Non-allergic rhinitis: diagnosis and management.
Patients in the rhinitis clinic with negative skin prick tests present a challenge. Non-allergic rhinitis consists of a variety of conditions including infection, hormonal changes, drugs and autonomic dysfunction. There is also a range of systemic disorders to be considered. The pathogeneses of many of these are less well understood than that of allergic rhinitis, diagnosis and treatment pathways are also more complex. A detailed accurate history needs to be taken followed by relevant investigations which may include allergen challenge, because skin prick and RAST-negative allergic rhinitis is now recognised. Nitric oxide levels may prove helpful: elevated levels suggest inflammation, very low levels indicate the possibility of primary ciliary dyskinesia or cystic fibrosis. Treatment is of the underlying cause when found: for those without obvious pathology a trial of combined therapy with topical corticosteroids plus antihistamine or plus anti-cholinergic may be worth while. A complex inter-relationship between allergic and infectious rhinitis is becoming apparent.
Scadding
G K
GK
Clinical Immunology and Rhinology, Royal National Throat, Nose and Ear Hospital, London, UK. g.scadding@ucl.ac.uk
D004342:Drug Hypersensitivity / Q000150:complications; D004802:Eosinophilia / Q000209:etiology; D005512:Food Hypersensitivity / Q000150:complications; D006801:Humans; D007239:Infections / Q000150:complications; D012220:Rhinitis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy