Chronic Non-Allergic Rhinitis (NAR) is a group of rhinitis symptoms without allergic or infectious causes.  NAR affects at least 23 percent of rhinitis cases in the United States and impacts an estimated 20 to 30 million patients.  A negative result on allergy testing is one unifying characteristic of chronic non-allergic rhinitis.  Clinically, non-allergic triggers include weather changes, tobacco smoke, automotive emission fumes, and irritants such as chemicals with strong odors.  Patients suffering from NAR typically experience nasal congestion and rhinorrhea, but do not suffer from sneezing, itchy, watery eyes and eczema.  It is more common in women, with a female-to-male ratio of approximately 2.5 to 1.  Additionally, NAR usually affects people older than 35 years of age with no family history of allergy.

Occupational rhinitis is a result of occupational exposure to a range of irritants, such as latex, flour, chemicals, and fine particles.  Symptoms typically worsen throughout the work week and improve with time away from work.

Non-Allergic Rhinitis with Nasal Eosinophilia Syndrome is an inflammatory type of rhinitis with increased eosinophils evident in nasal secretions and on nasal biopsy.  This unique non-allergic rhinitis responds well to intranasal corticosteroid treatment.

Atrophic rhinitis is characterized by late-onset symptoms along with nasal crusting and drying.  Geriatric rhinitis is also marked by late onset, occurring in older patients.  It presents as watery rhinorrhea that worsens upon exposure to patient-identified triggers, including foods, odors, or environmental irritants.

Gustatory rhinitis is a runny nose that occurs upon eating certain foods. Drug-induced rhinitis can occur with the use of various medications, such as anti-hypertensives, NSAIDs, phosphodiesterase-5 inhibitors, cocaine, and topical decongestants.  Hormonal rhinitis refers to the onset of nasal congestion and rhinorrhea associated with female hormones during the pregnancy.

Treatment is symptom-driven and patients should avoid identifiable triggers when possible.  NAR is not a histamine-mediated disease, so patients usually have poor responses to corticosteroid nasal sprays and oral antihistamines.  Intra-nasal antihistamines like Azelastine are effective for non-allergic rhinitis.  Intra-nasal ipratropium has also proven effective in decreasing rhinorrhea and is a reasonable monotherapy for patients who have rhinorrhea as a predominant symptom, particularly those with gustatory or weather-induced non-allergic rhinitis.  The effectiveness of nasal corticosteroids for non-allergic rhinitis is difficult to predict, with the exception of patients who suffer from NAR with eosinophils.

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