User menu

Accès à distance ? S'identifier sur le proxy UCLouvain

Non-allergic rhinitis: Position paper of the European Academy of Allergy and Clinical Immunology.

Primary tabs

Hellings, Peter W Klimek, Ludger Cingi, Cemal Agache, Ioana Akdis, Cezmi Hox, Valérie [UCL] Hupin, Cloé [UCL] Fokkens, Wytske Johanna

This EAACI position paper aims at providing a state-of-the-art overview on nonallergic rhinitis (NAR). A significant number of patients suffering from persistent rhinitis are defined as nonallergic noninfectious rhinitis (NANIR) patients, often denominated in short as having NAR. NAR is defined as a symptomatic inflammation of the nasal mucosa with the presence of a minimum of two nasal symptoms such as nasal obstruction, rhinorrhea, sneezing, and/or itchy nose, without clinical evidence of endonasal infection and without systemic signs of sensitization to inhalant allergens. Symptoms of NAR may have a wide range of severity and be either continuously present and/or induced by exposure to unspecific triggers, also called nasal hyperresponsiveness (NHR). NHR represents a clinical feature of both AR and NAR patients. NAR involves different subgroups: drug-induced rhinitis, (nonallergic) occupational rhinitis, hormonal rhinitis (including pregnancy rhinitis), gustatory rhinitis, senile rhinitis, and idiopathic rhinitis (IR). NAR should be distinguished from those rhinitis patients with an allergic reaction confined to the nasal mucosa, also called "entopy" or local allergic rhinitis (LAR). We here provide an overview of the current consensus on phenotypes of NAR, recommendations for diagnosis, a treatment algorithm, and defining the unmet needs in this neglected area of research.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès restreint
Publication date 2017
Language Anglais
Journal information "Allergy" - Vol. 72, p. 1657-1665 (2017)
Peer reviewed yes
Publisher Wiley-Blackwell Publishing Ltd. ((Denmark) Copenhagen )
issn 0105-4538
e-issn 1398-9995
Publication status Publié
Affiliations UCL - SSS/IREC/LUNS - Pôle pneumologie, ORL (airways) et dermatologie (skin)
UCL - (SLuc) Service d'oto-rhino-laryngologie
Keywords classification ; nonallergic rhinitis ; rhinitis ; treatment
Links
  1. Bousquet J., Khaltaev N., Cruz A. A., Denburg J., Fokkens W. J., Togias A., Zuberbier T., Baena-Cagnani C. E., Canonica G. W., Van Weel C., Agache I., Aït-Khaled N., Bachert C., Blaiss M. S., Bonini S., Boulet L.-P., Bousquet P.-J., Camargos P., Carlsen K.-H., Chen Y., Custovic A., Dahl R., Demoly P., Douagui H., Durham S. R., Van Wijk R. Gerth, Kalayci O., Kaliner M. A., Kim Y.-Y., Kowalski M. L., Kuna P., Le L. T. T., Lemiere C., Li J., Lockey R. F., Mavale-Manuel S., Meltzer E. O., Mohammad Y., Mullol J., Naclerio R., O’Hehir R. E., Ohta K., Ouedraogo S., Palkonen S., Papadopoulos N., Passalacqua G., Pawankar R., Popov T. A., Rabe K. F., Rosado-Pinto J., Scadding G. K., Simons F. E. R., Toskala E., Valovirta E., Van Cauwenberge P., Wang D.-Y., Wickman M., Yawn B. P., Yorgancioglu A., Yusuf O. M., Zar H., Annesi-Maesano I., Bateman E. D., Kheder A. Ben, Boakye D. A., Bouchard J., Burney P., Busse W. W., Chan-Yeung M., Chavannes N. H., Chuchalin A., Dolen W. K., Emuzyte R., Grouse L., Humbert M., Jackson C., Johnston S. L., Keith P. K., Kemp J. P., Klossek J.-M., Larenas-Linnemann D., Lipworth B., Malo J.-L., Marshall G. D., Naspitz C., Nekam K., Niggemann B., Nizankowska-Mogilnicka E., Okamoto Y., Orru M. P., Potter P., Price D., Stoloff S. W., Vandenplas O., Viegi G., Williams D., Allergic Rhinitis and its Impact on Asthma (ARIA) 2008* : ARIA: 2008 Update, 10.1111/j.1398-9995.2007.01620.x
