NON ALLERGIC RHINITIS

Babak Saedi

Assistant Professor Of Tehran University

Imam Khomainey hospital

Introduction nearly 2.5 percent of the

$47 billion annual direct cost for respiratory treatment in the United States.

50% are diagnosed with a form of NAR, and the rest are diagnosed with allergic rhinitis (AR).

Introduction

Rhinitis, in which the classification by etiology may be allergic or nonallergic, is a disorder characterized by inflammation of the mucous membranes lining the nasal passages.

In many instances, AR and NAR are often indistinguishable and coexist.

Non allergic rhinitis Nonallergic rhinitis is

characterized by sporadic or persistent perennial nasal symptoms that do not result from IgE mediated immunopathologic events.

The symptoms can be similar to allergic rhinitis, but with a less prominent nasal itch and conjunctival irritation.

The incidence increase by age

Review article \\ No studies were

found that specifically sought to differentiate between allergic and nonallergic rhinitis on the basis of clinical symptoms, signs on physical examination, or the presence or absence of co morbid conditions.

No diagnostic test has been specifically developed to diagnose nonallergic rhinitis

Given the absence of studies to differentiate nonallergic rhinitis, diagnostic testing rather than symptoms or signs is necessary to differentiate isolated vasomotor or nonallergic rhinitis from allergic rhinitis.

patient will complain of rhinorrhea, nasal congestion, and sneezing despite a negative allergic history, skin testing, and nasal cytology.

CLASSES OF RHINITIS Nonallergic rhinitis with

eosinophilia Hormone-related disorders Hypothyroidism Acromegaly Puberty Pregnancy Postmenopausal Irritant Temperature Barometric changes Gustatory Chemical exposure Animal proteins Wheat Latex

Perfumes Exhaust fumes Pesticides Cleaning agents Room deodorizers Floral fragrances Cosmetics Irritant Air pollution Ozone Tobacco smoke Paint fumes Atrophic rhinitis Cocaine abuse Surgery Aging Associated systemic disorders Idiopathic or vasomotor

MEDICATIONS CONTRIBUTING TO RHINITIS

Cocaine Topical nasal decongestants AIpha-adrenoceptor antagonists Reserpine Hydralazine Angiotensin-converting enzyme inhibitors Beta-blockers Methyldopa Guanethidine Phentolamine Oral contraceptives Nonsteroidal antiinflammatory medications Aspirin Psychotropic agents Thioridazine Chlordiazepoxide Chlorpromazine Amitriptyline Perphenazine Alprazolam

Diagnosis in NAR

Diagnosis of NAR is based on thorough history, complete head and neck examination, and diagnostic tests

Examination includes nasal endoscopy.

Nasal cytology(lack of inflammation→NAR)

treatment

Environmental control

Physical treatment

treatment

Antihistamines : symptomatic relief a nasal topical product –azelastine (an H1 antihistamine) –

for the treatment of vasomotor rhinitis.Intranasal corticosteroids : recommended for long-

term therapy in nonallergic rhinitis Sympathomimetics : symptomatic Anticholinergic: ipratropium in reducing nose blowing and

rhinorrhea Cromoglycate: improvement in symptoms

COMMONLY PRESCRIBED ANTIHISTAMINES

First generation Diphenhydramine Clemastine Chlorpheniramine

Second generation Acrivastine Loratadine

Third generation Fexofenadine Cetirizine

Topical Azelastine

Topical steroid

Beclomethasone→ Narrow margin of safety

Budesonide

Fluticasone→ NARES

Mometasone

Surgical treatment

Anatomical correction

FESS

Vidin neurectomy