Rhinitis classification: Difference between revisions

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Latest revision as of 00:00, 30 July 2020

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
	Infectious(viral, bacterial, fungal, parasitic)	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
	Hormonally-induced	Menstrual cycle related
	Drug-induced^[9] Local inflammatory type Neurogenic type Idiopathic(unknown) type	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: Infection with organisms such as Klebsiella ozaenae Turbulent air flow Climate factors Racial factors
	Atrophic rhinitis	Secondary atrophic rhinitis- causes include: Extensive surgery Granulomatous diseases Direct trauma Radiotherapy
	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
Mild- None of the following two domains is present: Sleep disturbance; or 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: Sleep disturbance; or Impairment of daily activities, leisure and/or sport; impairment in school or work Severe- Both of the following two domains are present: Sleep disturbance; or Impairment of daily activities, leisure and/or sport; impairment in school or work

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.

Template:WH Template:WS

[pmidPMID:18662584-1] 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).

[pmid17153005-2] Settipane RA, Charnock DR (2007). "Epidemiology of rhinitis: allergic and nonallergic". Clin Allergy Immunol. 19: 23–34. PMID 17153005.

[CTOIA-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.

[pmid21364228-4] 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.

[pmidPMID:_24007929-5] Sacre-Hazouri JA (2012). "[Chronic rhinosinusitis in children]". Rev Alerg Mex. 59 (1): 16–24. PMID 24007929 PMID: 24007929 Check |pmid= value (help).

[Diseases_of_the_Sinuses-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.

[pmid18331513-7] 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.

[pmid11284809-8] Monteseirin J, Camacho MJ, Bonilla I, Sánchez-Hernández C, Hernández M, Conde J (2001). "Honeymoon rhinitis". Allergy. 56 (4): 353–4. PMID 11284809.

[pmid20210811-9] 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.

[pmidpmid24007929-10] Sacre-Hazouri JA (2012). "[Chronic rhinosinusitis in children]". Rev Alerg Mex. 59 (1): 16–24. PMID pmid24007929 Check |pmid= value (help).

