Nonallergic rhinitis is the inflammation of the nasal lining membranes without any immunoglobulin E mediation, as documented by allergen skin testing.
Major signs and symptoms include nasal itching, watery rhinorrhea, nasal obstruction/congestion, sneezing and postnasal drainage.
Symptoms can reverse spontaneously with or without treatment.


  • Nonallergic rhinitis (NAR) is a diagnosis of rhinitis without any immunoglobulin E (IgE) mediation, as documented by allergen skin testing or radioallergosorbent testing (RAST)
  • A detailed clinical history & physical exam should be obtained to rule out other nasal conditions which can cause similar symptoms


Types of Nonallergic Rhinitis
Extrinsic Cause
  • Drug-induced rhinitis
    • May be caused by a variety of medications (eg beta-blockers, ACE inhibitors, beta-blockers, NSAIDs, Aspirin, oral contraceptives, prolonged use of nasal decongestants)
    • Symptoms are nasal blockage, rhinorrhea, crusting, pain & nasal septum perforation
    • Rhinitis medicamentosa
      • Results from prolonged use (>5-10 days) of intranasal decongestants
      • Nasal congestion & rhinorrhea result from loss of adrenergic tone rather than the original cause of rhinitis
      • Nasal function normalizes in 7-21 days after discontinuation of decongestants
  • Gustatory rhinitis
    • Usually presents w/ watery rhinorrhea secondary to vagally mediated nasal vasodilatation that occurs w/in few hours of oral ingestion
    • Common triggers are hot & spicy foods
  • Hormonal rhinitis
    • Symptoms appear when hormonal imbalances occur (eg hypothyroidism, acromegaly, pregnancy, puberty, menstruation, oral contraceptive use)
    • Usual symptoms are nasal congestion & rhinorrhea
  • Occupational rhinitis
    • Symptoms are usually triggered by an inhaled irritant (eg wood dusts, chemicals, grains)
    • Patients report that symptoms are present only when they are in the workplace
Inflammatory Rhinitis
  • Granulomatous diseases
    • Eg Wegener’s, Sarcoidosis
      • Presents w/ inflammatory rhinitis w/ negative skin prick test
      • Nasal mucosa appears to be red or granulomatous, sometimes w/ crusting & bleeding, nasal perforation or collapsed nasal bridge
  • Systemic diseases
    • Eg Sjogren’s syndrome, rheumatoid arthritis, systemic lupus erythematosus (SLE), Churg-Strauss syndrome
  • Nonallergic Rhinitis w/ Eosinophilia Syndrome (NARES)
    • Eosinophils comprising 10-20% of cells are seen on nasal smear
    • Usual symptoms are nasal obstruction, sneezing, rhinorrhea, nasal pruritus & hyposmia
    • May lead to nasal polyposis, asthma & Aspirin sensitivity

Infectious Rhinitis

  • Usually caused by a viral or bacterial upper respiratory infection
  • See Rhinosinusitis - Acute, Bacterial Disease Management Chart if bacterial infection is suspected
  • Symptoms include clear to mucopurulent nasal discharge, facial pain & pressure, postnasal drainage w/ cough, altered sense of smell, which resolve within 7-10 days
  • Vasomotor rhinitis
    • General category for all remaining types of nonallergic rhinitis
    • Usually due to parasympathomimetic activity which results in vasodilation & edema of the nasal vessels
    • Symptoms may worsen w/ exposure to cold air, stress, inhaled irritants or strong odors


The following features in the clinical history are suggestive of nonallergic rhinitis:

  • Adult onset of symptoms w/ symptoms occurring throughout the year
  • Previous negative allergy testing
  • Sensitivity to smoke, perfume, environmental irritants & changes in weather conditions
  • Overuse of topical decongestants
  • Prominent symptoms of postnasal drainage & nasal obstruction
  • Nasal crusting or drying
  • Facial pain

Physical Examination

Nasal Exam
  • Preferably performed by endoscopy
  • May reveal the following:
    • Erythematous mucosal tissue
    • Swollen nasal turbinates
    • Nasal crease
    • Rhinorrhea w/ clear, cloudy or colored discharge
    • Mouth breathing
  • Patient should be referred to a specialist if findings are more consistent w/ a structural etiology than rhinitis (eg tumors, nasal polyps, septal deviation, turbinate hypertrophy)
    • Surgical treatment may be required
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Respirology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Stephen Padilla, 14 Jan 2019
Overall, the risk of lung cancer is higher in former and current smokers with higher concentrations of high sensitivity C-reactive protein (hsCRP), according to a study. Additionally, circulating hsCRP is not associated with the risk of lung adenocarcinoma and may reflect a prediagnostic disease state rather than a causal risk for lung cancer.