Non-allergic rhinitis (NAR) occurs in absence endonasal infection and sensitization to inhalant allergens

A significant number of patients suffering from persistent rhinitis are defined as non-allergic non-infectious rhinitis (NANIR) patients, often denominated in short as having non-allergic rhinitis (NAR).

NAR is defined as a symptomatic inflammation of the nasal mucosa with the presence of minimal 2 nasal symptoms like nasal obstruction, rhinorrhoea, sneezing, and/or itchy nose, without clinical evidence of endonasal infection and without systemic signs of sensitization to inhalant allergens (i.e., no allergy).

Symptoms of NAR may have a wide range of severity, and be either continuously present and/or induced by exposure to unspecific triggers, also called nasal hyperresponsiveness (NHR). NHR represents a clinical feature of both AR and NAR patients.

NAR involves different subgroups:

- drug-induced rhinitis
- (non-allergic) occupational rhinitis
- hormonal rhinitis (including pregnancy rhinitis)
- gustatory rhinitis
- senile rhinitis
- idiopathic rhinitis (IR)

NAR should be distinguished from those rhinitis patients with an allergic reaction confined to the nasal mucosa, also called ‘entopy’ or local allergic rhinitis (LAR).


Non‐Allergic Rhinitis: Position paper of the European Academy of Allergology and Clinical Immunology

Japanese guidelines for allergic diseases 2017 - free, open access funded by Japanese Society of Allergology

The Japanese Society of Allergology offers a set of review articles in the journal Allergology International (AI) Vol. 66, Issue 2, covering the Japanese Guidelines for Allergic Diseases 2017. This issue will be of great help to both clinical and basic investigators working in this field:

Japanese guidelines for adult asthma 2017

Japanese guidelines for childhood asthma 2017

Japanese guidelines for allergic rhinitis 2017

Japanese guidelines for allergic conjunctival diseases 2017

Japanese guidelines for atopic dermatitis 2017

Japanese guidelines for food allergy 2017

Japanese guidelines for occupational allergic diseases 2017


Japanese guidelines for allergic diseases 2017 - free, open access funded by Japanese Society of Allergology

Chronic urticaria -- “Agony of Hives” -- is the focus of World Allergy Week 2017 (2-8 April)

Understanding Chronic Urticaria Is the Focus of World Allergy Week 2017: World Allergy Organization says there is hope for the “Agony of Hives”.

From World Allergy Organization (WAO) press release (Milwaukee, WI. March 9, 2017):

WAO, together with its member societies around the world, will host World Allergy Week from April 2-8, 2017. The theme and educational focus will be: The Agony of Hives – What to do when hives and swelling will not go away.

Chronic urticaria is defined as episodic or daily hives lasting for at least six weeks and impairing quality of life. To date there is no cure for the disease and suffering can last several years. “Too many people with chronic urticaria give up hope when the symptoms don’t go away,” said Paul Greenberger, MD, of Northwestern University in Chicago. “But there is hope for controlling chronic urticaria with the aid of the allergist.”

During World Allergy Week 2017 experts will provide information to physicians and the general public about the importance of the role of the allergist in diagnosing and managing the disease. “There are multiple options available for treating chronic urticaria,” said Mario Sánchez Borges, MD, of Centro Médico Docente – La Trinidad, in Caracas, Venezuela, and President of the World Allergy Organization. “Allergists have the necessary expertise in the diagnosis and treatment of chronic urticaria including knowledge about medication options. They also are able to teach patients about the condition, which is important in improving quality of life.”

Up to 1.8% of the population currently has chronic urticaria. More research on the global prevalence of the disease is needed. World Allergy Week 2017 organizers plan to draw attention to this and other future needs regarding chronic urticaria.

“The World Allergy Organization has 97 member societies around the world and many of them will participate along with us in World Allergy Week 2017,” said Dr Sánchez Borges. “They will hold workshops for physicians, patient education events and other activities that will help to increase awareness of the disease itself and share information about how to get relief from symptoms that can often seem unbearable.”

Recently, a highly effective biologic therapy (anti-IgE therapy) has become available for chronic urticaria. Experts will discuss the disease and approaches to patient care during a webinar to be held on April 4.

For more information about World Allergy Week 2017 and chronic urticaria, visit: To find a member society of the World Allergy Organization in your country or region, visit:

Urticaria (hives): what is the cause? (click to enlarge the image).

Chronic Urticaria Treatment Options in 6 Steps (click to enlarge the image). En Español.

Laboratory Diagnosis of Chronic Urticaria (click to enlarge the image).

Anti-FceR1 autoantibodies in chronic autoimmune urticaria: IgG against FceRI (receptor for IgE) (click to enlarge the image).


Greenberger PA. Chronic urticaria: new management options. World Allergy Organ J. 2014; 7:31

Kocatürk E, Maurer M, Metz M, Grattan C. Looking forward to new targeted treatments for chronic spontaneous urticaria. Clin Transl Allergy 2017, 7:1.

