Nasal hyperreactivity in allergic and non-allergic rhinitis: a potential risk factor for non-specific building-related illness

Indoor Air. 2007 Aug;17(4):328-33. doi: 10.1111/j.1600-0668.2007.00482.x.


Self-reported non-allergic nasal symptom triggers in non-allergic ('vasomotor') rhinitis overlap with commonly identified environmental exposures in non-specific building-related illness. These include extremes of temperature and humidity, cleaning products, fragrances, and tobacco smoke. Some individuals with allergic rhinitis also report non-allergic triggers. We wished to explore the phenotypic overlap between allergic and non-allergic rhinitis by ascertaining self-reported non-allergic nasal symptom triggers among allergic rhinitics. Sixty subjects without work-related respiratory exposures or symptoms, aged 19-68 years, stratified by age, gender and (skin test-proven) allergic rhinitis status, were queried with regard to self-reported non-allergic nasal symptom triggers (aggregate score 0-8). In this sample, the number of self-reported non-allergic triggers was bimodal, with peaks at 1 and 5. Forty-two percent of seasonal allergic rhinitic subjects reported more than three non-allergic triggers, compared with only 3% of non-allergic non-rhinitics (P < 0.01). Subjects over 35 years were more likely to report one or more non-allergic triggers, particularly tobacco smoke (P < 0.05). Allergic rhinitics reported more non-allergic symptom triggers than did non-allergic, non-rhinitics. As indexed by self-reported reactivity to non-specific physical and chemical triggers, both non-allergic rhinitics and a subset of allergic rhinitics may constitute susceptible populations for non-specific building-related illness.

Practical implications: Judging by self-report, a substantial subset of individuals with allergic rhinitis--along with all individuals with nonallergic rhinitis (by definition)--are hyperreactive to non-allergic triggers. There is overlap between these triggers (elicited in the process of obtaining a clinical diagnosis) and environmental characteristics associated with ''problem buildings.'' Since individuals with self-identified rhinitis report an excess of symptoms in most epidemiologic studies of problem buildings (even in the absence of unusual aeroallergen levels), rhintics may be acting as a ''sentinel'' subgroup when indoor air quality is suboptimal. Together, non-allergic rhinitics plus allergic rhinitics with prominent non-allergic triggers, are thought to constitute approximately one-sixth of the US population.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Air Pollutants / adverse effects*
  • Bronchial Hyperreactivity / epidemiology
  • Bronchial Hyperreactivity / etiology
  • Bronchial Hyperreactivity / pathology*
  • Detergents / adverse effects
  • Environmental Exposure* / adverse effects
  • Environmental Exposure* / statistics & numerical data
  • Household Products / adverse effects
  • Humans
  • Humidity
  • Middle Aged
  • Perfume / adverse effects
  • Rhinitis / epidemiology
  • Rhinitis / etiology
  • Rhinitis / pathology*
  • Rhinitis, Allergic, Perennial / epidemiology
  • Rhinitis, Allergic, Perennial / etiology
  • Rhinitis, Allergic, Perennial / pathology
  • Rhinitis, Allergic, Seasonal / epidemiology
  • Rhinitis, Allergic, Seasonal / etiology
  • Rhinitis, Allergic, Seasonal / pathology
  • Risk Factors
  • Seasons
  • Sex Factors
  • Skin / immunology*
  • Temperature
  • Tobacco Smoke Pollution / adverse effects


  • Air Pollutants
  • Detergents
  • Perfume
  • Tobacco Smoke Pollution