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Immunology and Allergy Clinics of North America
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DOI: 10.1016/s0889-8561(05)70149-1
  • Biology
  • Medicine


Patients with chronic rhinitis frequently ask, “Isn't everybody allergic?”, and physicians tend to label all patients with chronic rhinitis as allergic. However, epidemiologic studies indicate that 15% to 20% of individuals are atopic, and yet the prevalence of chronic rhinitis is much higher, with nearly 40% of individuals having some rhinitis symptoms. 22,49 This difference suggests that approximately 50% of patients with chronic rhinitis are not allergic 8 , and studies of patients from allergy and otolaryngology clinics demonstrate that 28% to 60% of patients with chronic rhinitis are skin test negative. 35,38,42,56 Patients with nonallergic rhinitis comprise a heterogeneous group with variable presentations. Similar to patients with allergic rhinitis, these individuals often have nasal obstruction, increased secretions, and sneezing. Patients, however, tend to present at an older age, have less pruritus—either nasal or ocular—and have symptoms that are perennial or sporadic without clear seasonality and are exacerbated by nonspecific triggers. Often these patients complain of sinus headaches and postnasal drip. Because the repertoire of nasal symptoms is limited, it may be difficult by clinical criteria to differentiate between allergic rhinitis and nonallergic rhinitis, let alone to differentiate the nonallergic rhinitis syndromes into subsets. For this reason, ancillary testing may be necessary. The focus of this article is to discuss the primary nonallergic rhinitis syndromes (Box 1). The categories of nonallergic rhinitis are based on a descriptive nomenclature rather than specific causation and, as such, may be subject to future modifications. For practical purposes, it is worth separating chronic nonallergic rhinitis into subgroups because there are differences in presentation, physical examination, laboratory findings, and most importantly, treatment response. Box 1 Classification of Chronic Rhinitis Allergic Rhinitis Seasonal Perennial Nonallergic Rhinitis Primary Nonallergic, noneosinophilic rhinitis (vasomotor rhinitis) Nonallergic, eosinophilic rhinitis (NARES) Without polyps With polyps Atrophic rhinitis (ozena) Secondary Hormonal Pregnancy Hypothroidism Acromegaly Drug-Induced Oral Agents Estrogen Antihypertensives Phenothiazines Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) Topical Agents α-Adrenergic (rhinitis medicamentosa) Cocaine Granulomatous Sarcoidosis Wegener's granulomatosis Midline granuloma Relapsing polychondritis Rhinoscleromatosis

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