Review Article
Current Approaches to Diagnosis and Management of Rhinitis
Abstract
Rhinitis affects >20% of the population and is a common reason patients visit their primary care physician. Proper therapeutic intervention initially requires differentiating rhinitis from acute and chronic rhinosinusitis. After establishing rhinitis as the etiology of a patient’s symptoms, a careful, thoughtful history and physical examination aids the cause. Rhinitis can be allergic, nonallergic, or mixed (having features of both allergic and nonallergic rhinitis). Therapeutic interventions vary, depending on the etiology of rhinitis. Symptoms that are refractory to avoidance and pharmacotherapy warrant referral to an allergist or otolaryngologist for consideration of immunotherapy or surgical intervention. In many cases, adhering to an evidence-based therapeutic treatment algorithm will allow physicians to effectively manage rhinitis.This content is limited to qualifying members.
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References
1. Settipane RA, Charnock DR. Epidemiology of rhinitis: allergic and nonallergic. Clin Allergy Immunol. 2007; 19: 23–34.
2. Settipane RA. Rhinitis: a dose of epidemiological reality. Allergy Asthma Proc. 2003; 24: 147–154.
3. Ozdoganoglu T, Songu M, Inancli HM. Quality of life in allergic rhinitis. Ther Adv Respir Dis. 2012; 6: 25–39.
4. Georgitis JW. Prevalence and differential diagnosis of chronic rhinitis. Curr Allergy Asthma Rep. 2001; 1: 202–206.
5. Compalati E, Ridolo E, Passalacqua G, et al. The link between allergic rhinitis and asthma: the United Airways disease. Expert Rev Clin Immunol. 2010; 6: 413–423.
6. Ker J, Hartert TV. The atopic march: what’s the evidence? Ann Allergy Asthma Immunol. 2009; 103: 282–289.
7. Zheng T, Yu J, Oh MH, et al. The atopic march: progression from atopic dermatitis to allergic rhinitis and asthma. Allergy Asthma Immunol Res. 2011; 3: 67–73.
8. Parham P . The Immune System. 3rd ed. New York: Garland Science; 2005; .
9. Baraniuk JN. Pathogenesis of allergic rhinitis. J Allergy Clin Immunol. 1997; 99: S763–S772.
10. Bush RK. Does allergen avoidance work? Immunol Allergy Clin North Am. 2011; 31: 493–507.
11. Nurmatov U, van Schayck CP, Hurwitz B, et al. House dust mite avoidance measures for perennial allergic rhinitis: an updated Cochrane systematic review. Allergy. 2012; 67: 158–165.
12. O’Meara TJ, Sercombe JK, Morgan G, et al. The reduction of rhinitis symptoms by nasal filters during natural exposure to ragweed and grass pollen. Allergy. 2005; 60: 529–532.
13. Taivainen AI, Tukiainen HO, Terho EO, et al. Powered dust respirator helmets in the prevention of occupational asthma among farmers. Scand J Work Environ Health. 1998; 24: 503–507.
14. Garavello W, Somigliana E, Acaia B, et al. Nasal lavage in pregnant women with seasonal allergic rhinitis: a randomized study. Int Arch Allergy Immunol. 2010; 151: 137–141.
15. Navarro A, Valero A, Rosales MJ, et al. Clinical use of oral antihistamines and intranasal corticosteroids in patients with allergic rhinitis. J Investig Allergol Clin Immunol. 2011; 21: 363–369.
16. Nayak A, Langdon RB. Montelukast in the treatment of allergic rhinitis: an evidence-based review. Drugs. 2007; 67: 887–901.
17. Horak F, Zieglmayer UP. Azelastine nasal spray for the treatment of allergic and nonallergic rhinitis. Expert Rev Clin Immunol. 2009; 5: 659–669.
18. Georgy MS, Saltoun CA. Chapter 3: Allergen immunotherapy: definition, indication, and reactions. Allergy Asthma Proc. 2012; 33: S9–S11.
19. Koshkareva YA, Krouse JH. Immunotherapy—traditional. Otolaryngol Clin North Am. 2011; 44: 741–752.
20. Lin SY, Leatherman B. Sublingual immunotherapy. Otolaryngol Clin North Am. 2011; 44: 753–764.
21. Radulovic S, Wilson D, Calderon M, et al. Systematic reviews of sublingual immunotherapy (SLIT). Allergy. 2011; 66: 740–752.
22. Calderon MA, Eichel A, Makatsori M, et al. Comparability of subcutaneous and sublingual immunotherapy outcomes in allergic rhinitis clinical trials. Curr Opin Allergy Clin Immunol. 2012; 12: 249–256.
23. Bahceciler NN, Cobanoglu N. Subcutaneous versus sublingual immunotherapy for allergic rhinitis and/or asthma. Immunotherapy. 2011; 3: 747–756.