Maurer M, Church MK, Goncalo M, Sussman G, Sanchez Borges M. Management and treatment of chronic urticaria. J Eur Acad Dermatol Venereol. 2015; 29(Suppl3): 16-32.

Maurer M, Rosén K, Hsieh HJ, Saini S, Grattan C et al. Omalizumab for the treatment of chronic idiopathic or spontaneous urticaria. N Engl J Med. 2013 Mar 7;368(10):924-35

Sanchez Borges M, Asero R, Ansotegui IJ, Baiardini I, Bernstein JA et al. Diagnosis and treatment of urticaria and angioedema, a worldwide perspective. World Allergy Organ J. 2012; 5:125

Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z et al. The EAACI/GA²LEN/EDF/WAO Guideline for the definition, classification, diagnosis and management of Urticaria. The 2013 revision and update. Allergy 2014:69; 868-887

Image source: Urticaria, Wikipedia, public domain.

Should you stop steroid eye drops before a skin patch test for contact dermatitis?

No, is the simple answer.

Avoid using test sites to which topical glucocorticoids, antihistamines, immunosuppressants, or immunomodulators are applied. The use of topical steroids or immunosuppressants at or near potential test sites should be avoided from at least one week prior to patch testing through the conclusion of patch testing.

Oral steroids may cause false-negative results of patch testing.

The effect of concomitant systemic antihistamine administration on the performance of patch testing is
unknown. The current recommendation from AAAAI is not stop oral antihistamines.

Topical steroids, antihistamines and other immunosuppressants (e.g., tacrolimus) may be used on non-test areas, but should be avoided on potential patch test areas prior to and during testing.

Simple instructions: Preparing for the Test

- Your skin should be clear for 2 weeks before the test if possible.
- Avoid exposing your back to the sun for 1 week before the testing.
- Stop these medicines for 1 week before your appointment: topical steroids to the back

- Stop these medicines for 3-5 days before the test: Oral corticosteroids and Non-steroid anti-inflammatories (NSAIDs)

- Do not apply any ointments, creams or lotions to the back 4 hours before the appointment.

Contact Dermatitis - An Approach to Treatment (click to enlarge the image).


T.R.U.E. TEST Quick Reference Guide
Allergy Patch Skin Testing

AAAAI Tweetup! Meet the allergists who are updating Twitter with the latest allergy news from the #AAAAI17 meeting

Here is the list of the allergists who are planning to use Twitter to post updates from the #AAAAI17 meeting. The list is open for edit, please feel free to add your own info. It shows the availability of the allergists by date and if they are planning to attend the Tweetup (a meeting of people who use Twitter or are following the tweets). If interested in a real life meeting Tweetup during the #AAAAI17, sign up in the spreadsheet above. This will be the Sixth Annual Tweetup during AAAAI! We started in 2012.

Here is the Tweetup info - come meet us for a chat at:

#AAAAI17 Tweetup
Saturday, March 4, 2017: 2:30 PM-3:30 PM
Atlanta Marriott Marquis, Atrium Level, Room A702

This is a free, informal event, no ticket required. Suggested topics: how to tweet? why to tweet? who to follow? research projects using social media, Twitter for patient education, etc.

The Tweetup will be hosted by Dr. Matthew Bowdish @MatthewBowdish and Dr. Alexei Gonzalez @docalergias

The hashtag for the meeting is #AAAAI17

The hashtag for the 2017 annual meeting of the American Academy of Allergy, Asthma and Immunology (AAAAI) is #AAAAI17

Type #AAAAI17 in Twitter Search box to find all recent updates from  #AAAAI17

You can also find info about the #AAAAI6 hashtag on the website of Symplur:

How to use Twitter to post updates from #AAAAI17 meeting

See examples of best practice by @MatthewBowdish and @DrAnneEllis posted here: (tweets were summarized in a series of blog posts by me). For example, the tweets from 2012 AAAAI meeting reached more than 250,000 people.

I would strongly encourage you to post updates on Twitter from the CME conferences that you are planning to attend in the future. Here is how to do it: Twitter for Physicians: How to use Twitter to keep track of the latest news and scientific meetings, and share information with colleagues and patients.

WAO TV Social Media Guide for Allergists

Here is WAO TV Social Media Guide for Allergists:

Dr Stukus: How to use Twitter to engage patients

Dr Bowdish: Best practices for Twitter use by allergists

Dr Bowdish: How to use Twitter during a scientific conference: AAAAI, ACAAI, etc.

Dr Ramirez: How allergists can use Facebook for patient education


The impact of social media on a major international emergency medicine conference -- Neill et al. -- Emergency Medicine Journal

PLOS ONE: Tweeting the Meeting: An In-Depth Analysis of Twitter Activity at Kidney Week 2011

Tweeting the Meeting: Investigating Twitter Activity At the 2012 AAAAI Conference - Disclaimer: I am one of the authors.

How to share up to 4 photos in a single Tweet - Great for conference posters - see example

How to Make the Most of A National Scientific Conference
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