Current Approaches to Diagnosis and Management of Rhinitis
Current Approaches to Diagnosis and Management of Rhinitis
Rhinitis affects >20% of the population and is a common reason patients visit their primary care physician. Proper therapeutic intervention initially requires differentiating rhinitis from acute and chronic rhinosinusitis. After establishing rhinitis as the etiology of a patient's symptoms, a careful, thoughtful history and physical examination aids the cause. Rhinitis can be allergic, nonallergic, or mixed (having features of both allergic and nonallergic rhinitis). Therapeutic interventions vary, depending on the etiology of rhinitis. Symptoms that are refractory to avoidance and pharmacotherapy warrant referral to an allergist or otolaryngologist for consideration of immunotherapy or surgical intervention. In many cases, adhering to an evidence-based therapeutic treatment algorithm will allow physicians to effectively manage rhinitis.
Rhinitis is defined as inflammation of the nose and nasal cavity. Differentiating rhinitis from acute and chronic rhinosinusitis can be challenging. All three diagnoses are extremely common in the primary care and emergency department setting. There is also significant overlap in the presenting constellation of symptoms. Rhinitis alone is estimated to affect >20% of the adult population in the United States and cost billions in healthcare spending annually. Rhinitis is further separated into subclassifications that ultimately direct therapeutic planning. A systematic approach with careful attention to subtle differences in symptoms and physical findings allows one to differentiate rhinitis from acute or chronic rhinosinusitis and determine when and whether consultant referral is needed.
Rhinitis encompasses three primary entities: allergic rhinitis (AR), nonallergic rhinitis (NAR), and mixed rhinitis (MR), which involves elements of both AR and NAR. In addition, less common forms of rhinitis, including neoplastic and obstructive rhinitis, should be on the differential. AR is the most common form, affecting >32 million Americans. NAR is estimated to affect >19 million Americans, and MR affects >26 million Americans.
Rhinitis is a disease affecting all ages and races, with patient complaints of rhinorrhea, sneezing, and nasal congestion. Decreased quality of life, increased missed work hours, and increased healthcare utilization contribute to the broad economic burden of rhinitis. Considerable overlap in rhinitis types (Fig. 1) can make diagnosis and management challenging. The impact and prevalence of the various forms of rhinitis change with age; older adult populations have a higher frequency of NAR, whereas pediatric and young adult populations have an increased frequency of AR. No matter the age or specific subtype of rhinitis, accurate diagnosis and treatment are critical to improve quality of life for this population.
(Enlarge Image)
Figure 1.
Overlap in rhinitis types can make diagnosis and management challenging. AR, allergic rhinitis;MR,mixed rhinitis; NAR, nonallergic rhinitis.
Abstract and Introduction
Abstract
Rhinitis affects >20% of the population and is a common reason patients visit their primary care physician. Proper therapeutic intervention initially requires differentiating rhinitis from acute and chronic rhinosinusitis. After establishing rhinitis as the etiology of a patient's symptoms, a careful, thoughtful history and physical examination aids the cause. Rhinitis can be allergic, nonallergic, or mixed (having features of both allergic and nonallergic rhinitis). Therapeutic interventions vary, depending on the etiology of rhinitis. Symptoms that are refractory to avoidance and pharmacotherapy warrant referral to an allergist or otolaryngologist for consideration of immunotherapy or surgical intervention. In many cases, adhering to an evidence-based therapeutic treatment algorithm will allow physicians to effectively manage rhinitis.
Introduction
Rhinitis is defined as inflammation of the nose and nasal cavity. Differentiating rhinitis from acute and chronic rhinosinusitis can be challenging. All three diagnoses are extremely common in the primary care and emergency department setting. There is also significant overlap in the presenting constellation of symptoms. Rhinitis alone is estimated to affect >20% of the adult population in the United States and cost billions in healthcare spending annually. Rhinitis is further separated into subclassifications that ultimately direct therapeutic planning. A systematic approach with careful attention to subtle differences in symptoms and physical findings allows one to differentiate rhinitis from acute or chronic rhinosinusitis and determine when and whether consultant referral is needed.
Rhinitis encompasses three primary entities: allergic rhinitis (AR), nonallergic rhinitis (NAR), and mixed rhinitis (MR), which involves elements of both AR and NAR. In addition, less common forms of rhinitis, including neoplastic and obstructive rhinitis, should be on the differential. AR is the most common form, affecting >32 million Americans. NAR is estimated to affect >19 million Americans, and MR affects >26 million Americans.
Rhinitis is a disease affecting all ages and races, with patient complaints of rhinorrhea, sneezing, and nasal congestion. Decreased quality of life, increased missed work hours, and increased healthcare utilization contribute to the broad economic burden of rhinitis. Considerable overlap in rhinitis types (Fig. 1) can make diagnosis and management challenging. The impact and prevalence of the various forms of rhinitis change with age; older adult populations have a higher frequency of NAR, whereas pediatric and young adult populations have an increased frequency of AR. No matter the age or specific subtype of rhinitis, accurate diagnosis and treatment are critical to improve quality of life for this population.
(Enlarge Image)
Figure 1.
Overlap in rhinitis types can make diagnosis and management challenging. AR, allergic rhinitis;MR,mixed rhinitis; NAR, nonallergic rhinitis.