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.

Introduction

  • Rhinitis is the inflammation of the nasal lining membranes

Definition

  • Nonallergic rhinitis is a diagnosis of rhinitis without any immunoglobulin E (IgE) mediation, as documented by allergen skin testing

Etiology

Types of Nonallergic Rhinitis
Drug-induced Rhinitis
  • May be caused by a variety of medications [eg nonsteroidal anti-inflammatory drugs (NSAIDs), Aspirin, nasal decongestants]
  • Rhinitis medicamentosa is a rebound nasal congestion that results from prolonged use (5-7 days) of nasal decongestants
    • Symptoms include nasal congestion & edema
Gustatory Rhinitis
  • Usually presents with watery rhinorrhea that may be due to vagally mediated nasal vasodilatation that occurs within a few hours of oral ingestion
  • Common triggers are hot & spicy foods
Hormonal Rhinitis
  • Symptoms appear when hormonal imbalances occur (eg hypothyroidism, puberty, menstruation, oral contraceptive use or even pregnancy in adolescents)
  • Usual symptoms are nasal congestion & rhinorrhea
Infectious Rhinitis
  • Usually caused by a viral infection
  • Secondary bacterial infection with sinus involvement is a common complication, symptoms of which may include nasal or postnasal discharge of any quality, cough & fever
    • See Rhinosinusitis - Acute Bacterial Disease Management Chart if bacterial infection is suspected
Nonallergic Rhinitis with Eosinophilia Syndrome (NARES)
  • Characterized by eosinophilia on nasal smear
  • Symptoms are perennial & may consist of nasal obstruction, sneezing, rhinorrhea, nasal pruritus & hyposmia
Autonomic/Vasomotor Rhinitis or Idiopathic Nonallergic Rhinitis
  • Rhinitis due to nasal hyperresponsiveness to a variety of nonspecific irritants, like strong odors, chemical irritants or environmental changes in temperature, humidity
  • A diagnosis of exclusion
  • Associated with absence of identifiable inflammation on nasal smear

Signs and Symptoms

Major signs & symptoms
  • Nasal itching
  • Rhinorrhea
  • Nasal congestion, with or without obstruction
  • Sneezing
Other signs & symptoms 
  • Headache
  • Conjunctival symptoms, eye pruritus
  • Pruritus of the nose, palate, ears
  • Postnasal drainage
  • Impaired smell 
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