction of sympathetic or parasympathetic nerves in the nose). […] Patients for whom an allergic cause cannot be found by allergy skin testing or serum specific IgE immunoassay (Immunocap/RAST) for environmental aeroallergens are classified as having nonallergic rhinitis.

• #78 Pathogenic Mechanisms of Idiopathic Nonallergic Rhinitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3650978/

  Idiopathic nonallergic rhinitis (iNAR) has been difficult to define because of the long differential diagnosis of rhinopathy in the absence of allergic rhinitis. iNAR has traditionally been a diagnosis of exclusion with no clear unifying pathophysiology. Increased sensitivity to triggers such has climate changes, cold air, tobacco smoke, strong odors, and perfumes have been thought to be characteristic, but recent studies do not support this hypersensitivity hypothesis. […] New investigations of the local nasal environment and systemic „functional” syndromes have offered new insights into this condition. iNAR may be a heterogenous disorder that includes (1) anatomic abnormalities requiring nasal endoscopy for diagnosis, (2) incipient, local atopy (entopy), (3) dysfunction of nociceptive nerve sensor and ion channel proteins, and (4) autonomic dysfunction as found in chronic fatigue syndrome and other functional disorders.

• #79 Nonallergic rhinitis: Common problem, chronic symptoms | MDedge

  https://ma1.mdedge.com/content/nonallergic-rhinitis-common-problem-chronic-symptoms

  Mechanisms are mostly unknown. While allergic rhinitis leads to symptoms when airborne allergens bind with specific immunoglobulin E (IgE) in the nose, the etiology of most forms of nonallergic rhinitis is unknown. However, several mechanisms have been proposed. These include entopy (local nasal IgE synthesis with negative skin tests), nocioceptive dysfunction (hyperactive sensory receptors), and autonomic nervous system abnormalities (hypoactive or hyperactive dysfunction of sympathetic or parasympathetic nerves in the nose). […] Patients for whom an allergic cause cannot be found by allergy skin testing or serum specific IgE immunoassay (Immunocap/RAST) for environmental aeroallergens are classified as having nonallergic rhinitis.

• #80 Chronic Nonallergic Rhinitis | AAFP

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

  Intranasal corticosteroids are first-line therapy for nonallergic rhinitis. […] Subgroups of patients with nonallergic rhinitis may not respond to intranasal corticosteroids, such as those with symptoms triggered predominantly by weather and temperature changes. […] Intranasal antihistamines are effective for nonallergic rhinitis, likely because of their actions as anti-inflammatory and neuroinflammatory blockers. […] Although there is more evidence for using intranasal corticosteroids combined with intranasal antihistamines to treat allergic rhinitis, this combination is also beneficial in patients with nonallergic rhinitis whose symptoms are not adequately controlled with either therapy alone. […] Intranasal ipratropium has been proven effective in decreasing rhinorrhea and is a reasonable monotherapy for patients who have rhinorrhea as a predominant symptom.

• #81 Chronic Nonallergic Rhinitis | AAFP

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

  Intranasal corticosteroids are first-line therapy for nonallergic rhinitis. […] Subgroups of patients with nonallergic rhinitis may not respond to intranasal corticosteroids, such as those with symptoms triggered predominantly by weather and temperature changes. […] Intranasal antihistamines are effective for nonallergic rhinitis, likely because of their actions as anti-inflammatory and neuroinflammatory blockers. […] Although there is more evidence for using intranasal corticosteroids combined with intranasal antihistamines to treat allergic rhinitis, this combination is also beneficial in patients with nonallergic rhinitis whose symptoms are not adequately controlled with either therapy alone. […] Intranasal ipratropium has been proven effective in decreasing rhinorrhea and is a reasonable monotherapy for patients who have rhinorrhea as a predominant symptom.

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

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

  Autonomic stimuli have a greater effect on patients with nonallergic rhinitis than on those with allergic rhinitis. […] Autonomic imbalance favoring the parasympathetic system increases nasal blood flow, edema, and secretions, creating an overall presentation of rhinorrhea and nasal obstruction. […] Elevated concentrations of immunoglobulin G subclass 1 (IgG1) and immunoglobulin G subclass 4 (IgG4) anti-IgE autoantibodies have been found in patients with nonallergic rhinitis compared with control subjects. […] Therapy for allergic rhinitis is focused on desensitization and use of decongestants, antihistamines, and mast-cell mediators. […] A wide variety of etiologies are involved in nonallergic rhinitis. […] Therefore, treatment options should not be implemented randomly. […] It is also valuable to distinguish between allergic and nonallergic rhinitis before a treatment method is chosen.

• #83

  https://link.springer.com/article/10.1007/s11882-016-0638-1

  In the experience of the author of this paper, capsaicin is not effective in rhinitis of the elderly or in NAR caused by smoking. […] New drugs targeting TRPV1 are developed and may offer the potential to control medical conditions characterized by sensory neuronal hyper-responsiveness, including the nasal hyper-reactivity that underlies NAR.

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