  2. Bousquet Jean, Bachert Claus, Canonica Giorgio W., Casale Thomas B., Cruz Alvaro A., Lockey Richard J., Zuberbier Torsten, Unmet needs in severe chronic upper airway disease (SCUAD), 10.1016/j.jaci.2009.06.027
  3. Hellings P. W., Fokkens W. J., Akdis C., Bachert C., Cingi C., Dietz de Loos D., Gevaert P., Hox V., Kalogjera L., Lund V., Mullol J., Papadopoulos N. G., Passalacqua G., Rondón C., Scadding G., Timmermans M., Toskala E., Zhang N., Bousquet J., Uncontrolled allergic rhinitis and chronic rhinosinusitis: where do we stand today?, 10.1111/all.12040
  4. Hastan D., Fokkens W. J., Bachert C., Newson R. B., Bislimovska J., Bockelbrink A., Bousquet P. J., Brozek G., Bruno A., Dahlén S. E., Forsberg B., Gunnbjörnsdóttir M., Kasper L., Krämer U., Kowalski M. L., Lange B., Lundbäck B., Salagean E., Todo-Bom A., Tomassen P., Toskala E., van Drunen C. M., Bousquet J., Zuberbier T., Jarvis D., Burney P., Chronic rhinosinusitis in Europe - an underestimated disease. A GA2LEN study : Chronic rhinosinusitis in Europe, 10.1111/j.1398-9995.2011.02646.x
  5. Fokkens, Rhinology, 50, 1 (2012)
  6. Greiner Alexander N, Hellings Peter W, Rotiroti Guiseppina, Scadding Glenis K, Allergic rhinitis, 10.1016/s0140-6736(11)60130-x
  7. Rondón Carmen, Campo Paloma, Togias Alkis, Fokkens Wytske J., Durham Stephen R., Powe Desmond G., Mullol Joaquim, Blanca Miguel, Local allergic rhinitis: Concept, pathophysiology, and management, 10.1016/j.jaci.2012.02.032
  8. Kowalski M. L., Asero R., Bavbek S., Blanca M., Blanca-Lopez N., Bochenek G., Brockow K., Campo P., Celik G., Cernadas J., Cortellini G., Gomes E., Niżankowska-Mogilnicka E., Romano A., Szczeklik A., Testi S., Torres M. J., Wöhrl S., Makowska J., Classification and practical approach to the diagnosis and management of hypersensitivity to nonsteroidal anti-inflammatory drugs, 10.1111/all.12260
  9. Morais-Almeida M., Santos N., Pereira A. M., Branco-Ferreira M., Nunes C., Bousquet J., Fonseca J. A., Prevalence and classification of rhinitis in preschool children in Portugal: a nationwide study, 10.1111/all.12221
  10. Orban, Rhinology, 51, 111 (2013)
  11. Hox V., Steelant B., Fokkens W., Nemery B., Hellings P. W., Occupational upper airway disease: how work affects the nose, 10.1111/all.12347
  12. Jovancevic, Rhinology, 48, 7 (2010)
  13. Van Gerven Laura, Alpizar Yeranddy A., Wouters Mira M., Hox Valérie, Hauben Esther, Jorissen Mark, Boeckxstaens Guy, Talavera Karel, Hellings Peter W., Capsaicin treatment reduces nasal hyperreactivity and transient receptor potential cation channel subfamily V, receptor 1 (TRPV1) overexpression in patients with idiopathic rhinitis, 10.1016/j.jaci.2013.08.026
  14. Bernstein Jonathan A., Allergic and mixed rhinitis: Epidemiology and natural history, 10.2500/aap.2010.31.3380
  15. Hellings, Rhinology, 50, 339 (2012)
