NONALLERGIC RHINITIS

NONALLERGIC RHINITIS
Vasomotor Rhinitis
Vasomotor rhinitis can be the primary cause of chronic nasal congestion, rhinorrhea or, less commonly, sneezing paroxysms. About one-fifth of patients who seek medical attention at an allergy/immunology subspecialty clinic complaining of chronic rhinitis will actually have nonallergic, vasomotor rhinitis; one-third of patients in whom allergic rhinitis is diagnosed will also have a vasomotor component to the disease. Nonspecific nasal hyperreactivity leads to symptoms triggered by cold temperature, inhaled irritants, strong odors, spicy food, and other nonallergic environmental stimuli. Intranasal corticosteroids (eg, fluticasone), azelastine, and ipratropium, and oral decongestants may be effective as monotherapy or in combination.
Nasal Polyposis
Compared with the general population, nasal polyps are not found more frequently in patients with allergic rhinitis, but they are associated with aspirin sensitivity syndrome, chronic sinusitis, allergic fungal sinusitis, Churg-Strauss syndrome, and cystic fibrosis. Benign inflammatory outgrowths of nasosinus mucosa, nasal polyps (see photograph) can lead to nasal airway obstruction, hyposmia, and chronic sinusitis. Compared with placebo, topical corticosteroids have been shown to improve polyposis, but the response rate to topical agents alone is commonly inadequate and treatment with systemic corticosteroids is usually required. Since concomitant chronic sinusitis is almost always present, cotreatment with appropriate antibiotics is usually recommended. Some cases will require surgical intervention, and regardless of the treatment, recurrence is a frequent complication.