Non‐allergic rhinitis: Position paper of the European Academy of Allergy and Clinical Immunology

Abstract

This EAACI position paper aims at providing a state‐of‐the‐art overview on nonallergic rhinitis (NAR). A significant number of patients suffering from persistent rhinitis are defined as nonallergic noninfectious rhinitis (NANIR) patients, often denominated in short as having NAR. NAR is defined as a symptomatic inflammation of the nasal mucosa with the presence of a minimum of two nasal symptoms such as nasal obstruction, rhinorrhea, sneezing, and/or itchy nose, without clinical evidence of endonasal infection and without systemic signs of sensitization to inhalant allergens. Symptoms of NAR may have a wide range of severity and be either continuously present and/or induced by exposure to unspecific triggers, also called nasal hyperresponsiveness (NHR). NHR represents a clinical feature of both AR and NAR patients. NAR involves different subgroups: drug‐induced rhinitis, (nonallergic) occupational rhinitis, hormonal rhinitis (including pregnancy rhinitis), gustatory rhinitis, senile rhinitis, and idiopathic rhinitis (IR). NAR should be distinguished from those rhinitis patients with an allergic reaction confined to the nasal mucosa, also called “entopy” or local allergic rhinitis (LAR). We here provide an overview of the current consensus on phenotypes of NAR, recommendations for diagnosis, a treatment algorithm, and defining the unmet needs in this neglected area of research.

Antileukotrienes improve naso‐ocular symptoms and biomarkers in patients with NARES and asthma

“…In contrast to the extensive amount of information found in the literature on AR, there is limited data on the treatment of NAR, for which the intense symptoms can negatively affect the patient's quality of life. Our preliminary results suggest for the first time that some NARES patients may significantly benefit from treatment with montelukast 10 mg once a day.…”

“…Currently, the effects of montelukast on symptomatic patients with nonallergic rhinitis (NAR), and in particular on NAR with eosinophilic syndrome (NARES), have not been investigated in the literature. Nonallergic rhinitis includes an extensive list of different phenotypes that differ in terms of pathogenic mechanisms and clinical features . Several authors have encouraged the detection of inflammation in patients affected by NAR because the type of inflammatory pattern may impact differently both the disease severity and therapeutic response.…”

A New Class of Polymeric Anti-Allergen Nasal Barrier Film Solution for the Treatment of Allergic Rhinitis

“…Subsequent exposure to allergens activates these cells which instantly produce the classical inflammatory mediators of allergic reactions, including histamines [20]. As a local defense mechanism, the nasal mucosa then becomes totally infiltrated by inflammatory and immune cells, leading to a chronic inflammatory cascade and the typical symptoms of allergic rhino-sinusitis, which persist as long as new allergens come in contact with the nasal mucosa.…”

A Precision Medicine Approach to Rhinitis Evaluation and Management

“…Home environmental interventions (acaricides and bedroom control programs) may be of some benefit in reducing dust mite load and rhinitis symptoms [78]. One of the main problems to achieve an effective eradication of allergens lies in the adherence or compliance with the recommendations of these measures, since it may require modifications of the house, control of moisture sources, control of pets and insects, and improvements in the ventilation of the house, among others [79].…”