Non-allergic hyper-reactive rhinitis

Abstract:

Non-allergic hyper-reactive rhinitis is a diagnosis by exclusion, i.e. rhinitis with nonspecific symptoms, without significant infection, in which the allergic etiology is excluded, i.e. the IgE-mediated process. Nasal symptoms in nonallergic hyper-reactive rhinitis may be provoked shortly by nasal irritation, i.e. only when exposed to the reflex responses trigger, but may also be persistent. Idiopathic rhinopathy is phenotype of non-allergic rhinitis, where the etiology and the triggering factor are unknown, with no significant levels of inflammatory cells and mediators in the nasal mucosa. According to the symptoms it may be the answer of the nasal mucosa to irritants, by rhinorrhea or sneezing, while obstruction is more frequent than rhinorrhea in the persistent type. In these types of rhinitis, the leading role is played by the proteins regulating the ion channels in the nasal mucosa, as well as cholinergic and other neural reflexes, leading to congestion, hyper-secretion or sneezing. In the differential diagnosis, local allergic rhinitis has to be noted, i.e. rhinitis caused by the reaction of the incriminated allergen exclusively with Ig-E synthesized in the nasal mucosa. Therapy of hyper-reactive rhinitis is based on the avoidance of triggers of the reaction, and the cleansing of nasal cavities, use of antihistamines, topical corticosteroids and anticholinergics. 

Key words:
cholinergic reflexes; irritant rhinitis; local allergic rhinitis; nasal hyper-reactivity; neurogenic inflammation; non-allergic rhinitis with eosinophilia