Rhinitis natural history, complications and prognosis

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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 is a heterogeneous group of disorders that can significantly impact the quality of life of the affected individual[1] A heightened awareness of the condition and its potential debilitating comorbidities/complications is essential for a timely intervention.[1][2]

Natural History, Complications, Prognosis

Natural History

Rhinitis is a very common disease, and it is sometimes erroneously viewed as a trivial disease.[3][1] Allergic rhinitis rarely occurs in isolation, it is a product of a genetic predisposition, epigenetic events, and environmental exposures, and it is frequently associated with other forms of atopy such as eczema, asthma, and allergic eye disease(allergic rhinoconjunctivitis).[4][5][6] The vast majority of individuals with asthma have rhinitis, and allergic eye disease has been reported to affect almost all patients with allergic rhinitis.[4][7] Nonallergic rhinitis is also associated with asthma.[8][7] Frequent extension of rhinitis into the sinuses also occur, resulting in rhinosinusitis.[9][1] Children with nonallergic rhinitis have a higher likelihood of undergoing remission, compared with those with allergic rhinitis, who tend to have a more persistent disease.[8] Remission occurs in up to 73% of four year old children with nonallergic rhinitis by the age of eight years.[8] Rhinitis is a significant cause of lost school and work days, and it constitutes a huge financial burden to the society.[10][3] Untreated/poorly treated chronic rhinitis is associated with a diminished quality of life, disordered sleep, impaired work performance, and several other co-morbidities.[1][5]


The complications of rhinitis include the following:[7][3][11]

Allergic comorbidities associated with Allergic rhinitis include:[7]

  • Allergic eye diseases[4]
  1. Seasonal allergic conjunctivitis
  2. Perennial allergic conjunctivitis
  3. Vernal keratoconjunctivitis
  4. Atopic keratoconjunctivitis


Resolution of allergic rhinitis occurs in only 10-20% of children within 10 years.[17] A higher likelihood of remission has been documented in children with nonallergic rhinitis compared to the allergic type, with remission occurring within four years in about 73% of four year old children suffering from nonallergic rhinitis.[8] Poorly treated rhinitis is strongly associated with a decreased quality of life and several other co-morbidities.[1]


  1. 1.0 1.1 1.2 1.3 1.4 1.5 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.
  2. Skoner DP (2001). "Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis". J Allergy Clin Immunol. 108 (1 Suppl): S2–8. PMID 11449200.
  3. 3.0 3.1 3.2 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 18662584.
  4. 4.0 4.1 4.2 Shaker M, Salcone E (2016). "An update on ocular allergy". Curr Opin Allergy Clin Immunol. 16 (5): 505–10. doi:10.1097/ACI.0000000000000299. PMID 27490123.
  5. 5.0 5.1 Sacre Hazouri JA (2006). "[Allergic rhinitis. Coexistent diseases and complications. A review and analysis]". Rev Alerg Mex. 53 (1): 9–29. PMID 16634358.
  6. Mims JW (2014). "Epidemiology of allergic rhinitis". Int Forum Allergy Rhinol. 4 Suppl 2: S18–20. doi:10.1002/alr.21385. PMID 25182349.
  7. 7.0 7.1 7.2 7.3 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. 8.0 8.1 8.2 8.3 Westman M, Stjärne P, Asarnoj A, Kull I, van Hage M, Wickman M; et al. (2012). "Natural course and comorbidities of allergic and nonallergic rhinitis in children". J Allergy Clin Immunol. 129 (2): 403–8. doi:10.1016/j.jaci.2011.09.036. PMID 22056609.
  9. Dykewicz MS, Hamilos DL (2010). "Rhinitis and sinusitis". J Allergy Clin Immunol. 125 (2 Suppl 2): S103–15. doi:10.1016/j.jaci.2009.12.989. PMID 20176255.
  10. Schoenwetter WF, Dupclay L, Appajosyula S, Botteman MF, Pashos CL (2004). "Economic impact and quality-of-life burden of allergic rhinitis". Curr Med Res Opin. 20 (3): 305–17. doi:10.1185/030079903125003053. PMID 15025839.
  11. Blaiss MS (2008). "Pediatric allergic rhinitis: physical and mental complications". Allergy Asthma Proc. 29 (1): 1–6. doi:10.2500/aap2008.29.3072. PMID 18302831.
  12. 12.0 12.1 Sih T, Mion O (2010). "Allergic rhinitis in the child and associated comorbidities". Pediatr Allergy Immunol. 21 (1 Pt 2): e107–13. doi:10.1111/j.1399-3038.2009.00933.x. PMID 19664013.
  13. Turley R, Cohen SM, Becker A, Ebert CS (2011). "Role of rhinitis in laryngitis: another dimension of the unified airway". Ann Otol Rhinol Laryngol. 120 (8): 505–10. PMID 21922973.
  14. Deliu M, Belgrave D, Simpson A, Murray CS, Kerry G, Custovic A (2014). "Impact of rhinitis on asthma severity in school-age children". Allergy. 69 (11): 1515–21. doi:10.1111/all.12467. PMC 4209798. PMID 24958195.
  15. Rotiroti, Giuseppina; Scadding, Glenis (July 2016). "Allergic Rhinitis-an overview of a common disease". Paediatrics and Child Health. Volume 26 (Issue 7): 298–303. Retrieved January 20, 2017.
  16. Baig MA, Qadir A, Rasheed J (2006). "A review of eosinophilic gastroenteritis". J Natl Med Assoc. 98 (10): 1616–9. PMC 2569760. PMID 17052051  17052051 Check |pmid= value (help).
  17. Sly RM (1999). "Changing prevalence of allergic rhinitis and asthma". Ann Allergy Asthma Immunol. 82 (3): 233–48, quiz 248-52. doi:10.1016/S1081-1206(10)62603-8. PMID 10094214.

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