Rhinitis classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Fatimo Biobaku M.B.B.S [2]
Overview
Rhinitis can be broadly classified into allergic and nonallergic rhinitis.[1] Some forms of rhinitis are not easily classified as either allergic or nonallergic,[1] and sometimes, there also appear to be an overlap of both allergic and nonallergic rhinitis (sometimes referred to as 'mixed' rhinitis).[2] The classification and diagnosis of nonallergic rhinitis is challenging due to its diverse etiology, and it is also not well understood compared to the allergic type.[3]
Classification
- Rhinitis can be broadly classified into allergic and nonallergic rhinitis, however, some forms of rhinitis cannot be easily classified into these two categories.[1] An understanding of the fact that there is no widely accepted and scientifically valid classification of the various forms of rhinitis is essential, this is mostly due to the poor phenotyping of the forms of rhinitis that do not fall under the allergic and infectious categories.[4] A comprehensive classification of rhinitis based on the etiology is depicted in the table below:
| Classification of Rhinitis[1][5][6][7] | ||
|---|---|---|
| Class | Types/causes | |
| Allergic rhinitis | US Joint Task Force on Practice Parameters(JTF) classification of allergic rhinitis | Seasonal (hay fever) |
| Perennial | ||
| Episodic
(Triggered by sporadic exposure to aeroallergens not normally present in the patient's environment) | ||
| Allergic Rhinitis and its Impact on Asthma(ARIA) classification of allergic rhinitis | Intermittent | |
| Persistent | ||
| Nonallergic rhinitis | Vasomotor rhinitis | Irritant triggered |
| Cold air/Dry air | ||
| Exercise | ||
| Emotional | ||
| Sexual activity[8] | ||
| Undetermined or poorly defined triggers | ||
| Gustatory rhinitis | ||
| Infectious(viral, bacterial, fungal, parasitic) | Acute | |
| Chronic | ||
| NARES
(Nonallergic rhinitis with eosinophilia syndrome) |
||
| Occupational rhinitis | IgE-mediated
(caused by protein and chemical allergens) |
|
| Immune mechanism uncertain
(caused by chemical respiratory sensitizers) | ||
| Work-exacerbated/work-aggravated rhinitis
(occurs in nonoccupational settings but it is aggravated by work exposure) | ||
| Other rhinitis syndromes | Hormonally-induced | Gestational |
| Menstrual cycle related | ||
Drug-induced[9]
|
Rhinitis medicamentosa | |
| Oral contraceptives | ||
| Antihypertensives and cardiovascular agents | ||
| Aspirin/NSAIDs | ||
| Other drugs such as phosphodiesterase-5 selective inhibitors | ||
| Atrophic rhinitis | Primary atrophic rhinitis- causes include:
| |
Secondary atrophic rhinitis- causes include:
| ||
| Rhinitis associated with inflammatory-immunologic disorders | Granulomatous infections | |
| Wegener granulomatosis | ||
| Sarcoidosis | ||
| Sjogren's syndrome | ||
| Midline granuloma | ||
| Churg-Strauss syndrome | ||
| Relapsing polychondritis | ||
| Amyloidosis | ||
- Allergic rhinitis can also be graded by the level of severity. However, there is no generally accepted method for grading the severity of allergic rhinitis.[1]
| Modified Classification of Allergic Rhinitis According to Severity of Symptoms and Quality of Life Impairment[10][7][11]
| |
|---|---|
| Type of allergic rhinitis | Clinical characteristic |
| Intermittent | Symptoms are present on fewer than four days a week and for less than four weeks |
| Persistent | Symptoms are present on more than four days a week and for more than four consecutive weeks |
| |
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA; et al. (2008). "The diagnosis and management of rhinitis: an updated practice parameter". J Allergy Clin Immunol. 122 (2 Suppl): S1–84. doi:10.1016/j.jaci.2008.06.003. PMID PMID:18662584 Check
|pmid=value (help). - ↑ Settipane RA, Charnock DR (2007). "Epidemiology of rhinitis: allergic and nonallergic". Clin Allergy Immunol. 19: 23–34. PMID 17153005.
- ↑ Paraskevopoulos, Giannis; Kalogiros, Lampros (March 2016). "Non-Allergic Rhinitis". Current Treatment Options in Allergy. Volume 3 (Issue 1): 45–68. doi:10.1007/s40521-016-0072-6. Retrieved January 5, 2017.
- ↑ Sin B, Togias A (2011). "Pathophysiology of allergic and nonallergic rhinitis". Proc Am Thorac Soc. 8 (1): 106–14. doi:10.1513/pats.201008-057RN. PMID 21364228.
- ↑ Sacre-Hazouri JA (2012). "[Chronic rhinosinusitis in children]". Rev Alerg Mex. 59 (1): 16–24. PMID 24007929 PMID: 24007929 Check
|pmid=value (help). - ↑ Romeo, Jonathan; Dykewicz, Mark (2014). "Chapter 9:Differential Diagnosis of Rhinitis and Rhinosinusitis". Diseases of the Sinuses. Springer New York. pp. 133–152. ISBN 978-1-4939-0265-1.
- ↑ 7.0 7.1 Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A; et al. (2008). "Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen)". Allergy. 63 Suppl 86: 8–160. doi:10.1111/j.1398-9995.2007.01620.x. PMID 18331513.
- ↑ Monteseirin J, Camacho MJ, Bonilla I, Sánchez-Hernández C, Hernández M, Conde J (2001). "Honeymoon rhinitis". Allergy. 56 (4): 353–4. PMID 11284809.
- ↑ Varghese M, Glaum MC, Lockey RF (2010). "Drug-induced rhinitis". Clin Exp Allergy. 40 (3): 381–4. doi:10.1111/j.1365-2222.2009.03450.x. PMID 20210811.
- ↑ Sacre-Hazouri JA (2012). "[Chronic rhinosinusitis in children]". Rev Alerg Mex. 59 (1): 16–24. PMID pmid24007929 Check
|pmid=value (help). - ↑ Van Hoecke H, Vastesaeger N, Dewulf L, De Bacquer D, van Cauwenberge P (2006). "Is the allergic rhinitis and its impact on asthma classification useful in daily primary care practice?". J Allergy Clin Immunol. 118 (3): 758–9. doi:10.1016/j.jaci.2006.05.015. PMID 16950299.