  16. Bousquet J., Fokkens W., Burney P., Durham S. R., Bachert C., Akdis C. A., Canonica G. W., Dahlen S.-E., Zuberbier T., Bieber T., Bonini S., Bousquet P. J., Brozek J. L., Cardell L.-O., Crameri R., Custovic A., Demoly P., Van Wijk R. G., Gjomarkaj M., Holland C., Howarth P., Humbert M., Johnston S. L., Kauffmann F., Kowalski M. L., Lambrecht B., Lehmann S., Leynaert B., Lodrup-Carlsen K., Mullol J., Niggemann B., Nizankowska-Mogilnicka E., Papadopoulos N., Passalacqua G., Schünemann H. J., Simon H.-U., Todo-Bom A., Toskala E., Valenta R., Wickman M., Zock J. P., Important research questions in allergy and related diseases: nonallergic rhinitis: a GA2LEN paper : Important research questions in allergy and related diseases, 10.1111/j.1398-9995.2008.01715.x
  17. Westman Marit, Stjärne Pär, Asarnoj Anna, Kull Inger, van Hage Marianne, Wickman Magnus, Toskala Elina, Natural course and comorbidities of allergic and nonallergic rhinitis in children, 10.1016/j.jaci.2011.09.036
  18. Chiang Wen Chin, Chen Yu Ming, Tan Henry K.K., Balakrishnan Abhilash, Liew Woei Kang, Lim Hwee Hoon, Goh Si Hui, Loh Wen Yin, Wong Petrina, Teoh Oon Hoe, Goh Anne, Chay Oh Moh, Allergic rhinitis and non-allergic rhinitis in children in the tropics: Prevalence and risk associations, 10.1002/ppul.22554
  19. Bachert C., van Cauwenberge P., Olbrecht J., van Schoor J., Prevalence, classification and perception of allergic and nonallergic rhinitis in Belgium, 10.1111/j.1398-9995.2006.01054.x
  20. Shaaban Rafea, Zureik Mahmoud, Soussan David, Neukirch Catherine, Heinrich Joachim, Sunyer Jordi, Wjst Matthias, Cerveri Isa, Pin Isabelle, Bousquet Jean, Jarvis Deborah, Burney Peter G, Neukirch Françoise, Leynaert Bénédicte, Rhinitis and onset of asthma: a longitudinal population-based study, 10.1016/s0140-6736(08)61446-4
  21. Chawes Bo Lund Krogsgaard, Bønnelykke Klaus, Kreiner-Møller Eskil, Bisgaard Hans, Children with allergic and nonallergic rhinitis have a similar risk of asthma, 10.1016/j.jaci.2010.06.026
  22. Settipane Russell A., Other Causes of Rhinitis: Mixed Rhinitis, Rhinitis Medicamentosa, Hormonal Rhinitis, Rhinitis of the Elderly, and Gustatory Rhinitis, 10.1016/j.iac.2011.05.011
  23. MALMBERG H., GRAHNE B., HOLOPAINEN E., BINDER E., Ipratropium (Atrovent) in the treatment of vasomotor rhinitis of elderly patients, 10.1111/j.1365-2273.1983.tb01441.x
  24. Rodriguez Kenneth, Rubinstein Elaine, Ferguson Berrylin J., Clear anterior rhinorrhea in the population : Rhinorrhea of aging-a comparative study, 10.1002/alr.21583
  25. Hox Valérie, Vanoirbeek Jeroen A., Alpizar Yeranddy A., Voedisch Sabrina, Callebaut Ina, Bobic Sonja, Sharify Ali, De Vooght Vanessa, Van Gerven Laura, Devos Fien, Liston Adrian, Voets Thomas, Vennekens Rudi, Bullens Dominique M. A., De Vries Annick, Hoet Peter, Braun Armin, Ceuppens Jan L., Talavera Karel, Nemery Benoit, Hellings Peter W., Crucial Role of Transient Receptor Potential Ankyrin 1 and Mast Cells in Induction of Nonallergic Airway Hyperreactivity in Mice, 10.1164/rccm.201208-1358oc
  26. Karjalainen Antti, Martikainen Rami, Klaukka Timo, Saarinen Kimmo, Uitti Jukka, Risk of Asthma Among Finnish Patients With Occupational Rhinitis, 10.1378/chest.123.1.283
  27. Shusterman Dennis, Nonallergic Rhinitis, 10.1016/j.iac.2015.12.013
