Key Points

• Symptoms of nonallergic rhinitis include chronic nasal obstruction and eosinophils on nasal smear, in the absence of allergy.

• Topical glucocorticoid steroid therapy is useful in treatment of NARES.

• Aggravating factors include physical changes or irritants for vasomotor rhinitis.

• Ipratropium bromide is best for controlling symptoms of vasomotor rhinitis.

Some patients with perennial rhinitis are not atopic by history or skin testing. Chronic nasal obstruction is the predominant symptom, and the condition may be associated with sinus disease and nasal polyps. Although there is no evidence of allergy by skin testing, numerous eosinophils are present, and the diagnosis is readily made by examining the nasal secretions for eosinophils and eosinophilic cationic protein (Kramer et al., 2004). The condition is also called nonallergic rhinitis with eosinophilia (NARES). A substantial number of patients have chronic rhinitis with rhinor-rhea, postnasal drainage, and chronic or intermittent nasal obstruction. Symptoms are aggravated by many physical or irritant factors, such as cold air, odors, and smoke. Skin tests are negative, and no eosinophils are present in the tissue or secretions.

Topical glucocorticoid therapy is much more effective than antihistamines or decongestants for NARES. As with asthmatic patients, patients with associated sinus disease and nasal polyps are at risk for adverse reactions to aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). Patients with NARES are also at risk for obstructive sleep apnea (Wallace et al., 2008). Ipratropium bromide (0.03%) spray solution, fluticasone, and azelastine nasal sprays have all been shown to be effective treatment. Some patients benefit from antihistamine-decongestant combinations. The regular use of buffered saline lavage can also provide satisfactory symptomatic relief.

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