[pmid16950299-11] 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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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Rhinitis}}
-{{CMG}}
+{{CMG}}{{AE}} {{FB}}
 ==Overview==
+Rhinitis can be broadly classified into allergic and nonallergic rhinitis.<ref name="pmidPMID:18662584">{{cite journal| author=Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA et al.| title=The diagnosis and management of rhinitis: an updated practice parameter. | journal=J Allergy Clin Immunol | year= 2008 | volume= 122 | issue= 2 Suppl | pages= S1-84 | pmid=PMID:18662584 | doi=10.1016/j.jaci.2008.06.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18662584  }} </ref> Some forms of rhinitis are not easily classified as either allergic or nonallergic,<ref name="pmidPMID:18662584" /> and sometimes, there also appear to be an overlap of both allergic and nonallergic rhinitis (sometimes referred to as 'mixed' rhinitis).<ref name="pmid17153005">{{cite journal| author=Settipane RA, Charnock DR| title=Epidemiology of rhinitis: allergic and nonallergic. | journal=Clin Allergy Immunol | year= 2007 | volume= 19 | issue=  | pages= 23-34 | pmid=17153005 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17153005  }} </ref> 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.<ref name="CTOIA">{{cite journal |last=Paraskevopoulos |first=Giannis |last2=Kalogiros |first2=Lampros |date=March 2016 |title=Non-Allergic Rhinitis |url=http://link.springer.com/article/10.1007/s40521-016-0072-6 |journal=Current Treatment Options in Allergy |volume= Volume 3 |issue= Issue 1 |pages=45–68 |doi=10.1007/s40521-016-0072-6 |access-date=January 5, 2017 }} </ref>
 ==Classification==
+* Rhinitis can be broadly classified into allergic and nonallergic rhinitis, however, some forms of rhinitis cannot be easily classified into these two categories.<ref name="pmidPMID:18662584">{{cite journal| author=Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA et al.| title=The diagnosis and management of rhinitis: an updated practice parameter. | journal=J Allergy Clin Immunol | year= 2008 | volume= 122 | issue= 2 Suppl | pages= S1-84 | pmid=PMID:18662584 | doi=10.1016/j.jaci.2008.06.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18662584  }} </ref>  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.<ref name="pmid21364228">{{cite journal| author=Sin B, Togias A| title=Pathophysiology of allergic and nonallergic rhinitis. | journal=Proc Am Thorac Soc | year= 2011 | volume= 8 | issue= 1 | pages= 106-14 | pmid=21364228 | doi=10.1513/pats.201008-057RN | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21364228  }} </ref> A  comprehensive classification of rhinitis based on the etiology is depicted in the table below:
 {| class="wikitable"
-! colspan="3" |'''Classification of Rhinitis'''
+! colspan="3" |'''Classification of Rhinitis'''<ref name="pmidPMID:18662584" /><ref name="pmidPMID: 24007929">{{cite journal| author=Sacre-Hazouri JA| title=[Chronic rhinosinusitis in children]. | journal=Rev Alerg Mex | year= 2012 | volume= 59 | issue= 1 | pages= 16-24 | pmid=PMID: 24007929 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24007929  }} </ref><ref name="Diseases of the Sinuses">{{cite book |last1=Romeo |first1=Jonathan |last2=Dykewicz |first2=Mark |title=Diseases of the Sinuses |publisher=Springer New York |date=2014 |pages=133-152 |chapter=Chapter 9:Differential Diagnosis of Rhinitis and Rhinosinusitis |isbn=978-1-4939-0265-1}}</ref><ref name="pmid18331513" />
 |-
-| rowspan="4" |'''Allergic rhinitis'''
+!Class
-|''Traditional classification of allergic rhinitis''
+! colspan="2" |Types/causes
-|''ARIA classification of allergic rhinitis''
 |-
-|Seasonal
+| rowspan="5" |'''Allergic rhinitis'''
-|Intermittent
+| rowspan="3" |''US Joint Task Force on Practice Parameters(JTF) classification of allergic rhinitis''
+|Seasonal ([[hay fever]])
 |-
 |Perennial
-|Persistent
 |-
 |Episodic
-|
+(Triggered by sporadic exposure to aeroallergens not normally present in the patient's environment)
+|-
+| rowspan="2" |''Allergic Rhinitis and its Impact on Asthma(ARIA) classification of allergic rhinitis''
+|Intermittent
+|-
+|Persistent
 |-
-| rowspan="8" |'''Nonallergic rhinitis'''
+| rowspan="10" |'''Nonallergic rhinitis'''
-| rowspan="4" |Vasomotor rhinitis
+| rowspan="6" |[[Vasomotor rhinitis]]
 |Irritant triggered
 |-
@@ Line 28: / Line 34: @@
 |-
 |Exercise
+|-
+|Emotional
+|-
+|Sexual activity<ref name="pmid11284809">{{cite journal| author=Monteseirin J, Camacho MJ, Bonilla I, Sánchez-Hernández C, Hernández M, Conde J| title=Honeymoon rhinitis. | journal=Allergy | year= 2001 | volume= 56 | issue= 4 | pages= 353-4 | pmid=11284809 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11284809  }} </ref>
