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Nonallergic rhinitis: therapeutic options

Bernstein, Jonathan A.

Current Opinion in Allergy & Clinical Immunology: August 2013 - Volume 13 - Issue 4 - p 410–416
doi: 10.1097/ACI.0b013e3283630cd8
PHARMACOTHERAPY AND EVIDENCE BASED MEDICINE: Edited by David Khan and Enrico Compalati

Purpose of review: The purpose of this review is to briefly discuss methods for classifying Nonallergic rhinitis (NAR), the current understanding of its immunopathogenesis, scientific evidence-based treatment options along with anecdotal clinical experience for selecting different treatment regimens for these challenging patients.

Recent findings: NAR also known as idiopathic rhinitis, irritant-induced rhinitis and vasomotor rhinitis is a heterogeneous condition that has been classified many different ways, but currently there is no consensus on definition for this condition due to its poorly elucidated mechanism(s) of action. A typical patient presents with nasal congestion, postnasal drainage with or without a cough associated with, to a lesser extent, some degree of sneezing, itching, and rhinorrhea. Recent studies have proposed more specific approaches for characterizing rhinitis subtypes. It is speculated that this condition is due to an autonomic imbalance resulting in an overactive parasympathetic and perhaps an underactive sympathetic nervous system. Our poor understanding of NAR mechanism(s) of action has significantly hindered progress in developing novel therapies for this condition.

Summary: Further investigation is required to understand the neurogenic signaling pathways that lead to this aberrant response. Until we have selective therapies for NAR, treatment requires selecting the medication or combination of medications best suited to the symptomatic needs of the patient.

Division of Immunology/Allergy Section, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA

Correspondence to Jonathan A. Bernstein, MD, University of Cincinnati College of Medicine, 3255 Eden Avenue ML#563, Cincinnati, OH 45267–0563, USA. Tel: +1 513 558 5533; fax: +1 513 558 3799; e-mail: Jonathan.Bernstein@uc.edu

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