EAACI: Position Paper on Non-Allergic Rhinitis Management

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NAR is defined as symptomatic inflammation of nasal mucosa with presence of at least 2 nasal symptoms
NAR is defined as symptomatic inflammation of nasal mucosa with presence of at least 2 nasal symptoms

HealthDay News — An overview of the current consensus on phenotypes of non-allergic rhinitis (NAR), recommendations for diagnosis, and a treatment algorithm are presented in a position paper published online May 5 in Allergy.

Peter W. Hellings, MD, PhD, from the University Hospitals Leuven in Belgium, and colleagues provide an overview of non-allergic, non-infectious rhinitis, often denominated NAR, which is defined as a symptomatic inflammation of the nasal mucosa with the presence of at least two nasal symptoms, such as nasal obstruction, rhinorrhea, sneezing, and/or itchy nose, with no clinical evidence of endonasal infection. NAR also has no systemic signs of sensitization to inhalant allergens.

The authors note that diagnosis of NAR is based on a detailed medical history and exclusion of clinically relevant sensitization to airborne allergens, and exclusion of clinical signs of rhinosinusitis. Anterior rhinoscopy should be used to assess any signs of infection, endonasal crust formation, and/or significant anatomical deformities. The position paper also recommends nasal endoscopy for evaluation of the entire endonasal cavity, including the ostiomeatal complex. 

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"Chronic rhinosinusitis [CRS] with nasal polyps and CRS without nasal polyps should not be overlooked in patients with NAR, as symptomatology between NAR and CRS patients may overlap in part," the authors write. "Nasal endoscopy is the preferred means of diagnosis of CRS, and computed tomography scans should be reserved for those patients with suspicion of CRS and without nasal endoscopy available."

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