rhinitis%20-%20nonallergic%20(pediatric)
RHINITIS - NONALLERGIC (PEDIATRIC)
Rhinitis is the inflammation of the nasal lining membranes.
Nonallergic rhinitis is a diagnosis of rhinitis without any immunoglobulin E (IgE) mediation, as documented by allergen skin testing.
Signs & symptoms are nasal itching, rhinorrhea, nasal congestion with or without obstruction and sneezing.

Diagnosis

  • A detailed clinical history & physical exam should be obtained to rule out other nasal conditions that may mimic signs & symptoms of rhinitis

History

  •  Nasal congestion and postnasal drip are the more common presenting symptoms compared to allergic rhinitis
  • Previous negative allergy testing
  • Sensitivity to smoke, perfume, environmental irritants & changes in weather conditions
  • Overuse of topical decongestants
  • Nasal crusting or drying
  • Facial pain

Physical Examination

Nasal Exam
  • Can be carried out using a nasal speculum (anterior rhinoscopy) or by endoscopy
    • Endoscopy is indicated when symptoms persist despite treatment; for assessment of nasal perforations, ulceration & polyps
  • May reveal the following:
    • Mucosa may be edematous, hyperemic or pale
    • Swollen nasal turbinates (note size & color)
    • Rhinorrhea with clear, cloudy or colored discharge
      • Bacterial sinusitis is considered if colored discharge is noted
    • Mouth breathing especially in chronic congestion
  • Patient should be referred to a specialist if findings are more consistent with a structural etiology than rhinitis (eg tumors, nasal polyps, septal deviation, adenoidal hypertrophy, etc)
Other physical findings may include:
  • Enlarged tonsils
  • Lymphadenopathy
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