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Rhinitis, Nonallergic

para>Topical/intranasal corticosteroids are regarded as safe during pregnancy. ‚

Second Line

  • Oral decongestants are effective in relieving congestion (2)[A].
  • Usage is limited by side effects (insomnia, irritability, hypertension, palpitations).
  • Topical decongestants are effective for short-term treatment but should not be used for daily treatment due to the risk of rebound congestion (rhinitis medicamentosa) (2)[B].

ALERT

OTC cough and cold preparations should be avoided in children <6 years of age.

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ISSUES FOR REFERRAL

  • Consider referral to an allergist/immunologist if symptoms are complicated by an uncontrolled allergic component.
  • Consider referral to an otolaryngologist if symptoms are complicated by a structural process.
  • Treatment failure considered after at least 6 to 12 months of medical management before surgical options considered. Many surgical techniques show no long-term benefits but carry potential risks (e.g., persistent pain).

ADDITIONAL THERAPIES

High-volume, low-pressure nasal saline rinse (such as a squeeze bottle) is effective for relief of NAR symptoms: Irrigant solution should be properly sterilized before use (2)[A],(6)[B]. ‚

COMPLEMENTARY & ALTERNATIVE MEDICINE

Intranasal capsaicin BID has shown to be effective in reducing congestion, sinus pressure and pain, and headache in one small randomized controlled study (2)[A],(7)[B]. A 2015 Cochrane review noted that capsaicin appears to have beneficial effects on overall nasal symptoms up to 36 weeks after treatment based on a few, small studies (8)[C]. ‚

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Follow-up plan should be based on the individual 's response to treatment. Usually will be a chronic condition that will require daily long-term treatment. ‚

DIET

  • Avoidance of foods that exacerbate the symptoms
  • Avoidance of alcohol

PATIENT EDUCATION

  • Education on trigger avoidance
  • Emphasis on medication compliance on daily basis

PROGNOSIS

Prognosis is good with continued adherence to treatment regimen and trigger avoidance. ‚

REFERENCES

11 Rond ƒ ³n ‚ C, Campo ‚ P, Togias ‚ A, et al. Local allergic rhinitis: concept, pathophysiology, and management. J Allergy Clin Immunol. 2012;129(6):1460 " “1467.22 Lieberman ‚ P, Pattanaik ‚ D. Nonallergic rhinitis. Curr Allergy Asthma Rep. 2014;14(6):439.33 Meltzer ‚ EO. The role of nasal corticosteroids in the treatment of rhinitis. Immunol Allergy Clin North Am. 2011;31(3):545 " “560.44 Kalpaklioglu ‚ AF, Kavut ‚ AB. Comparison of azelastine versus triamcinolone nasal spray in allergic and nonallergic rhinitis. Am J Rhinol Allergy. 2010;24(1):29 " “33.55 Lieberman ‚ P, Meltzer ‚ EO, LaForce ‚ CF, et al. Two-week comparison study of olopatadine hydrochloride nasal spray 0.6% versus azelastine hydrochloride nasal spray 0.1% in patients with vasomotor rhinitis. Allergy Asthma Proc. 2011;32(2):151 " “158.66 Dunn ‚ JD, Dion ‚ GR, McMains ‚ KC. Efficacy of nasal irrigations and nebulizations for nasal symptom relief. Curr Opin Otolaryngol Head Neck Surg. 2013;21(3):248 " “251.77 Bernstein ‚ JA, Davis ‚ BP, Picard ‚ JK, et al. A randomized, double-blind, parallel trial comparing capsaicin nasal spray with placebo in subjects with a significant component of nonallergic rhinitis. Ann Allergy Asthma Immunol. 2011;107(2):171 " “178.88 Gevorgyan ‚ A, Segboer ‚ C, Gorissen ‚ R, et al. Capsaicin for non-allergic rhinitis. Cochrane Database Syst Rev. 2015;(7):CD010591.

ADDITIONAL READING

  • Jacobs ‚ R, Lieberman ‚ P, Kent ‚ E, et al. Weather/temperature-sensitive vasomotor rhinitis may be refractory to intranasal corticosteroid treatment. Allergy Asthma Proc. 2009;30(2):120 " “127.
  • Kaliner ‚ MA, Baraniuk ‚ JN, Benninger ‚ MS, et al. Consensus description of inclusion and exclusion criteria for clinical studies on nonallergic rhinopathy (NAR), previously referred to as vasomotor rhinitis (VMR), nonallergic rhinitis, and/or idiopathic rhinitis. World Allergy Organ J. 2009;2(8):180 " “184.
  • Schroer ‚ B, Pien ‚ LC. Nonallergic rhinitis: common problem, chronic symptoms. Cleve Clin J Med. 2012;79(4):285 " “293.
  • Wallace ‚ DV, Dykewicz ‚ MS, Bernstein ‚ DI, et al. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol. 2008;122(2)(Suppl):S1 " “S84.

CODES

ICD10

  • J31.0 Chronic rhinitis
  • J00 Acute nasopharyngitis [common cold]
  • J30.0 Vasomotor rhinitis

ICD9

  • 472.0 Chronic rhinitis
  • 460 Acute nasopharyngitis [common cold]

SNOMED

  • non-allergic rhinitis (disorder)
  • Common cold (disorder)
  • Vasomotor rhinitis (disorder)
  • rhinitis medicamentosa (disorder)
  • Irritant rhinitis (disorder)

CLINICAL PEARLS

  • NAR shares many symptoms with allergic rhinitis but is not mediated by the IgE pathway systemically.
  • NAR and allergic rhinitis may coexist (mixed rhinitis).
  • Topical treatment with intranasal steroids, intranasal antihistamines, intranasal anticholinergics, and nasal saline irrigation are effective in controlling NAR symptoms.
  • Trigger avoidance is a key component of NAR treatment.
  • Compliance to treatment key for continued symptomatic relief