Evaluating the Risk Factors for Nonallergic Vasomotor Rhinitis

Mark T. O'Hollaren, MD


May 26, 2006

Questionnaire Evaluation and Risk Factor Identification for Nonallergic Vasomotor Rhinitis

Brandt D, Bernstein JA
Ann Allergy Asthma Immunol. 2006;96:526-532

One of the most common reasons patients seek help from a primary care physician is evaluation and treatment of nasal congestion, rhinorrhea, sneezing, and postnasal drainage. Rhinitis may be associated with significant comorbid conditions, such as sinusitis, otitis media, and asthma. It is also a common cause of missed school and work. Chronic rhinitis may have allergic triggers, or may be nonallergic in nature. Because there is vasomotor congestion involving the blood flow to the nasal membranes, nonallergic rhinitis is often termed nonallergic vasomotor rhinitis.

Brandt and Bernstein developed questionnaire outlining allergic and nonallergic triggers of rhinitis. The questionnaire was distributed in a blinded fashion to 100 patients with chronic rhinitis, selected randomly in an allergist's office. The study authors then compared the results of the questionnaire with the allergist's assessment.

It appeared that certain triggers were associated with allergic rhinitis, whereas others were associated with nonallergic rhinitis. Those triggers associated with allergic rhinitis included the production of symptoms upon exposure to cats, dogs, feathers, and other furred animals as well as seasonal variation in rhinitis symptoms. Those triggers associated with nonallergic vasomotor rhinitis include the production of symptoms upon exposure to changes in temperature, car and diesel exhaust, perfumes and fragrances, cleaning products, incense, newsprint, and hairspray as well as alcoholic beverages, eating, and spicy foods in particular. Those who had the onset of their symptoms later in life (ie, 35 years of age) were also more likely to have nonallergic vasomotor rhinitis.

Chronic rhinitis is an extremely common condition that is frequently seen by both primary care physicians and specialists in allergy and otolaryngology alike. Unlike our understanding of the pathophysiology of allergic rhinitis, the physiologic basis of nonallergic vasomotor rhinitis is poorly understood. These insights into more accurate characterization of nonallergic rhinitis through the clinical history are very helpful. The gold standard used to differentiate allergic from nonallergic rhinitis remains a careful clinical history in combination with appropriate allergy skin tests (or in selected patients, in vitro tests). There is some overlap between some of these symptoms in both allergic and nonallergic rhinitis. This research, however, may help minimize needless expenditures for allergy control devices and products if the chance of allergic triggers is significantly less likely on the basis of the clinical history.