The distinguishing clinical features of nonallergic rhinitis patients

Aneeza W. Hamizan*, Mark Azer, Raquel Alvarado, Peter Earls, Henry P. Barham, Jessica Tattersall, Janet Rimmer, Larry Kalish, William A. Sewell, Richard Harvey

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    5 Citations (Scopus)


    Background: Not all rhinitis patients are affected by an immunoglobulin E (IgE)-mediated inflammatory process. Skin and serum allergy assessments are limited in their ability to define local allergic rhinitis (LAR). Thus, patients with negative systemic allergy assessments comprise a mix of those who truly have nonallergic rhinitis (NAR) and patients with LAR. Objective: To determine the clinical characteristics of patients with NAR. Methods: A cross-sectional study was performed on consecutive adults with rhinitis symptoms who underwent turbinate surgery. NAR patients were defined by excluding allergy using both systemic (serum-specific IgE and/or skin prick test) and local (inferior turbinate tissue-specific IgE) tests. Allergic rhinitis (AR) patients were defined by any positive systemic or local test toward aeroallergens. The clinical characteristics studied included allergic comorbidities (asthma, eczema, allergic conjunctivitis), inhalant allergen triggers (dust, pollen, animal dander), and environmental triggers (Cincinnati Irritant Index [CII]). Results: There were 154 participants (41.79 ± 14.78 years, 37.7% female). NAR patients (11.7%) were older (49.33 ± 15.99 vs 40.78 ± 14.38 years, P =.02), had less self-reported asthma (5.6% vs 36.3%, P <.01) and house dust inhalant trigger (38.9 vs 65.2%, P =.03) compared to AR patients. The CII score was similar for NAR and AR (31.06 ± 28.88 vs 35.49 ± 24.70, P =.61). Conclusion: Patients who were older, without asthma, and lacked an inhalant allergy trigger were more likely to have true NAR. Environmental triggers are not distinguishing features of NAR. This may be used as a guide to identify rhinitis patients whose symptoms are truly nonallergic etiology compared to those with falsely negative systemic allergy assessment but may still need management for LAR.

    Original languageEnglish
    Pages (from-to)524-530
    Number of pages7
    JournalAmerican Journal of Rhinology and Allergy
    Issue number5
    Early online date20 May 2019
    Publication statusPublished - 1 Sept 2019


    • Cincinatti irritant index
    • immunoglobulin E
    • inferior turbinate tissue
    • local allergic rhinitis
    • local test
    • nonallergic rhinitis


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