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]


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]


  • 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)

(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
Nonallergic rhinitis Vasomotor rhinitis Irritant triggered
Cold air/Dry air
Sexual activity[8]
Undetermined or poorly defined triggers
Gustatory rhinitis
Infectious(viral, bacterial, fungal, parasitic) Acute

(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
  • Local inflammatory type
  • Neurogenic type
  • Idiopathic(unknown) type
Rhinitis medicamentosa
Oral contraceptives
Antihypertensives and cardiovascular agents
Other drugs such as phosphodiesterase-5 selective inhibitors
Atrophic rhinitis Primary atrophic rhinitis- causes include:
  • Infection with organisms such as Klebsiella ozaenae
  • Turbulent air flow
  • Climate factors
  • Racial factors
Secondary atrophic rhinitis- causes include:
  • Extensive surgery
  • Granulomatous diseases
  • Direct trauma
  • Radiotherapy
Rhinitis associated with inflammatory-immunologic disorders Granulomatous infections
Wegener granulomatosis
Sjogren's syndrome
Midline granuloma
Churg-Strauss syndrome
Relapsing polychondritis

  • 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
  • Mild- None of the following two domains is present:
  1. Sleep disturbance; or
  2. Impairment of daily activities, leisure and/or sport; impairment in school or work OR symptoms present but do not affect quality of life
  • Moderate- One of the following two domains is present:
  1. Sleep disturbance; or
  2. Impairment of daily activities, leisure and/or sport; impairment in school or work
  • Severe- Both of the following two domains are present:
  1. Sleep disturbance; or
  2. Impairment of daily activities, leisure and/or sport; impairment in school or work


  1. 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).
  2. Settipane RA, Charnock DR (2007). "Epidemiology of rhinitis: allergic and nonallergic". Clin Allergy Immunol. 19: 23–34. PMID 17153005.
  3. 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.
  4. 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.
  5. Sacre-Hazouri JA (2012). "[Chronic rhinosinusitis in children]". Rev Alerg Mex. 59 (1): 16–24. PMID 24007929 PMID: 24007929 Check |pmid= value (help).
  6. 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. 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.
  8. Monteseirin J, Camacho MJ, Bonilla I, Sánchez-Hernández C, Hernández M, Conde J (2001). "Honeymoon rhinitis". Allergy. 56 (4): 353–4. PMID 11284809.
  9. 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.
  10. Sacre-Hazouri JA (2012). "[Chronic rhinosinusitis in children]". Rev Alerg Mex. 59 (1): 16–24. PMID pmid24007929 Check |pmid= value (help).
  11. 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.

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