Chronic Nonallergic Rhinitis

Am Fam Physician. 2018 Aug 1;98(3):171-176.


Chronic nonallergic rhinitis encompasses a group of rhinitis subtypes without allergic or infectious etiologies. Although chronic nonallergic rhinitis represents about one-fourth of rhinitis cases and impacts 20 to 30 million patients in the United States, its pathophysiology is unclear and diagnostic testing is not available. Characteristics such as no evidence of allergy or defined triggers help define clinical subtypes. There are eight subtypes with overlapping presentations, including nonallergic rhinopathy, nonallergic rhinitis with nasal eosinophilia syndrome, atrophic rhinitis, senile or geriatric rhinitis, gustatory rhinitis, drug-induced rhinitis, hormonal rhinitis, and occupational rhinitis. Treatment is symptom-driven and similar to that of allergic rhinitis. Patients should avoid known triggers when possible. First-line therapies include intranasal corticosteroids, intranasal antihistamines, and intranasal ipratropium. Combination therapy with decongestants and first-generation antihistamines can be considered if monotherapy does not adequately control symptoms. Nasal irrigation and intranasal capsaicin may be helpful but need further investigation.

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Disease Management
  • Environmental Exposure / adverse effects
  • Eosinophilia / diagnosis
  • Eosinophilia / etiology
  • Humans
  • Nasal Decongestants / therapeutic use
  • Rhinitis / classification*
  • Rhinitis / diagnosis
  • Rhinitis / etiology*


  • Adrenal Cortex Hormones
  • Nasal Decongestants