Rhinitis Treatment Care

Rhinitis is an inflammation of the mucous membranes of the nose and can be triggered by a reaction to an allergen, a non-allergic irritant, or both. 70% of patients with non-allergic rhinitis present after the age of 20 and often there is no evidence of a familial pattern. There is also a strong female predominance in non-allergic rhinitis not seen in allergic rhinitis.

Patients who suffer from perennial non-allergic rhinitis (PNAR) have nasal symptoms caused by things such as strong smells and irritants. It may be difficult to distinguish from seasonal allergic rhinitis (or “hay fever,” caused by outdoor allergens like pollens) and perennial allergic rhinitis (caused by year-round indoor allergens like dust and pet dander), making it challenging to diagnose and manage. Adding to the confusion is that many people have both PNAR and allergic rhinitis.

Chronic sinusitis also causes a variety of nasal symptoms, which must be distinguished from rhinitis in order to treat sinusitis appropriately. Most symptoms of rhinitis involve the anterior aspects of the nose while sinusitis tends to cause posterior symptoms. As the sinus cavities become inflamed, chemical mediators similar to those seen in allergic rhinitis are released leading to rhinitic symptoms. The multitude of other non-allergic rhinitis triggers tend to either cause mucosal vascular engorgement, lead to damage of the nasal mucosa, or act to initiate inflammatory cascades.

Causes of Perennial Non-allergic Rhinitis

Patients with non-allergic rhinitis almost always complain of perennial symptoms. While triggers of allergic rhinitis are aeroallergens, the list of non-allergic rhinitis triggers is broad. It includes :

1. strong smells and irritants
2. changes in weather
3. barometric pressure
4. hormonal fluctuations
5. ingestion of alcohol or food (gustatory).

Symptoms of Perennial Non-allergic Rhinitis

The signs and symptoms of PNAR to watch for include:

1. Onset and progression of nasal congestion
2. Runny nose
3. post-nasal drip without itching

There are also subtle differences on physical examination. Classically, the nasal mucosa in allergic rhinitis is edematous, boggy and often with a blue-white hue. The nasal examination in non-allergic rhinitis is more variable depending on the underlying cause of the disorder. Nasal mucosa may appear essentially normal with increased clear watery secretions or may be erythematous or even atrophic.