Evolving paradigms of treatment of allergic and nonallergic rhinitis

Allergic rhinitis (AR) is a prevalent disease affecting approximately 15% of the US population, which is approximately 50 million individuals. More broadly, it is estimated that 400 to 500 million people worldwide experience AR. Not surprisingly, AR has a significant impact on quality of life due to increased fatigue, cognitive impairment, sleep disturbances, presenteeism or absenteeism, and impairment of performance, which all contribute to an increased cost burden to the medical system. Recent studies have identified social determinants of health including income level, age of migration from rural to urban areas or to high-income countries, and access to health care as important factors associated with the prevalence of allergic diseases. However, up to 25% of individuals have non-AR triggered by mechanical, osmotic, and chemical irritants, and 50% have mixed rhinitis characterized by allergic and nonallergic triggers. Uncontrolled chronic rhinitis subtypes have all been associated with asthma, eczema, chronic or recurrent sinusitis, cough, and both tension and migraine headaches. This review will address AR and non-AR with a focus on evolving treatments in adults.