xRead - Nonallergic Rhinitis (September 2025)

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BAROODY ET AL

J ALLERGY CLIN IMMUNOL PRACT JUNE 2024

TAKE AWAYS Nonallergic rhinopathy is present in up to 80% of patients with chronic nonallergic rhinitis syndromes. It is readily diag nosed by asking about family history, age of onset, seasonality, triggers including cold dry air, smoke, volatile compounds, fra grances, and bleach, which form part of the Cincinnati IIS. A TRPV1 overexpression in the trigeminal sensory system appears to be a key component of NAR. Histamine works via TRPV1 to release neuropeptides to cause many of the symptoms of allergy. A TRPV1 activation is a cardinal mechanistic pathway involved in both AR and NAR. Once diagnosis of NAR is made and an AR component is ruled out, medical treatment involves anticholinergics, INAH, INCS, intranasal capsaicin, and saline irrigation. Patients who do not respond well to medical therapy can be approached with surgical treatment to shrink the turbinates or interrupt some of the causative neural pathways. REFERENCES 1. Greiwe J, Bernstein JA. Nonallergic rhinitis: diagnosis. Immunol Allergy Clin North Am 2016;36:289-303. 2. Kaliner MA. Classi fi cation of nonallergic rhinitis syndromes with a focus on vasomotor rhinitis, proposed to be known henceforth as nonallergic rhinopathy. World Allergy Organ J 2009;2:98-101. 3. Kaliner MA, Baraniuk JN, Benninger M, Bernstein JA, Lieberman P, Meltzer EO, et al. Consensus de fi nition of nonallergic rhinopathy, previously referred to as vasomotor rhinitis, nonallergic rhinitis, and/or idiopathic rhinitis. World Allergy Organ J 2009;2:119-20. 4. Kaliner MA, Baraniuk JN, Benninger MS, Bernstein JA, Lieberman P, Meltzer EO, et al. Consensus description of inclusion and exclusion criteria for clinical studies of nonallergic rhinopathy (NAR), previously referred to as vasomotor rhinitis (VMR), nonallergic rhinitis, and/or idiopathic rhinitis. World Allergy Organ J 2009;2:180-4. 5. Kaliner MA, Farrar JR. Consensus Review and de fi nition of nonallergic rhinitis with a focus on vasomotor rhinitis, proposed to be known henceforth as nonal lergic rhinopathy part 1. Introduction. World Allergy Organ J 2009;2:97. 6. Kaliner MA, Farrar JR. Consensus review and de fi nition of nonallergic rhinitis with a focus on vasomotor rhinitis, proposed to be known henceforth as nonallergic rhinopathy: introduction to part 2. World Allergy Organ J 2009;2:155. 7. Bernstein JA, Levin LS, Al-Shuik E, Martin VT. Clinical characteristics of chronic rhinitis patients with high vs low irritant trigger burdens. Ann Allergy Asthma Immunol 2012;109:173-8. 8. Greiwe JC, Bernstein JA. Allergic and mixed rhinitis: diagnosis and natural evolution. J Clin Med 2019;8:2019. 9. Bernstein JA. Characterizing rhinitis subtypes. Am J Rhinol Allergy 2013;27: 457-60. 10. Dykewicz MS, Wallace DV, Amrol DJ, Baroody FM, Bernstein JA, Craig TJ, et al. Rhinitis 2020: a practice parameter update. J Allergy Clin Immunol 2020; 146:721-67. 11. Settipane RA, Kaliner MA. Chapter 14: nonallergic rhinitis. Am J Rhinol Al lergy 2013;27:48-51. 12. Segboer C, Gevorgyan A, Avdeeva K, Chusakul S, Kanjanaumporn J, Aeumjaturapat S, et al. Intranasal corticosteroids for non-allergic rhinitis. Cochrane Database Syst Rev 2019;11:CD010592. 13. Jacobs RL, Freedman PM, Boswell RN. Nonallergic rhinitis with eosinophilia (NARES syndrome). Clinical and immunologic presentation. J Allergy Clin Immunol 1981;67:253-62. 14. Rondon C, Campo P, Galindo L, Blanca-Lopez N, Cassinello MS, Rodriguez Bada JL, et al. Prevalence and clinical relevance of local allergic rhinitis. Al lergy 2012;67:1282-8. 15. Brandt D, Bernstein JA. Questionnaire evaluation and risk factor identi fi cation for nonallergic vasomotor rhinitis. Ann Allergy Asthma Immunol 2006;96:526-32. 16. Settipane RA. Epidemiology of vasomotor rhinitis. World Allergy Organ J 2009;2:115-8. 17. Settipane RA, Charnock DR. Epidemiology of rhinitis: allergic and nonallergic. Clin Allergy Immunol 2007;19:23-34. 18. Bachert C, van Cauwenberge P, Olbrecht J, van Schoor J. Prevalence, classi fi cation and perception of allergic and nonallergic rhinitis in Belgium. Allergy 2006;61:693-8.

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