Allergic and Nonallergic Rhinitis: Update on Pathophysiology and Clinical Management

An understanding of the pathophysiology will dictate appropriate therapy for allergic and nonallergic rhinitis. Cholinergic pathways when stimulated produce typical secretions that can be identified by their grandular constituents so as to implicate neurologic stimulation. By contrast secretions typical of increased vascular permeability are found in allergic reactions and upper respiratory infections. In general it is worthwhile to treat early since the nose can be primed so as to produce symptoms at lower doses as the season continues. The mainstay of therapy continues to be antihistamines, which typically treat the sneezing, runny nose, and itchy eyes, nose and throat. The decongestants can ameliorate stuffy nose and systemic agents, such as phenylpropanolamine or pseudoephedrine, are preferred over the topical agents. Anti-inflammatory preparations such as Nasalcrom or steroid aerosols such as those containing belcomethasone, funisolide, budesonide, or Triamcinolone can prove very useful. If a neurologic mechanism or predominantly rhinorrhea symptoms are present, an anticholinergic such as a ipratropium might be the treatment of choice. Immunotherapy also is anti-inflammatory and blocks late phase allergic reactions, so the choices of medication based on pathogenic mechanisms represents sensible treatment options for rhinitis.