  28. Kaliner Michael A., Classification of Nonallergic Rhinitis Syndromes With a Focus on Vasomotor Rhinitis, Proposed to be known henceforth as Nonallergic Rhinopathy : , 10.1097/wox.0b013e3181a9d55b
  29. Ellegård Eva, Hellgren Margareta, Torén Kjell, Karlsson Göran, The Incidence of Pregnancy Rhinitis, 10.1159/000010223
  30. Navarrete-Palacios Evelia, Hudson Robyn, Reyes-Guerrero Gloria, Guevara-Guzmán Rosalinda, Correlation Between Cytological Characteristics of the Nasal Epithelium and the Menstrual Cycle, 10.1001/archotol.129.4.460
  31. Hamano Nanako, Terada Nobuhisa, Maesako Ken-ichi, Ikeda Tatehiko, Fukuda Setsuya, Wakita Jun, Yamashita Tetsuji, Konno Akiyoshi, Expression of Histamine Receptors in Nasal Epithelial Cells and Endothelial Cells – The Effects of Sex Hormones, 10.1159/000023904
  32. Caparroz Fábio Azevedo, Gregorio Luciano Lobato, Bongiovanni Giuliano, Izu Suemy Cioffi, Kosugi Eduardo Macoto, Rhinitis and pregnancy: literature review, 10.1016/j.bjorl.2015.04.011
  33. Wei Junxiang, Gerlich Jessica, Genuneit Jon, Nowak Dennis, Vogelberg Christian, von Mutius Erika, Radon Katja, Hormonal factors and incident asthma and allergic rhinitis during puberty in girls, 10.1016/j.anai.2015.04.019
  34. Varghese M., Glaum M. C., Lockey R. F., Drug-induced rhinitis, 10.1111/j.1365-2222.2009.03450.x
  35. Kirsche H., Klimek L., ASS-Intoleranz-Syndrom und persistierende Rhinosinusitis : Differentialdiagnostik und Therapie, 10.1007/s00106-015-0008-7
  36. Subramanian Hariharan, Gupta Kshitij, Ali Hydar, Roles of Mas-related G protein–coupled receptor X2 on mast cell–mediated host defense, pseudoallergic drug reactions, and chronic inflammatory diseases, 10.1016/j.jaci.2016.04.051
  37. Van Gerven Laura, Boeckxstaens Guy, Jorissen Mark, Fokkens Wytske, Hellings Peter W., Short-time cold dry air exposure: A useful diagnostic tool for nasal hyperresponsiveness : Cold Dry Air Exposure for NHR Diagnosis, 10.1002/lary.23495
  38. Jutel M., Papadopoulos N. G., Gronlund H., Hoffman H.-J., Bohle B., Hellings P., Braunsthal G.-J., Muraro A., Schmid-Grendelmeier P., Zuberbier T., Agache I., Recommendations for the allergy management in the primary care, 10.1111/all.12382
  39. Rondón Carmen, Fernández Javier, López Soledad, Campo Paloma, Doña Inmaculada, Torres Maria J., Mayorga Cristobalina, Blanca Miguel, Nasal inflammatory mediators and specific IgE production after nasal challenge with grass pollen in local allergic rhinitis, 10.1016/j.jaci.2009.07.018
  40. Scadding Glenis, Hellings Peter, Alobid Isam, Bachert Claus, Fokkens Wytske, van Wijk Roy, Gevaert Philippe, Guilemany Josep, Kalogjera Livije, Lund Valerie, Mullol Joaquim, Passalacqua Giovanni, Toskala Elina, van Drunen Cornelius, Diagnostic tools in Rhinology EAACI position paper, 10.1186/2045-7022-1-2
  41. Van Gerven, Rhinology, 50, 227 (2012)
  42. Powe D. G., Jagger C., Kleinjan A., Carney A. S., Jenkins D., Jones N. S., 'Entopy': localized mucosal allergic disease in the absence of systemic responses for atopy, 10.1046/j.1365-2222.2003.01737.x
  43. Rondón C., Campo P., Galindo L., Blanca-López N., Cassinello M. S., Rodriguez-Bada J. L., Torres M. J., Blanca M., Prevalence and clinical relevance of local allergic rhinitis, 10.1111/all.12002