 |-
 |Undetermined or poorly defined triggers
@@ Line 34: / Line 44: @@
 |
 |-
-| rowspan="2" |Infectious
+| rowspan="2" |Infectious(viral, bacterial, fungal, parasitic)
 |Acute
 |-
@@ Line 40: / Line 50: @@
 |-
 |NARES
+(Nonallergic rhinitis with eosinophilia syndrome)
 |
 |-
@@ Line 45: / Line 56: @@
 |IgE-mediated
 (caused by protein and chemical allergens)
-|
+| rowspan="3" |
 |-
 |Immune mechanism uncertain
 (caused by chemical respiratory sensitizers)
-|
 |-
-|Work-aggravated rhinitis
+|Work-exacerbated/work-aggravated rhinitis
-|
+(occurs in nonoccupational settings but it is aggravated by work exposure)
 |-
-| rowspan="15" |'''Other rhinitis syndromes'''
+| rowspan="17" |'''Other rhinitis syndromes'''
-| rowspan="2" |Hormonally induced
+| rowspan="2" |Hormonally-induced
 |Gestational
 |-
 |Menstrual cycle related
 |-
-| rowspan="5" |Drug-induced
+| rowspan="5" |Drug-induced<ref name="pmid20210811">{{cite journal| author=Varghese M, Glaum MC, Lockey RF| title=Drug-induced rhinitis. | journal=Clin Exp Allergy | year= 2010 | volume= 40 | issue= 3 | pages= 381-4 | pmid=20210811 | doi=10.1111/j.1365-2222.2009.03450.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20210811  }} </ref>
-|Rhinitis medicamentosa
+* Local inflammatory type
+* Neurogenic type
+* Idiopathic(unknown) type
+|[[Rhinitis medicamentosa]]
 |-
-|Oral contraceptives
+|[[Oral contraceptives]]
 |-
-|Antihypertensives and cardiovascular agents
+|[[Antihypertensives]] and cardiovascular agents
 |-
-|Aspirin/NSAIDs
+|[[Aspirin]]/[[NSAIDs]]
 |-
-|Other drugs
+|Other drugs such as phosphodiesterase-5 selective inhibitors
 |-
-|Atrophic rhinitis
+| rowspan="2" |[[Atrophic rhinitis]]
-|
+|[[Atrophic rhinitis|Primary atrophic rhinitis]]- causes include:
+* Infection with organisms such as Klebsiella ozaenae
+* Turbulent air flow
+* Climate factors
+* Racial factors
+|-
+|[[Atrophic rhinitis|Secondary atrophic rhinitis]]- causes include:
+* Extensive surgery
+* Granulomatous diseases
+* Direct trauma
+* Radiotherapy
 |-
-| rowspan="7" |Rhinitis associated with inflammatory-immunologic
+| rowspan="8" |Rhinitis associated with inflammatory-immunologic disorders
-disorders
 |Granulomatous infections
 |-
-|Wegener granulomatosis
+|[[Wegener granulomatosis]]
 |-
-|Sarcoidosis
+|[[Sarcoidosis]]
+|-
+|[[Sjogren's syndrome]]
 |-
 |Midline granuloma
 |-
-|Churg-Strauss
+|[[Churg-Strauss|Churg-Strauss syndrome]]
 |-
-|Relapsing polychondritis
+|[[Relapsing polychondritis]]
 |-
-|Amyloidosis
+|[[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.<ref name="pmidPMID:18662584" />
+{| class="wikitable"
+! colspan="2" |Modified Classification of Allergic Rhinitis According to Severity of Symptoms and Quality of Life Impairment<ref name="pmidpmid24007929">{{cite journal| author=Sacre-Hazouri JA| title=[Chronic rhinosinusitis in children]. | journal=Rev Alerg Mex | year= 2012 | volume= 59 | issue= 1 | pages= 16-24 | pmid=pmid24007929 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24007929  }} </ref><ref name="pmid18331513">{{cite journal| author=Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A et al.| title=Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). | journal=Allergy | year= 2008 | volume= 63 Suppl 86 | issue=  | pages= 8-160 | pmid=18331513 | doi=10.1111/j.1398-9995.2007.01620.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18331513  }} </ref><ref name="pmid16950299">{{cite journal| author=Van Hoecke H, Vastesaeger N, Dewulf L, De Bacquer D, van Cauwenberge P| title=Is the allergic rhinitis and its impact on asthma classification useful in daily primary care practice? | journal=J Allergy Clin Immunol | year= 2006 | volume= 118 | issue= 3 | pages= 758-9 | pmid=16950299 | doi=10.1016/j.jaci.2006.05.015 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16950299  }} </ref>
+;
+|-
+|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
+|-
+| colspan="2" |
+* Mild- None of the following two domains is present:
+# Sleep disturbance; or
+# 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:
+# Sleep disturbance; or
+# Impairment of daily activities, leisure and/or sport; impairment in school or work
+* Severe- Both of the following two domains are present:
+# Sleep disturbance; or
+# Impairment of daily activities, leisure and/or sport; impairment in school or work
 |}
@@ Line 95: / Line 149: @@
 {{WH}}
 {{WS}}
-[[Category:Needs content]]
 [[Category:Disease]]
-[[Category:Bacterial diseases]]
+[[Category:Up-To-Date]]
-[[Category:Pulmonology]]
 [[Category:Infectious disease]]
+[[Category:Otolaryngology]]
+[[Category:Immunology]]

Rhinitis classification: Difference between revisions

Latest revision as of 00:00, 30 July 2020

Overview

Classification

References

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