Nonallergic Vasomotor Rhinitis

Abstract

Chronic rhinitis is a difficult condition to diagnose and treat leading to miserable patients with frequent healthcare utilization and poor quality of life. A major barrier to proper treatment hinges on establishing the correct diagnosis. Therefore, appropriately characterizing chronic rhinitis subtypes is an essential first step toward symptomatic improvement. Classically, chronic rhinitis is divided into three main clinical phenotypes: allergic rhinitis (AR), infectious rhinitis, and nonallergic rhinitis (NAR). A number of NAR conditions will be discussed in different contexts throughout this book, but the most common form of NAR is nonallergic vasomotor rhinitis (NAVMR), which is the focus of this chapter. Unlike AR, which requires symptoms on exposure to a sensitizing aeroallergen confirmed by skin prick testing and/or serum-specific IgE, there are no conclusive tests available for the diagnosis of NAVMR. Instead NAVMR is a diagnosis of exclusion based on patients being nonatopic, with symptoms developing later in life, no seasonality or trouble around furry pets, no family history of allergies, and often symptoms in response to odorant and irritant triggers. Despite appropriate avoidance measures, medication administration technique, and adherence, NAVMR can be very challenging to treat because pathomechanisms are still poorly characterized, limiting the availability of therapies that target specific biologic pathways. The real-world cases presented in this chapter provide a comprehensive approach to working up a patient with NAVMR using evidence-based methodologies in an attempt to optimize care while limiting wasteful testing.