Non-allergic rhinitis

Last reviewed: 28 Feb 2023
Last updated: 30 Jan 2019



History and exam

Key diagnostic factors

  • presence of risk factors
  • nasal congestion
  • post-nasal drainage
  • rhinorrhoea
  • sore throat
More key diagnostic factors

Other diagnostic factors

  • ear plugging
  • sinus headaches
  • postural change triggers
  • absence of fever
  • sneezing
  • purulent discharge
  • bilateral symptoms
  • sinus pain
Other diagnostic factors

Risk factors

  • symptom onset age >35
  • no seasonal symptoms
  • no symptom exacerbation by cats
  • exposure to fragrance
  • exposure to smoke (e.g., wood, tobacco)
  • exposure to hairspray
  • exposure to pot pourris
  • changes in temperature
  • barometric changes
  • no family history of allergies
  • high oestrogen state
  • beta-blocker use
  • intranasal drug abuse
More risk factors

Diagnostic investigations

1st investigations to order

  • allergy prick skin tests
  • serological specific IgE testing
More 1st investigations to order

Investigations to consider

  • nasal eosinophil smear
  • sinus computed tomography
  • nasal endoscopy
  • nasal provocation test
More investigations to consider

Treatment algorithm


congestion predominant

rhinorrhoea predominant



Jonathan A. Bernstein, MD

Professor of Clinical Medicine

Department of Internal Medicine

Division of Immunology/Allergy Section

University of Cincinnati College of Medicine




JAB has acted as a consultant for Inflamax, MEDA, GSK, and ATL, and serves on a medical safety board for HAL Allergy; is a principle investigator or sub-principle investigator for over 30 pharmaceutical companies; has an investigator-initiated research project from Shire; is a protocol chair for a U44 clinical trial funded by NAIAD; is a speaker for AZ, Shire, and CSL Behring; and is an author of a number of references cited in this topic.


Professor Bernstein would like to gratefully acknowledge Dr Chris Codispoti, a previous contributor to this topic.


CC declares that he has no competing interests.

Peer reviewers

Elisabeth E. Adderson, MD

Associate Member

St. Jude Faculty Director

Pediatric Infectious Diseases Fellowship Program




EEA declares that she has no competing interests.

Ozgur Yigit, MD


ENT Department

Istanbul Training and Research Hospital




OY declares that he has no competing interests.

  • Differentials

    • Allergic rhinitis (seasonal, perennial, mixed)
    • Nasal polyposis
    • Deviated septum
    More Differentials
  • Guidelines

    • EAACI position paper on non-allergic rhinitis
    • BSACI guidelines for the diagnosis and management of allergic and non-allergic rhinitis
    More Guidelines
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