Clinical Review

ABC of allergies: Perennial rhinitis

BMJ 1998; 316 doi: http://dx.doi.org/10.1136/bmj.316.7135.917 (Published 21 March 1998) Cite this as: BMJ 1998;316:917
  1. I S Mackay,
  2. S R Durham

    Perennial rhinitis may be defined clinically as an inflammatory condition of the nose characterised by nasal obstruction, sneezing, itching, or rhinorrhoea, occurring for an hour or more on most days throughout the year. In one study in London of adults between the ages of 16 and 65 years, the prevalence of rhinitis was 16%; of these, 8% had perennial symptoms, 6% perennial and seasonal symptoms, and 2% seasonal symptoms alone. As with asthma, both seasonal and perennial rhinitis seem to be increasing.

    Non-allergic, non-infective rhinitis*

    • Idiopathic rhinitis refers to a heterogeneous group of patients with nasal hyperresponsiveness to non-specific triggers such as strong smells (eg, perfumes, bleach, and solvents), tobacco smoke, vehicle exhaust fumes, and changes in environmental temperature and humidity in the absence of an identifiable underlying cause

    • Non-allergic rhinitis with eosinophilia syndrome (NARES) is characterised by nasal eosinophilia (usually in young women) with perennial nasal symptoms with negative results on skin prick testing and normal IgE concentrations. Patients usually respond well to topical corticosteroids

    • Hormonal rhinitis can occur during pregnancy, puberty, hypothyroidism, and acromegaly. Postmenopausal women may develop atrophic changes, elderly men sometimes watery rhinorrhoea (“old man's drip”)

    • Drug induced rhinitis is associated with several drugs. β sympathomimetic receptor antagonists (β blockers) and angiotensin converting enzyme inhibitors have been associated with nasal symptoms, as have topical ophthalmic β blockers, chlorpromazine, oral contraceptives, aspirin, and other non-steroidal anti-inflammatory agents

    • Food induced rhinitis Gustatory rhinorrhoea may occur during consumption of hot and spicy foods. Non-IgE mediated hypersensitivity may result from food colourings and preservatives. Alcohol, in addition to the mechanisms above, also acts as a vasodilator, which may result in nasal obstruction

    • Emotional factors including stress and sexual arousal can affect the nose, probably due to autonomic stimulation

    *Poorly understood and more difficult to identify specific causes

    Classification

    Allergic rhinitis—Perennial allergic rhinitis can …

    Sign in

    Free trial

    Register for a free trial to thebmj.com to receive unlimited access to all content on thebmj.com for 14 days.
    Sign up for a free trial

    Subscribe