Rhinitis management guidelines

The British Society for Allergy and Clinical Immunology

Classification and differential diagnosis

  • Rhinitis is defined as having two of the listed symptoms for ≥1 hour/day for ≥2 weeks
    • blockage
    • running (including postnasal drip)
    • sneezing (including nasal itch)
  • Classification is shown in the chart below
  • Nasal problems are often multifactorial, this needs to be taken into account when using the classification or considering treatment
  • Allergic rhinitis:
    • is common and affects over 20% of the UK population
    • is diagnosed by history and examination, and should be backed up by specific allergy tests where identification of specific triggers will enable avoidance or affect choice of treatment
  • Non-allergic rhinitis:
    • has a multifactorial aetiology
    • if eosinophilic, usually responds to treatment with corticosteroids
    • may be a presenting complaint for systemic disorders such as Wegener’s granulomatosis, Churg–Strauss syndrome and sarcoidoisis
  • Infective rhinitis:
    • can be caused by viruses, and less commonly by bacteria, fungi and protozoa
    • is often more severe in allergic patients especially if infection occurs at the time of allergen exposure
    • treatment that addresses only the acute problem may result in incomplete resolution of the infection or a later recurrence
  • Since the mucosa of the the nose and sinuses is continuous, rhinitis should be called rhinosinusitis

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