Non-allergic rhinitis: a case report and review
Cyrus H Nozad, L Madison Michael, D Betty Lew, Christie F Michael
Abstract
Rhinitis is characterized by rhinorrhea, sneezing, nasal congestion, nasal itch and/or postnasal drip. Often the first step in arriving at a diagnosis is to exclude or diagnose sensitivity to inhalant allergens. Non-allergic rhinitis (NAR) comprises multiple distinct conditions that may even co-exist with allergic rhinitis (AR). They may differ in their presentation and treatment. As well, the pathogenesis of NAR is not clearly elucidated and likely varied. There are many conditions that can have similar presentations to NAR or AR, including nasal polyps, anatomical/mechanical factors, autoimmune diseases, metabolic conditions, genetic conditions and immunodeficiency.
Rhinitis is characterized by rhinorrhea, sneezing, nasal congestion, nasal itch and/or postnasal drip. Often the first step in arriving at a diagnosis is to exclude or diagnose sensitivity to inhalant allergens. Non-allergic rhinitis (NAR) comprises multiple distinct conditions that may even co-exist with allergic rhinitis (AR). They may differ in their presentation and treatment. As well, the pathogenesis of NAR is not clearly elucidated and likely varied. There are many conditions that can have similar presentations to NAR or AR, including nasal polyps, anatomical/mechanical factors, autoimmune diseases, metabolic conditions, genetic conditions and immunodeficiency.
Here we present a case of a rare condition initially diagnosed and treated as typical allergic rhinitis vs. vasomotor rhinitis, but found to be something much more serious. This case illustrates the importance of maintaining an appropriate differential diagnosis for a complaint routinely seen as mundane. The case presentation is followed by a review of the potential causes and pathogenesis of NAR.
Introduction
The term rhinitis can be used to describe many distinct entities with varying pathogeneses, despite similar presentations. Generally, rhinitis is considered allergic if significant inhalant allergy is diagnosed and is considered non-allergic when symptomatology is perennial or periodic and not IgE mediated. Thus non-allergic rhinitis (NAR) comprises a mixed bag of conditions ranging from vasomotor rhinitis (VMR) to hormonally induced rhinitis.
Overall, rhinitis results in significant cost to the world population. In 2002, the direct and indirect costs for allergic rhinitis (AR) were estimated to be $7.3 billion and $4.28 billion, respectively. Given that an estimated 1 in 3 patients with rhinitis are diagnosed with NAR, with 19 million people in the United States alone, it is reasonable to conclude that NAR also results in a significant economic burden.
NAR is a condition primarily seen in adulthood with 70% of cases developing after the age of 20. There is a greater prevalence among females compared to males, and the overall prevalence of NAR in industrialized countries has ranged from 20-40%. The following case presentation is an example of a patient with typical NAR symptoms who fits the epidemiological profile, but who presented atypically, failed to respond to standard therapy and was subsequently found to have a much more serious underlying condition.
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Introduction
The term rhinitis can be used to describe many distinct entities with varying pathogeneses, despite similar presentations. Generally, rhinitis is considered allergic if significant inhalant allergy is diagnosed and is considered non-allergic when symptomatology is perennial or periodic and not IgE mediated. Thus non-allergic rhinitis (NAR) comprises a mixed bag of conditions ranging from vasomotor rhinitis (VMR) to hormonally induced rhinitis.
Overall, rhinitis results in significant cost to the world population. In 2002, the direct and indirect costs for allergic rhinitis (AR) were estimated to be $7.3 billion and $4.28 billion, respectively. Given that an estimated 1 in 3 patients with rhinitis are diagnosed with NAR, with 19 million people in the United States alone, it is reasonable to conclude that NAR also results in a significant economic burden.
NAR is a condition primarily seen in adulthood with 70% of cases developing after the age of 20. There is a greater prevalence among females compared to males, and the overall prevalence of NAR in industrialized countries has ranged from 20-40%. The following case presentation is an example of a patient with typical NAR symptoms who fits the epidemiological profile, but who presented atypically, failed to respond to standard therapy and was subsequently found to have a much more serious underlying condition.
DOWNLOAD COMPLETE PDF HERE
information very useful .. rhinitis is a dangerous disease if the let continuously in our bodies, when exposed to rhinitis symptoms check with your doctor immediately ..