Table 1 Types of non-allergic rhinitis, clinical presentation and treatments

Vasomotor Rhinitis

Typically adult onset, sporadic or persistent nasal symptoms trigged by strong smells, cold air, changes in temperature, humidity, barometric pressure, strong emotions, alcohol and changes in hormone levels.

Intranasal corticosteroids and/or intranasal antihistamines are the mainstay of therapy

   Gustatory Rhinitis

Profuse rhinorrhea after ingestion of heated foods, spicy foods or alcohol.

Intranasal ipratropium bromide as needed.

   Infectious Rhinitis

Nasal congestion, mucopurulent nasal discharge, frontal headache, olfactory disturbances, postnasal drainage and cough.

Symptomatic treatment for viral infections. Topical antibacterial agents, i.e. mupirocin, for suspected bacterial infections.

   Non-allergic rhinitis with eosinophilia syndrome (NARES)

Typically adult onset. Individuals experience year round profuse rhinorrhea and nasal congestion. These patients have negative allergy skin testing and normal serum IgE levels.

Intranasal corticosteroids.

Occupational Rhinitis:[54–58]

   Annoyance

Patients report rhinitis symptoms that are purely subjective after occupational exposures. Symptoms are typically fragrance-induced, and occur without evidence of nasal inflammation.

Avoidance of triggers, nasal saline, nasal corticosteroids and nasal antihistamines.

   Irritant

Rhinitis symptoms after occupational exposure to irritants (e.g. cigarette smoke), and these patients have objective findings such as inflammation of the nasal mucosa without apparent immunologic or allergic basis.

Avoidance of triggers, nasal saline, nasal corticosteroids and nasal antihistamines.

   Corrosive

Rhinitis symptoms that occur after occupational exposure, to high concentrations of irritating and soluble chemical gases that in turn cause nasal inflammation which can break down and ulcerate the nasal mucosa.

Avoidance of the inciting agent.

   Allergic

Rhinitis symptoms due to an IgE mediated reaction to an occupational exposure.

Avoidance of triggers, nasal saline, nasal corticosteroids and nasal antihistamines.

Other Rhinitis Syndromes:[60–63]

   Hormonally induced Rhinitis

Includes menstrual cycle related rhinitis and rhinitis of pregnancy. Rhinitis of pregnancy typically begins in the 2nd trimester with severe congestion and resolves about 2 weeks postpartum[25].

Usually requires no specific pharmacologic intervention and treatment consists of saline nose spray or nasal lavage. External nasal dilator may be effective for patients with pregnancy-related nocturnal nasal congestion. Intranasal glucocorticoids have not been shown to be effective.

   Rhinitis Medicamentosa

Severe nasal congestion, due to a rebound effect from overuse of topical decongestants, such as oxymetazoline and phenylephrine.

Topical nasal corticosteroids and/or oral corticosteroids, with progressive withdrawal of the topical decongestant over 3-7 days.

Atrophic Rhinitis:[66–68]

   Primary Atrophic Rhinitis

Progressive nasal atrophy, mucosal colonization with Klebsiella ozaenae or other organisms, and a foul smelling nasal discharge. It can be seen as a post surgical complication, i.e. status post turbinectomy.

Nasal lavage, lubrication and topical antibiotics are used for mucopurulent secretions lasting beyond 2 days. Oral antibiotics can also be used for acute infections. Surveillance rhinoscopy should be performed at least twice a year if the patient remains symptomatic[26].

   Secondary Atrophic Rhinitis