Idiopathische Rhinitis

Abstract

Idiopathic Rhinitis (IR) is a term for a group of nasal diseases of unknown aetiology. Formerly, these diseases were called vasomotor rhinitis, but because there is no indication of a disorder in the vasomotor system, this term has been abandoned. Other terms, like non-infectious non-allergic rhinitis and non-allergic non-infectious perennial rhinitis are purely descriptive. Potential pathomechanisms in IR could be 1) neural dysfunction/dysregulation; 2) immunological inflammatory responses; and 3) changes of the permeability of the mucosa, leading to increase entrance of potential harmful substances. Idiopathic Rhinitis is a diagnosis by exclusion, meaning that a number of more or less defined nasal conditions as a cause of rhinitis have been excluded - not only allergic rhinitis. Although a considerable progress was made in the standardization of provocation tests or biomarkers in nasal secretions, there are today no specific test available to confirm the diagnosis rhinitis in many non allergic conditions. An evidence-based review of treatment outcomes shows topical sprays of steroids, antihistamines to be of benefit in idiopathic rhinitis. Furthermore, nasal saline solution is effective in many patients with IR. Multiple surgical procedures have been suggested for IR, but should be reserved for patients who fail medical therapy.

Review of Rhinitis: Classification, Types, Pathophysiology

“…The most common type of NAR is considered to be idiopathic rhinitis or vasomotor rhinitis. This type of rhinitis consists of approximately 71% of non-allergic rhinitis, with a worldwide prevalence of 320-million people and without a clear correlation with the rates of comorbid asthma [ 61 , 62 ] Idiopathic rhinitis is associated with symptoms which are not related to allergic infectious triggers, without a clear etiology [ 1 , 5 ]. The diagnosis is usually made following exclusion of AR.…”

“…Noxious odorants, chemical irritants, cleaning agents, and changes in environmental status such as temperature, humidity, and barometric pressure are considered to be triggering factors for the manifestation of idiopathic rhinitis. Several molecular pathways have been found to be involved; one of them is characterized by tachykinin release and the inhibition of mediators of the sympathetic system, leading to an elevated parasympathetic response [ 62 ]. This mechanism is not strongly supported by evidence.…”

Nasal inflammatory mediators and specific IgE production after nasal challenge with grass pollen in local allergic rhinitis

“…4,5 There is evidence to support the existence of a new form of local allergic rhinitis (LAR) or entopy with local production of specific IgE (sIgE) and a positive response to a nasal allergen provocation test (NAPT) in patients previously diagnosed with IR. [6][7][8][9] However, the immunologic mechanisms involved have not yet been studied in sufficient detail.…”

Botulinumtoxin A als mögliche therapeutische Option zur Behandlung der allergischen und idiopathischen Rhinitis - Ergebnisse einer randomisierten, doppelblinden, placebokontrollierten Studie

“…Auch Stickstoffmonoxid (NO) wurde als nichtadrenerger nichtcholinerger Neurotransmitter im zentralen und peripheren Nervensystem als Kotransmitter in parasympathischen Nervenfasern nachgewiesen und kann cholinerge Wirkungen an Drüsen und Gefäßen modulieren (HESS et al 2000, DAMM 2006.…”

“…Man kann aber davon ausgehen, dass die tägliche Einschränkung der Lebensqualität vergleichbar ist mit der Situation von Patienten, die an einer allergischen Rhinitis leiden (RYDEN et al 2004). Die IR betrifft häufig Frauen, beginnt meist im mittleren und ist eine Ausschlussdiagnose (NUMATA et al 1999, DAMM 2006. Als mögliche (bisher noch unbekannte) Pathomechanismen der idiopathischen Rhinitis werden heute neurale Dysregulationen, immunologisch-inflammatorische Störungen oder Schädigungen der Mukosa mit nachfolgender Permeabilitätssteigerung für irritative Substanzen diskutiert (DAMM 2006).…”