Rhinitis

Last updated May 3, 2022

Key Points

Key Points

  • Rhinitis is classified as allergic or nonallergic, but not all types of rhinitis can be easily separated into one of these categories (eg, occupational rhinitis has been classified separately from allergic and nonallergic because it may have components of both) (refer to Table 1).1
  • Conditions that mimic symptoms of rhinitis include nasal polyps, cerebrospinal fluid rhinorrhea, ciliary dyskinesia syndrome, and structural/mechanical factors that include1:
    • Cleft palate
    • Foreign bodies
    • Deviated septum/septal wall anomalies
    • Pharyngonasal reflux
    • Nasal tumors
    • Adenoidal hypertrophy
    • Trauma
    • Choanal atresia
    • Acromegaly (excess growth hormone)
  • Rhinitis is characterized ≥ 1 of the following nasal symptoms1:
    • Congestion
    • Rhinorrhea (anterior and posterior)
    • Sneezing
    • Itching
  • Rhinitis is usually associated with inflammation, but some forms of rhinitis such as vasomotor rhinitis or atrophic rhinitis are not predominantly inflammatory.1
  • Rhinitis frequently is accompanied by symptoms involving the eyes, ears, and throat.1
  • Rhinitis is a significant cause of widespread morbidity, medical treatment costs, reduced work productivity, and lost school days.1
  • Although sometimes mistakenly viewed as a trivial disease, symptoms of allergic and nonallergic rhinitis may significantly affect a patient’s quality of life and can be associated with conditions such as fatigue, headache, cognitive impairment, and sleep disturbance.1
  • Appropriate management of rhinitis may be an important component in effective management of coexisting or complicating respiratory conditions, such as asthma, sinusitis, and sleep apnea.1
  • The financial burden to society for allergic rhinitis is substantial and results from both direct costs and indirect costs (including loss of productivity).1
  • Allergic rhinitis affects between 10% and 30% of all adults and as many as 40% of children.1
    • In most studies, the ratio of allergic to pure nonallergic rhinitis is 3:1.1
    • Preliminary data suggest that 44% to 87% of patients with rhinitis may have mixed rhinitis, a combination of allergic and nonallergic rhinitis.1

Classification and Differential Diagnosis

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Physical Examination

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Rhinitis Management Algorithm

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Pharmacologic Therapy

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Action Plan

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