Abstract
Chronic rhinitis (CR) is divided into two main categories: allergic rhinitis (AR) and nonallergic rhinitis (NAR). These conditions are more recognizable to an experienced clinician, as they can be more clearly demarcated diagnostically. However, an additional 30% to 50% of patients with CR might have an overlap of NAR and AR, referred to as mixed rhinitis (MR). Progress in elucidating the pathophysiologic mechanisms behind MR and NAR has been made in the past several years, and there are now several guidelines published to assist the clinician in accurately diagnosing AR, NAR, and MR. Clinical history and subjective symptoms can provide clues for differentiating AR from MR and NAR, but allergy testing is recommended to confirm these conditions. Progress in accurately diagnosing patients with CR will be made as studies incorporate subjective (i.e., validated questionnaires such as the irritant index questionnaire (IIQ), medication responsiveness, and quality-of-life tools) and objective (i.e., nasal cytologic testing, nasal provocation, and biomarkers) methods characterizing rhinitis subtypes.
Highlights
Chronic rhinitis (CR) is an often-trivialized condition that is frequently poorly characterized, resulting in an incorrect diagnosis and subsequent treatment recommendations
Whereas confirmation of allergic rhinitis (AR) requires positive skin-prick or serologic specific immunoglobulin E (sIgE) testing that correlates with symptoms after exposure to the sensitizing aeroallergen, a diagnosis of nonallergic rhinitis (NAR) is made after negative skin-prick or serum sIgE testing to aeroallergens
Rondón et al estimates that local AR affects 25.7% of the rhinitis population and more than 47% of patients previously diagnosed with NAR, but these numbers have not been consistently confirmed by other investigators [24,31]
Summary
Chronic rhinitis (CR) is an often-trivialized condition that is frequently poorly characterized, resulting in an incorrect diagnosis and subsequent treatment recommendations. CR is divided into two main categories: allergic rhinitis (AR) and nonallergic rhinitis (NAR) [2] These conditions are more recognizable to an experienced clinician as they can be more clearly demarcated diagnostically. An additional 30% to 50% of patients with CR might have an overlap of NAR and AR referred to as MR (mixed rhinitis) that can be more challenging to diagnose [3]. This condition is often referred to as “the more difficult form or allergic rhinitis to treat”. Drug-induced rhinitis (Topical nasal decongestants, oral contraceptives, nonsteroidal anti-inflammatory drugs, antihypertensive medications, β-blockers) Infectious rhinitis
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