When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Non-allergic rhinitis

Last reviewed: 9 Nov 2024
Last updated: 31 Mar 2023

Summary

Definition

History and exam

Key diagnostic factors

  • nasal congestion
  • postnasal drainage
  • rhinorrhea
  • sore throat
Full details

Other diagnostic factors

  • ear plugging
  • sinus headaches
  • postural change triggers
  • absence of fever
  • sneezing
  • purulent discharge
  • bilateral symptoms
  • sinus pain
Full details

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 potpourris
  • changes in temperature
  • barometric changes
  • no family history of allergies
  • high estrogen state
  • beta-blocker use
  • intranasal drug abuse
Full details

Diagnostic tests

1st tests to order

  • allergy skin prick tests
  • serologic specific IgE testing
Full details

Tests to consider

  • nasal eosinophil smear
  • sinus computed tomography
  • nasal endoscopy
  • nasal provocation test
Full details

Treatment algorithm

ONGOING

intermittent

persistent

Contributors

Authors

Jonathan A. Bernstein, MD

Professor of Clinical Medicine

Department of Internal Medicine

Division of Immunology/Allergy Section

University of Cincinnati College of Medicine

Cincinnati

OH

Disclosures

JAB is a principal investigator, consultant, and speaker for Sanofi Regeneron, Novartis, Genentech, and AstraZeneca. JAB is a sub-principal investigator and speaker for GSK, a principal investigator and consultant for Merck, and a consultant and speaker for Optinose. JAB is a secretary treasurer for the American Academy of Allergy, Asthma, and Immunology (AAAAI), and a Vice Chairman of the AAAAI Foundation. JAB is on the board of directors for the World Allergy Organization, is an advisory board member for the US Hereditary Angioedema Association, is a member of the executive board for Interasma, and is Chairperson for Allergists for Israel. JAB is an author of a number of references cited in this topic.

Acknowledgements

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

Disclosures

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

Memphis

TN

Disclosures

EEA declares that she has no competing interests.

Ozgur Yigit, MD

Chief

ENT Department

Istanbul Training and Research Hospital

Istanbul

Turkey

Disclosures

OY declares that he has no competing interests.

  • Differentials

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

    • Rhinitis 2020: a practice parameter update
    • EAACI position paper on non-allergic rhinitis
    More Guidelines
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer