Allergic Rhinitis

Initial classification — Rhinitis

• Positive skin-prick test and/or nasal allergen challenge → Allergic
• Occupational (allergic and nonallergic)
• Negative skin-prick test and nasal allergen challenge → Nonallergic

Nonallergic — Infective

• Acute rhinosinusitis
• Chronic rhinosinusitis — Exclude predisposing causes:
• • Cystic fibrosis
• • Primary ciliary dyskinesia
• • Immunodeficiency
• • Immunopathology
• • Polyps

Nonallergic — Noninfective

• Nonallergic rhinitis with eosinophilia — Consider aspirin, entopy (local nasal IgE)
• Immunopathologic findings: • Eosinophilic granulomatosis with polyangiitis • Granulomatosis with polyangiitis • Sarcoidosis • Relapsing polychondritis • Systematic lupus erythematosus
• Structural abnormalities: • Deviated septum • Nasal valve dysfunction • Nasal polyps • Foreign body • Adenoidal hypertrophy • Choanal atresia • Cerebral fluid leak • Nasal or CNS tumors
• Hormonal: • Pregnancy • Menstrual cycle • Puberty • Hormone replacement therapy • Acromegaly • Hypothyroidism
• Drug-induced: • Oral contraceptive • Rhinitis medicamentosa • Antihypertensives • Cocaine abuse • Aspirin or NSAID
• Others: • Noninfective, nonallergic rhinitis • Neurogenic (gustatory, emotional, cold-air induced) • Atrophic • Gastroesophageal reflux • Idiopathic