Facts and Fictions about Non‐allergic Rhinitis

Abstract

Program Description: Background: AAAAI set up a working group for non-allergic rhinitis (NAR) 2 years ago to describe established facts about NAR with the purpose of identifying gaps in our knowledge based on a comprehensive review of existing literature. Dr Toskala is a member of this working group and most of the review data is now available. Methods: A literature search spanning the years 1960-2010 was performed and articles relevant to NAR were assigned into 7 categories. Information from each article was extracted into category-specific databases. Descriptive analyses were conducted. Results: A total of 2000 articles were reviewed out of which 40% were deemed relevant for data extraction. Reviews were excluded. The majority of articles described prospective, controlled studies. Very few articles offered epidemiologic information. The lack of universal terminology and of NAR phenotyping using objective criteria were the most striking knowledge gaps. Pathophysiology research covered areas of nasal hyperreactivity and autonomic nerve dysfunction, but the evidence was inconclusive. The presence of mucosal inflammation may identify distinct NAR syndromes such as local allergy with local IgE production in the absence of systemic sensitization. Medical management studies suggest that intranasal steroids and topical antihistamines are useful in some patients with NAR, but the responder phenotype is unclear. In patients with excessive rhinorrhea, anticholinergic treatment is effective. The use of capsaicin is supported by one randomized, placebo-controlled trial. Few combination trials were found. Many surgical procedures were reviewed, but there are no randomized controlled trials comparing medical versus surgical treatments. Educational Objectives: 1) Recognize, diagnosed and treat patients with NAR according to the evidence-based data. 2) Give a comprehensive review of published data about NAR with classification of the evidence. 3) Identify the gaps in our knowledge about NAR.