  44. Gómez Enrique, Campo Paloma, Rondón Carmen, Barrionuevo Esther, Blanca-López Natalia, Torres María José, Herrera Rocío, Galindo Luisa, Mayorga Cristobalina, Blanca Miguel, Role of the basophil activation test in the diagnosis of local allergic rhinitis, 10.1016/j.jaci.2013.07.016
  45. Rondón Carmen, Campo Paloma, Herrera Rocío, Blanca-Lopez Natalia, Melendez Lidia, Canto Gabriela, Torres Maria J., Blanca Miguel, Nasal allergen provocation test with multiple aeroallergens detects polysensitization in local allergic rhinitis, 10.1016/j.jaci.2011.06.012
  46. Patel, Allergy Asthma Proc, 28, 735 (2007)
  47. Segboer C. L., Holland C. T., Reinartz S. M., Terreehorst I., Gevorgyan A., Hellings P. W., van Drunen C. M., Fokkens W. J., Nasal hyper-reactivity is a common feature in both allergic and nonallergic rhinitis, 10.1111/all.12255
  48. Sanico, J Appl Physiol, 86, 1202 (1999)
  49. WIJK R. GERTH, DIEGES P.H., Nasal hyper-responsiveness to histamine, methacholine and phentolamine in patients with perennial non-allergic rhinitis and in patients with infectious rhinitis, 10.1111/j.1365-2273.1991.tb01961.x
  50. BRAAT JOSEPH P. M., MULDER PAUL G., FOKKENS WYTSKE J., van WIJK ROY GERTH, RIJNTJES EVERT, Intranasal Cold Dry Air Is Superior to Histamine Challenge in Determining the Presence and Degree of Nasal Hyperreactivity in Nonallergic Noninfectious Perennial Rhinitis, 10.1164/ajrccm.157.6.9701016
  51. Togias A G, Naclerio R M, Proud D, Fish J E, Adkinson N F, Kagey-Sobotka A, Norman P S, Lichtenstein L M, Nasal challenge with cold, dry air results in release of inflammatory mediators. Possible mast cell involvement., 10.1172/jci112113
  52. Baroody Fuad M., Nonallergic Rhinitis, 10.1016/j.iac.2015.12.005
  53. Baraniuk James N., Merck Samantha J., Neuroregulation of Human Nasal Mucosa, 10.1111/j.1749-6632.2009.04481.x
  54. Tan Ricardo, Corren Jonathan, Optimum Treatment of Rhinitis in the Elderly : , 10.2165/00002512-199507030-00002
  55. Saunders C. J., Christensen M., Finger T. E., Tizzano M., Cholinergic neurotransmission links solitary chemosensory cells to nasal inflammation, 10.1073/pnas.1402251111
  56. van Rijswijk J. B., Blom H. M., Fokkens W. J., Idiopathic rhinitis, the ongoing quest, 10.1111/j.1398-9995.2005.00975.x
  57. Varricchio A., Capasso M., De Lucia A., Awisati F., Varricchio A.M., Bettoncelli G., Ciprandi G., Intranasal Flunisolide Treatment in Patients with Non-Allergic Rhinitis, 10.1177/039463201102400213
  58. LÖFKVIST THORVALD, SVENSSON GUNNAR, TREATMENT OF VASOMOTOR RHINITIS WITH INTRANASAL BECLOMETHASONE DIPROPIONATE (BECOTIDE®) : Results from a Double-Blind Cross-Over Study, 10.1111/j.1398-9995.1976.tb01683.x
  59. BLOM H, GODTHELP T, FOKKENS W, KLEINJAN A, MULDER P, RIJNTJES E, The effect of nasal steroid aqueous spray on nasal complaint scores and cellular infiltrates in the nasal mucosa of patients with nonallergic, noninfectious perennial rhinitis, 10.1016/s0091-6749(97)70267-7
  60. Jacobs Robert, Lieberman Philip, Kent Edward, Silvey MaryJane, Locantore Nicholas, Philpot Edward E., Weather/temperature-sensitive vasomotor rhinitis may be refractory to intranasal corticosteroid treatment, 10.2500/aap.2009.30.3206
