The Distinguishing Clinical Features of Nonallergic Rhinitis Patients

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

Research output: Contribution to journalArticle

Abstract

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
JournalAmerican Journal of Rhinology and Allergy
DOIs
Publication statusPublished - 1 Jan 2019

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Rhinitis
Hypersensitivity
Immunoglobulin E
Turbinates
Asthma
Irritants
Dust
Dander
Allergic Conjunctivitis
Eczema
Pollen
Skin Tests
Serum
Allergens
Allergic Rhinitis
Comorbidity
Cross-Sectional Studies
Skin

Keywords

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

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology

Cite this

The Distinguishing Clinical Features of Nonallergic Rhinitis Patients. / Wan Hamizan, Aneeza Khairiyah; Azer, Mark; Alvarado, Raquel; Earls, Peter; Barham, Henry P.; Tattersall, Jessica; Rimmer, Janet; Kalish, Larry; Sewell, William A.; Harvey, Richard.

In: American Journal of Rhinology and Allergy, 01.01.2019.

Research output: Contribution to journalArticle

Wan Hamizan, AK, Azer, M, Alvarado, R, Earls, P, Barham, HP, Tattersall, J, Rimmer, J, Kalish, L, Sewell, WA & Harvey, R 2019, 'The Distinguishing Clinical Features of Nonallergic Rhinitis Patients', American Journal of Rhinology and Allergy. https://doi.org/10.1177/1945892419850750
Wan Hamizan, Aneeza Khairiyah ; Azer, Mark ; Alvarado, Raquel ; Earls, Peter ; Barham, Henry P. ; Tattersall, Jessica ; Rimmer, Janet ; Kalish, Larry ; Sewell, William A. ; Harvey, Richard. / The Distinguishing Clinical Features of Nonallergic Rhinitis Patients. In: American Journal of Rhinology and Allergy. 2019.
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abstract = "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.",
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AU - Barham, Henry P.

AU - Tattersall, Jessica

AU - Rimmer, Janet

AU - Kalish, Larry

AU - Sewell, William A.

AU - Harvey, Richard

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