24. Chhabra N, Houser SM. The surgical management of allergic rhinitis. Otolaryngol Clin North Am. 2011; 44: 779–795.
25. Kim YH, Kim BJ, Bang KH, et al. Septoplasty improves life quality related to allergy in patients with septal deviation and allergic rhinitis. Otolaryngol Head Neck Surg. 2011; 145: 910–914.
26. Chhabra N, Houser SM. Surgical options for the allergic rhinitis patient. Curr Opin Otolaryngol Head Neck Surg. 2012; 20: 199–204.
27. Gunhan K, Unlu H, Yuceturk AV, et al. Intranasal steroids or radiofrequency turbinoplasty in persistent allergic rhinitis: effects on quality of life and objective parameters. Eur Arch Otorhinolaryngol. 2011; 268: 845–850.
28. Conner BL, Georgitis JW. Practical diagnosis and treatment of allergic and nonallergic rhinitis. Prim Care. 1987; 14: 457–473.
29. Wilson KF, Spector ME, Orlandi RR. Types of rhinitis. Otolaryngol Clin North Am. 2011; 44: 549–559.
30. Barton RT. Vasomotor rhinitis of pregnancy. West J Surg Obstet Gynecol. 1958; 66: 347–348.
31. Gani F, Braida A, Lombardi C, et al. Rhinitis in pregnancy. Eur Ann Allergy Clin Immunol. 2003; 35: 306–313.
32. Garay R. Mechanisms of vasomotor rhinitis. Allergy. 2004; 59: 4–10.
33. Varghese M, Glaum MC, Lockey RF. Drug-induced rhinitis. Clin Exp Allergy. 2010; 40: 381–384.
34. Seftel AD. Phosphodiesterase type 5 inhibitor differentiation based on selectivity, pharmacokinetic, and efficacy profiles. Clin Cardiol. 2004; 27: I14–I19.
35. O’Hollaren MT, Porter GA. Angiotensin converting enzyme inhibitors and the allergist. Ann Allergy. 1990; 64: 503–506.
36. Ramey JT, Bailen E, Lockey RF. Rhinitis medicamentosa. J Investig Allergol Clin Immunol. 2006; 16: 148–155.
37. Lekas MD. Rhinitis during pregnancy and rhinitis medicamentosa. Otolaryngol Head Neck Surg. 1992; 107: 845–849.
38. Togias A, Naclerio RM. Cold air-induced rhinitis. Clin Allergy Immunol. 2007; 19: 267–281.
39. Wilfong ER, Dey RD. The release of nerve growth factor from the nasal mucosa following toluene diisocyanate. J Toxicol Environ Health A. 2005; 68: 1337–1348.
40. Waibel KH, Chang C. Prevalence and food avoidance behaviors for gustatory rhinitis. Ann Allergy Asthma Immunol. 2008; 100: 200–205.
41. Peden DB. Effect of pollutants in rhinitis. Curr Allergy Asthma Rep. 2001; 1: 242–246.
42. Jovancevic L, Georgalas C, Savovic S, et al. Gustatory rhinitis. Rhinology. 2010; 48: 7–10.
43. Alves A, Martins C, Delgado L, et al. Exercise-induced rhinitis in competitive swimmers. Am J Rhinol Allergy. 2010; 24: e114–e117.
44. Gelardi M, Ventura MT, Fiorella R, et al. Allergic and non-allergic rhinitis in swimmers: clinical and cytological aspects. Br J Sports Med. 2012; 46: 54–58.
45. Cingi C, Ozdoganoglu T, Songu M. Nasal obstruction as a drug side effect. Ther Adv Respir Dis. 2011; 5: 175–182.
46. Ellis AK, Keith PK. Nonallergic rhinitis with eosinophilia syndrome and related disorders. Clin Allergy Immunol. 2007; 19: 87–100.
47. Khalid AN, Mace JC, Smith TL. Outcomes of sinus surgery in ambulatory patients with immune dysfunction. Am J Rhinol Allergy. 2010; 24: 230–233.
48. Choi JH, Ahn IS, Lee HB, et al. A case of Churg-Strauss syndrome. Ann Dermatol. 2009; 21: 213–216.
49. Dutt SN, Kameswaran M. The aetiology and management of atrophic rhinitis. J Laryngol Otol. 2005; 119: 843–852.
50. deShazo RD, Stringer SP. Atrophic rhinosinusitis: progress toward explanation of an unsolved medical mystery. Curr Opin Allergy Clin Immunol. 2011; 11: 1–7.
51. Lieberman P. Treatment update: nonallergic rhinitis. Allergy Asthma Proc. 2001; 22: 199–202.