  61. Lundblad Lars, Sipilä Pekka, Farstad Torkjel, Drozdziewicz Dominika, Mometasone Furoate Nasal Spray in the Treatment of Perennial Non-allergic Rhinitis: A Nordic, Multicenter, Randomized, Double-blind, Placebo-controlled Study, 10.1080/000164801300366679
  62. Gehanno P., Deschamps E., Garay E., Baehre M., Garay R.P., Vasomotor Rhinitis: Clinical Efficacy of Azelastine Nasal Spray in Comparison with Placebo, 10.1159/000055714
  63. Banov Charles H., Lieberman Phil, Efficacy of azelastine nasal spray in the treatment of vasomotor (perennial nonallergic) rhinitis, 10.1016/s1081-1206(10)62352-6
  64. Xu Jason J., Sowerby Leigh, Rotenberg Brian W., Aspirin desensitization for aspirin-exacerbated respiratory disease (Samter's Triad): a systematic review of the literature : ASA desensitization for AERD, 10.1002/alr.21202
  65. Fruth K., Pogorzelski B., Schmidtmann I., Springer J., Fennan N., Fraessdorf N., Boessert A., Schaefer D., Gosepath J., Mann W. J., Low-dose aspirin desensitization in individuals with aspirin-exacerbated respiratory disease, 10.1111/all.12131
  66. Klimek L., Pfaar O., Aspirin Intolerance: Does Desensitization Alter the Course of the Disease?, 10.1016/j.iac.2009.07.008
  67. Klimek Ludger, Dollner Ralph, Pfaar Oliver, Mullol Joaquim, Aspirin Desensitization: Useful Treatment for Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) in Aspirin-Exacerbated Respiratory Disease (AERD)?, 10.1007/s11882-014-0441-9
  68. Eriksson J., Ekerljung L., Sundblad B.-M., Lötvall J., Torén K., Rönmark E., Larsson K., Lundbäck B., Cigarette smoking is associated with high prevalence of chronic rhinitis and low prevalence of allergic rhinitis in men, 10.1111/all.12095
  69. Blom H. M., van Rijswijk J. B., Garrelds I. M., Mulder P. G. H., Timmermans T., Gerth van Wijk R., Intranasal capsaicin is efficacious in non-allergic, non-infectious perennial rhinitis. A placebo-controlled study, 10.1046/j.1365-2222.1997.670842.x
  70. Ciabatti Pier Guido, D'Ascanio Luca, Intranasal Capsicum spray in idiopathic rhinitis: a randomized prospective application regimen trial, 10.1080/00016480802510186
  71. Van Rijswijk J. B., Boeke E. L., Keizer J. M., Mulder P. G. H., Blom H. M., Fokkens W. J., Intranasal capsaicin reduces nasal hyperreactivity in idiopathic rhinitis: a double-blind randomized application regimen study, 10.1034/j.1398-9995.2003.00203.x
  72. Fokkens Wytske, Hellings Peter, Segboer Christine, Capsaicin for Rhinitis, 10.1007/s11882-016-0638-1
  73. Holland Carlijn, van Drunen Cornelis, Denyer Jane, Smart Kevin, Segboer Christine, Terreehorst Ingrid, Newlands Amy, Beerahee Misba, Fokkens Wytske, Tsitoura Daphne C., Inhibition of capsaicin-driven nasal hyper-reactivity by SB-705498, a TRPV1 antagonist : Intranasal SB-705498 in humans, 10.1111/bcp.12219
  74. Orabi Ahmad A., Sen Aloke, Timms Michael S., Morar Pradeep, Patient satisfaction survey of outpatient-based topical local anesthetic KTP laser inferior turbinectomy: A prospective study, 10.2500/ajr.2007.21.3004
  75. Robinson, Am J Rhinol, 20, 197 (2006)
Bibliographic reference Hellings, Peter W ; Klimek, Ludger ; Cingi, Cemal ; Agache, Ioana ; Akdis, Cezmi ; et. al. Non-allergic rhinitis: Position paper of the European Academy of Allergy and Clinical Immunology.. In: Allergy, Vol. 72, p. 1657-1665 (2017)
Permanent URL http://hdl.handle.net/2078.1/191178