Nonallergic rhinitis converts to allergic rhinitis over time

Once allergy has been ruled out, most patients with nonallergic rhinitis (NAR) are not followed up in allergy clinics, despite the persistence of rhinitis symptoms.

A sample of 180 patients diagnosed with NAR during 2000-2004 was re-evaluated in 2007 by using:

- questionnaires
- spirometry
- skin prick testing
- specific IgE to common aeroallergens

Patients with NAR experienced worsening disease (52%), with an increase in the persistence (12%) and severity of nasal symptoms (9%) and new comorbidities (24%) over time.

The most frequent comorbidities at the re-evaluation were asthma (increasing from 32% to 55%) and conjunctivitis (from 28% to 43%), followed by chronic rhinosinusitis.

Sensitization to aeroallergens not present at the initial evolution was detected by means of skin prick testing, serum specific IgE measurement, or both in 24% of the patients.

The authors concluded that rhinitis associated with asthma, conjunctivitis, and sensitization to aeroallergens is likely to appear at a later date in adults initially given diagnoses of NAR.

A periodic allergy re-evaluation of patients with NAR might be necessary.



Treatment Options for Allergic Rhinitis (click to enlarge the image).

References:

Evolution of patients with nonallergic rhinitis supports conversion to allergic rhinitis. Rondón C, Doña I, Torres MJ, Campo P, Blanca M. J Allergy Clin Immunol. 2009 Apr 9.
Allergic and Non-Allergic Rhinitis Guidelines Updated
Allergic Rhinitis
Allergic Rhinitis and Conjunctivitis
Japanese guideline for allergic rhinitis: An evidence-based step-by-step strategy for treatment is described. Allergol Int. 2011 Mar;60(2):171-89.
Nonallergic rhinitis, CCJM 2012 review.
Image source: Illustration for "Aquiline or Roman Nose", Wikipedia, GNU Free Documentation License.