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Non-allergic rhinitis

Last reviewed: 1 Nov 2023
Last updated: 31 Mar 2023



History and exam

Key diagnostic factors

  • nasal congestion
  • postnasal drainage
  • rhinorrhea
  • 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 potpourris
  • changes in temperature
  • barometric changes
  • no family history of allergies
  • high estrogen state
  • beta-blocker use
  • intranasal drug abuse
More risk factors

Diagnostic investigations

1st investigations to order

  • allergy skin prick tests
  • serologic 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






Jonathan A. Bernstein, MD

Professor of Clinical Medicine

Department of Internal Medicine

Division of Immunology/Allergy Section

University of Cincinnati College of Medicine




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.


Professor Jonathan A. 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

    • Rhinitis 2020: a practice parameter update
    • EAACI position paper on non-allergic rhinitis
    More Guidelines
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