Materiały źródłowe

• #1 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 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 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.

• #2 Nonallergic Rhinitis – Clinical Tree

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

  Nonallergic rhinitis (NAR) is a chronic, highly prevalent condition that presents with symptoms of nasal congestion, obstruction, and rhinorrhea in the setting of a negative allergen test. […] The pathophysiology of NAR is a non-IgE-mediated inflammatory process resulting from dysregulation of neurogenic and autonomic responses. […] Despite the prevalence of NAR, its pathophysiology has not been well elucidated and is complex as well as multifactorial. […] Several of the suggested mechanisms of action associated with idiopathic NAR include non-IgE-mediated inflammatory responses, increased permeability of nasal epithelium, noninflammatory rhinopathy with nociceptive dysfunction, and dysregulation of neurogenic responses. […] The role of inflammation in NAR is controversial. […] 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. […] Another potential mechanism of NAR may implicate dysregulation of the autonomic system.

• #2 Vasomotor Rhinitis – StatPearls – NCBI Bookshelf

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

  Acetylcholine is the primary parasympathetic neurotransmitter that regulates mucus secretion and rhinorrhea. […] 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. The deep petrosal contains sympathetic fibers. The greater superficial petrosal nerve contains preganglionic parasympathetic secretomotor fibers for the lacrimal, palatine, and nasal mucus glands, as well as the nerves responsible for vasodilating the vessels of the nasal mucosa.

• #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. Chronic nonallergic rhinitis was previously referred to as nonallergic vasomotor or vasomotor rhinitis, but it was renamed because of a lack of evidence showing a vascular origin. 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 Pathogenic Mechanisms of Idiopathic Nonallergic Rhinitis

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

  The collection of sensor proteins on a neuron may be in constant flux depending on the conditions of inhaled air, desensitization, inflammation, and neurotrophins. […] 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. […] Peripheral sensitization leads to increased stimulation of the type C spinothalamic projection neurons. Easier transmission of pain impulses from type C neurons through these secondary neurons to cortical centers accounts for hyperalgesia. […] Dysfunction of the spinothalamic projection neurons may also have detrimental effects on the reticular and other brain stem systems leading to autonomic dysfunction and thalamic dysregulation of visceral and other sensory input. […] The influence of cold, dry air on airway functions is important for iNAR. Dose-dependent nasal airflow obstruction follows inhalation of cold, dry air only in nonallergic rhinitis. […] This suggests a hyperresponsiveness of the cold-sensing neural afferents.

• #4 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.

• #4 Rhinitis, Cold Air-Induced | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816428/all/Rhinitis__Cold_Air_Induced

  Cold airinduced rhinitis is a form of nonallergic rhinitis. […] Exact mechanism of cold airinduced rhinitis pathophysiology is uncertain. TRP ion channels appear to be involved. […] Mechanism of action is through activation of mast cell and sensory nerve stimulation, which generates a cholinergic secretory response. […] Activation of mast cells causes release of inflammatory mediators, which take part in mediating nasal congestion. […] Blocking mast cell products with antihistamine does not alter clinical response to cold air. […] Symptoms may reflect activation of a compensating mechanism to restore mucosal hemostasis.

• #5 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. […] The pathogenesis is unclear although neurosensory abnormalities have been suggested. […] The nasal mucosa of patients with vasomotor rhinitis is indistinguishable from those of normal subjects. […] Vasomotor rhinitis is a chronic nasal condition usually without eosinophia. […] The pathology of vasomotor rhinitis is in fact not very well-understood and more research is needed.

• #5 Non-Allergic Rhinitis | IntechOpen

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

  It occurs as a result of impaired vasomotor balance in the nose. […] 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.

• #6 Chronic Nonallergic Rhinitis | AAFP

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

  It also represents a group of heterogeneous syndromes with common underlying clinical characteristics such as nasal congestion and rhinorrhea, but without nasal, pharyngeal, or ocular itching; sneezing; pulmonary symptoms; eczema; or nasal polyps. […] 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.

• #7 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).

• #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. […] Nasal corticosteroids are also useful in patients with NARES, as evidence suggests that they inhibit inactivation of eosinophils and the resultant cascade leading to inflammation. […] A study by Kirtsreesakul et al, however, found that although patients with nonallergic rhinitis experienced improvement from nasal steroid therapy, it was to a lesser extent than in patients with allergic rhinitis.

• #9 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.

• #10 Rhinitis, Nonallergic | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816536/all/Rhinitis__Nonallergic

  Nonallergic rhinitis (NAR) is a syndrome composed of relapsing and remitting nasal congestion, rhinorrhea, postnasal drainage, and/or sneezing. […] Inflammatory form is associated with increased eosinophils, mast cells, or inflammatory markers. […] Noninflammatory form may be caused by abnormality in the autonomic nervous system. […] Exact mechanism is poorly understood. […] Proposed models include mucosal hyperresponsiveness and autonomic dysregulation leading to increasing glandular secretions and mucosal vasodilation. […] Localized IgE production in nasal mucosa is detected in some studies despite negative serum IgE, making it responsive to similar treatments used in allergic rhinitis. […] Underlying triggers include the following: Alterations in physical environment including barometric pressure and temperature, Inhaled chemical triggers such as perfumes, cigarette smoke, and cleaning products, Medications (rhinitis medicamentosa), especially overuse of OTC decongestant nasal sprays that leads to rebound nasal congestion and medication dependence, Hormonal changes (i.e., rhinitis of pregnancy, hypothyroidism, acromegaly, etc.), Laryngopharyngeal reflux can cause postnasal irritation and increased mucus production, Food, especially hot or spicy (gustatory rhinitis), Atrophy from age-related changes, Emotion related, Idiopathic.

• #11 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 NAR consensus panel of World Allergy Organization (WAO) edited a similar classification, excluding automatically both anatomical/mechanical nose abnormalities and CRS. […] Therefore, rather than trying to find some correspondences of the aforementioned categories of NAR in the pediatric population, it seems to be more useful to discuss some specific aspects of NAR, such as the emerging evidence on local allergic rhinitis (LAR), the growing interest on nasal cytology for the possibility of defining the features of NAR inflammation and the pathogenic role of some noxious agents for the nose, such as environmental pollutants. […] By definition, AR and LAR are sustained by an IgE-mediated inflammation and are mainly associated to a Th2 immune response. […] However, among seasonal and perennial forms of AR, nasal cytology evidenced different features of the inflammatory infiltrate into the nasal mucosa, which suggested some substantial differences in the pathophysiological immune cascade anyway.

• #12 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 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.

• #13 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.

• #14 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.

• #15 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.

• #16 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. […] The pathogenesis of NAR is not clearly elucidated and likely varied. […] The mechanisms underlying VMR are poorly understood. Generally it is thought to arise from an imbalance of autonomic input into the nasal mucosa. An initial stimulus results in nasal congestion and/or rhinorrhea induced by tachykinins from the central nervous system, which also inhibit sympathetic mediators and thus further enhance the parasympathetic response. […] Tai and Baraniuk suggested that sensory C-fiber stimulation leads to release of substance P (SP) and calcitonin gene-related peptides (CGRP). This in turn leads to increased plasma excretion and glandular secretion (via acetylcholine and muscarinic receptors) manifesting as pain and stuffiness.

• #17 Chronic Nonallergic Rhinitis | AAFP

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

  Currently, fluticasone propionate and beclomethasone are the only intranasal corticosteroids approved by the U.S. Food and Drug Administration (FDA) for the treatment of nonallergic rhinitis, although studies suggest other intranasal corticosteroids, including flunisolide, are effective for perennial rhinitis. […] 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, particularly those with gustatory nonallergic rhinitis or weather-induced nonallergic rhinitis.

• #18 Vasomotor Rhinitis – StatPearls – NCBI Bookshelf

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

  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.

• #19 Chronic Nonallergic Rhinitis | AAFP

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

  However, it is now recognized that patients who experience characteristic nasal symptoms in response to defined triggers have a nonallergic component either as the sole diagnosis or as part of a mixed rhinitis (i.e., in patients with positive allergy test findings). […] Treatment is symptom-driven, and patients should be advised to avoid any identifiable triggers when possible. […] Because allergic rhinitis and nonallergic rhinitis are both initially treated with intranasal corticosteroids, it may not be necessary to distinguish between the two diagnoses before initiating treatment in most patients. […] 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.

• #20 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.

• #21 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

  A series of non IgE-mediate immune responses are plausible, considering the heterogeneity of NAR, as evidenced by the nasal cytology and by the clinical observation. […] Moreover, in addition to immune-mediated mechanisms, several evidences showed that some neurogenic responses seem to play a fundamental role in the development of NAR inflammation and, probably, are involved in AR, too. […] Non IgE-mediated immune mechanisms could take place in several classified forms of NAR. […] Thus, this neurogenic reactivity seems to be dominant in those forms of NAR where the cellular inflammation resulted to be poorly expressed. […] 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.

• #22 Nonallergic Rhinitis | IntechOpen

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

  Non-allergic rhinitis (NAR) is a heterogeneous nasal disease with high global prevalence. […] 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. […] 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. […] Specialized epithelial chemosensors known as solitary chemosensory cells in the nasal cavity react to irritants via the canonical taste transduction cascade, activating peptidergic trigeminal nociceptive (pain) nerve fibers. […] Recent findings indicate an upregulation of the nociceptive TRPV1-SP signaling pathway in individuals with IR.

• #23 Prevalence, comorbidities, diagnosis, and treatment of nonallergic rhinitis: real-world comparison with allergic rhinitis

  https://www.e-cep.org/journal/view.php?number=20125555352

  Rhinitis is among the most common respiratory diseases in children. Nonallergic rhinitis, which involves nasal symptoms without evidence of systemic allergic inflammation or infection, is a heterogeneous entity with diverse manifestations and intensities. Nonallergic rhinitis accounts for 16%89% of the chronic rhinitis cases, affecting 1%50% (median 10%) of the total pediatric population. The clinical course of nonallergic rhinitis is generally rather mild and less likely to be associated with allergic comorbidities than allergic rhinitis. […] Nonallergic rhinitis is a diagnosis of exclusion that is characterized by signs and/or symptoms similar to allergic rhinitis (e.g., rhinorrhea, nasal obstruction, nasal itching, and sneezing after allergen exposure). After the exclusion of allergic rhinitis based on the identification of allergen sensitizations, nonallergic rhinitis is suspected and efforts are made to identify associated conditions like sinusitis or adenoid hypertrophy. […] Management of nonallergic rhinitis is essential due to its persistent and usually lifelong course. However, the treatment strategy of nonallergic rhinitis remains imprecise since its pathogenesis is poorly understood.

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