Mechanism
1. Autonomic Dysfunction
2. Increased blood supply to nasal mucosa
Epidemiology
1. More common in women
2. Perennial onset
Types
1. Runners (wet): Rhinorrhea predominates
2. Dry: Nasal obstruction, airway resistance predominates
Symptoms
1. Characteristics
  1. Nasal obstruction and congestion
  2. Rhinorrhea
  3. Pruritus and sneezing may occur
2. Provocative
  1. Odors (e.g. perfumes, Tobacco smoke)
  2. Alcohol
  3. Spicy food
  4. Humidity
  5. Temperature extremes (e.g. cold)
  6. Sunlight
  7. Gustatory Rhinitis (seen in older patients)
  8. Antihypertensive use
Signs
1. Normal nose exam
Diagnosis
1. Normal serum IgE
2. Normal RAST testing or Allergy Testing
Differential Diagnosis
Management
1. Avoid suspected triggers
2. Nasal obstruction predominant
  1. Step 1: Intranasal Steroid
  2. Step 2: Intranasal Antihistamine (Azelastine)
3. Rhinorrhea predominant
  1. Step 1: Intranasal Atrovent 0.03% two sprays bid-qid
  2. Step 2: Intranasal Intal
  3. Step 3: Intranasal Antihistamine (Azelastine)
4. Rhinorrhea, sneezing and post-nasal drainage
  1. Step 1: Intranasal Antihistamine (Azelastine)
  2. Step 2: Intranasal Intal
  3. Step 3: Intranasal Steroid
Management: Specific Cohorts
1. Pregnancy
  1. Step 1: Nasal Saline
  2. Step 2: Intranasal Atrovent (Pregnancy Category B)
2. Older patients
  1. Intranasal Atrovent
3. Children
  1. Age over 2 years
    1. Congestion: Intranasal Steroid limited to Nasonex
    2. Sneezing: Intranasal Intal
  2. Age over 6 years
    1. Rhinorrhea: Intranasal Atrovent
    2. Congestion: Intranasal Steroid
    3. Sneezing: Intranasal Intal
References
1. Settipane (2001) Ann Allergy {a 12185} Immunol 86:494
2. Wheeler (2005) Am Fam Physician 72(6):1057

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 8/14/2009. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.