Rhinitis--inflammation in the lining of the nose--is a prevalent condition that costs billions of dollars each year and results in significant burden to sufferers. The symptoms of allergic and vasomotor rhinitis--runny nose, nasal stuffiness and itch, and sneezing--overlap, thus making diagnosis unclear and sometimes incorrect, reports Dr. Nozad in "Clinical and Molecular Allergy." Although treatments for the two types of rhinitis overlap too, certain cases require timely treatment to prevent serious complications.
Allergic Rhinitis
About two out of three cases of rhinitis are caused by allergies, according to The Joint Task Force on Practice Parameters for Allergy and Immunology. Allergic rhinitis affects between 10 and 30 percent of adults and up to 40 percent of children. The prevalence of allergy-related rhinitis is increasing throughout the world.
Vasomotor Rhinitis
Vasomotor rhinitis is the most common type of nonallergic rhinitis, comprising 60 percent of cases. Unlike allergic rhinitis, it typically begins in adults, explains Dr. Nozad. The symptoms, which can be sporadic or constant, can be triggered by strong smells, cold air or temperature changes. Alcohol and emotional or physical stress also trigger this form of rhinitis. Vasomotor rhinitis is called "irritant rhinitis" and "idiopathic rhinitis," meaning that the cause is unknown, because the exact mechanism underlying it remains unclear, explains the Auckland Allergy Clinic.
Cause
The cause of vasomotor rhinitis is poorly understood, although experts believe it results from an overly sensitive response to stimuli or irritants in the air, such as changes in the atmosphere or pollutants, reports the Auckland Allergy Clinic. Allergic rhinitis is caused by reaction to an airborne allergen, such as mold, pollen, insect droppings or pet dander, reports the Joint Task Force on Practice Parameters for Allergy and Immunology.
Diagnosis
Any particles in the air, including pollen and animal dander, can cause symptoms in people with vasomotor rhinitis, even though they are not actually allergic to these things. This further confuses diagnosis. A simple skin test for allergies is essential to establish the type of rhinitis a person has. This should be performed by an allergist, who should take careful history and thoroughly examine the patient's nose and throat, stipulates Dr. Nozad.
Treatment
Nasal steroids and antihistamines are mainstays of therapy for both allergic and vasomotor rhinitis, according to "Clinical and Molecular Allergy." People have a variable response to antihistamines, which are more helpful for people with allergic rhinitis or a mixture of both vasomotor and allergic rhinitis, reports the Auckland Allergy Clinic. They provide relief for people whose most bothersome symptom is a runny nose. Nasal steroids do not start working right away, but they relieve all the rhinitis symptoms, especially stuffy nose.
Considerations
Doctors should use a stepwise pharmacologic approach, choosing the first medication based on the patient's main symptom, explains Dr. Wheeler in the "American Family Physician." For example, if the only symptom in a person with vasomotor rhinitis is a runny nose, then the doctor should prescribe ipratropium, a nasal spray that alleviates this symptom.
References
- "Non-Allergic Rhinitis: A Case Report and Review"; Clinical and Molecular Allergy. Nozad CH.2010.
- Auckland Allergy Clinic: "Vasomotor Rhinitis (VMR) or Idiopathic Non-Allergic Rhinitis"; 2003.
- "Vasomotor Rhinitis"; American Family Physician. Wheeler PW. 2005.
- "The Diagnosis and Management of Rhinitis: An Updated Practice Parameter"; 2008.
