Traditional triggers such as cat or dog exposure should be absent.
Symptoms and exam findings can overlap between perennial allergic rhinitis and non-allergic rhinitis (NAR), with nasal turbinates swollen and beefy red, scant mucus, cobblestoning of posterior pharynx from chronic postnasal drainage, and retraction of tympanic membranes indicating congestion.
A diagnosis of NAR requires negative specific IgE responses by skin or serologic testing.
Differentiation between the subtypes of non-allergic conditions, vasomotor rhinitis and non-allergic rhinitis with eosinophilia syndrome, is determined by the presence or absence of eosinophilia in the nasal passage.
Algorithm for pharmacotherapy differs dramatically from allergic rhinitis, although some agents overlap.
Structural problems or other complicating conditions should be ruled out with imaging if initial therapeutic trials fail to relieve symptoms. Possibilities include osteomeatal complex obstruction that occurs as a result of chronic inflammation or recurrent infections, severe nasal septal deviation and nasal polyposis, or, less commonly, tumor or foreign body.
The non-allergic rhinitis (NAR) conditions are vasomotor rhinitis (VMR) and non-allergic rhinitis with eosinophilia syndrome (NARES). To establish a definitive diagnosis of VMR or NARES, all other chronic rhinitis syndromes should be properly considered and excluded.
[1]
Nassef M, Shapiro G, Casale TB. Identifying and managing rhinitis and its subtypes: allergic and non-allergic components - a consensus report and materials from the Respiratory Allergic Disease Foundation. Curr Med Res Opin. 2006;22:2541-2548.
http://www.ncbi.nlm.nih.gov/pubmed/17265594?tool=bestpractice.com
[2]
Dykewicz MS, Fineman S, Skoner DP, et al. Diagnosis and management of rhinitis: complete guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol. 1998;81:478-518.
http://www.ncbi.nlm.nih.gov/pubmed/9860027?tool=bestpractice.com
Environmental tobacco smoke, perfumes and fragrances, as well as temperature and barometric changes may aggravate symptoms in NAR,
[1]
Nassef M, Shapiro G, Casale TB. Identifying and managing rhinitis and its subtypes: allergic and non-allergic components - a consensus report and materials from the Respiratory Allergic Disease Foundation. Curr Med Res Opin. 2006;22:2541-2548.
http://www.ncbi.nlm.nih.gov/pubmed/17265594?tool=bestpractice.com
[2]
Dykewicz MS, Fineman S, Skoner DP, et al. Diagnosis and management of rhinitis: complete guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol. 1998;81:478-518.
http://www.ncbi.nlm.nih.gov/pubmed/9860027?tool=bestpractice.com
but specific IgE responses by skin or serologic testing are all negative. The presence of eosinophils in the nasal mucosa in NARES distinguishes it from VMR.
[1]
Nassef M, Shapiro G, Casale TB. Identifying and managing rhinitis and its subtypes: allergic and non-allergic components - a consensus report and materials from the Respiratory Allergic Disease Foundation. Curr Med Res Opin. 2006;22:2541-2548.
http://www.ncbi.nlm.nih.gov/pubmed/17265594?tool=bestpractice.com
[2]
Dykewicz MS, Fineman S, Skoner DP, et al. Diagnosis and management of rhinitis: complete guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol. 1998;81:478-518.
http://www.ncbi.nlm.nih.gov/pubmed/9860027?tool=bestpractice.com
It is a chronic condition that should be distinguished from a common cold, which can manifest with symptoms of NAR but is self-limiting.