Other causes of rhinitis: mixed rhinitis, rhinitis medicamentosa, hormonal rhinitis, rhinitis of the elderly, and gustatory rhinitis

It is important to consider a comprehensive differential of possible rhinitis types when considering the diagnosis of chronic rhinitis, including at least 9 subtypes of nonallergic rhinitis: drug-induced rhinitis, gustatory rhinitis, hormonal-induced rhinitis, infectious rhinitis, nonallergic rhinitis with eosinophilia syndrome, occupational rhinitis, senile rhinitis, atrophic rhinitis, and nonallergic rhinopathy. This article focuses on some of the most common types of chronic rhinitis, including mixed rhinitis (allergic and nonallergic overlap), rhinitis medicamentosa, hormonal rhinitis, rhinitis of the elderly, and gustatory rhinitis.     

Occupational rhinitis

Work-related rhinitis, which includes work-exacerbated rhinitis and occupational rhinoconjunctivitis (OR), is two to three times more common than occupational asthma. High molecular weight proteins and low molecular weight chemicals have been implicated as causes of OR. The diagnosis of work-related rhinitis is established based on occupational history and documentation of immunoglobulin E (IgE) mediated sensitization to the causative agent if possible. Management of work-related rhinitis is similar to that of other causes of rhinitis and includes elimination or reduction of?exposure to causative agents combined with pharmacotherapy. If allergens?are commercially available, allergen immunotherapy can be considered.     

Occupational rhinitis

The present document is the result of a consensus reached by a panel of experts from European and nonEuropean countries on Occupational Rhinitis (OR), a disease of emerging relevance, which has received little attention in comparison to occupational asthma. The document covers the main items of OR including epidemiology, diagnosis, management, socio-economic impact, preventive strategies and medicolegal issues. An operational definition and classification of OR tailored to that of occupational asthma, as well as a diagnostic algorithm based on steps allowing different levels of diagnostic evidence, are proposed. The needs for future research are pointed out. Key messages are issued for each item.     

Occupational rhinitis

PURPOSE OF REVIEW: This review updates existing knowledge on occupational rhinitis based on epidemiological and clinical research studies published from 2003 to 2005. RECENT FINDINGS: The review covers new developments on the pathophysiology, diagnosis, monitoring and management of occupational rhinitis. This article also provides updated information on the prevalence and incidence of both occupational rhinitis and work-related symptoms of rhinitis, as well as on causal agents and personal risk factors associated with this condition. SUMMARY: Occupational rhinitis is frequently under-diagnosed due to a lack of physician awareness. Diagnosis is suspected when symptoms occur in relation to work. Differentiating between immunological sensitization and irritation may be difficult. Given the high prevalence of rhinitis in the general population from all causes, objective tests confirming the occupational origin are essential. Measures of inflammatory parameters via nasal lavage and objective assessment of nasal congestion both offer practical means of monitoring responses. Growing experience with acoustic rhinometry and peak nasal inspiratory flow suggests that these methods will have an increasingly important role in monitoring and diagnosing in the future. Recent findings indicate that work-related rhinitis is to some extent preventable. Surveillance of sensitized workers may allow early detection of occupational rhinitis.     

Occupational rhinitis

This article aims to define occupational rhinitis, classify its various causes, review the steps in its diagnosis, and describe its nonpharmacologic and pharmacologic principles of management. Occupational rhinitis frequently coexists with asthma but also occurs alone. Although it does not have the same impact as occupational asthma, occupational rhinitis causes distress, discomfort, and work inefficiency. By concentrating on the patient's workplace, the clinician has an opportunity to practice preventive medicine: to recognize substances in the patient's micro- and macroenvironment that are causing the problems and then to intervene by altering the environment or removing the patient from the environment.     

Pregnancy rhinitis

Pregnancy rhinitis has gained attention as a defined clinical entity that is recognized increasingly by medical professionals and by the public. It affects one in five pregnant women, and as far as we know, it is not caused by one single factor. Pregnant women should be informed about this cause of nasal congestion, and how to handle it. There is no cure known, but symptomatic treatment may be needed, because impaired nasal breathing can reduce quality of life and possibly affect the fetus. Simple measures, such as elevated head end of the bed, physical exercise, nasal saline washings, and nasal alar dilation can improve nasal breathing.     

Pathogenesis of rhinitis

Rhinitis is a heterogeneous condition that has been associated with inflammatory responses as in allergic rhinitis but can also occur in the absence of inflammation such as in so‐called idiopathic (previously ‘vasomotor’) rhinitis. Allergic rhinitis affects approximately one in four of the population of westernized countries and is characterized by typical symptoms of nasal itching, sneezing, watery discharge and congestion. The intention of this review is to illustrate key concepts of the pathogenesis of rhinitis. Imbalance in innate and adaptive immunity together with environmental factors is likely to play major roles. In allergic rhinitis, initial allergen exposure and sensitization involves antigen‐presenting cells, T and B lymphocytes and results in the generation of allergen‐specific T cells and allergen‐specific IgE antibodies. On re‐exposure to relevant allergens, cross‐linking of IgE on mast cells results in the release of mediators of hypersensitivity such as histamine and immediate nasal symptoms. Within hours, there is an infiltration by inflammatory cells, particularly Th2 T lymphocytes, eosinophils and basophils into nasal mucosal tissue that results in the late‐phase allergic response. Evidence for nasal priming and whether or not remodelling may be a feature of allergic rhinitis will be reviewed. The occurrence of so‐called local allergic rhinitis in the absence of systemic IgE will be discussed. Non‐allergic (non‐IgE‐mediated) rhinitis will be considered in the context of inflammatory and non‐inflammatory disorders.