Identifying and managing rhinitis and its subtypes: allergic and nonallergic components - a consensus report and materials from the Respiratory & Allergic Disease Foundation

Background: Rhinitis is one of the most common chronic disorders presenting to an internal medicine, pediatric, or family practice clinician. It can greatly impact a patient's quality of life and exerts a tremendous societal burden in terms of both its direct and indirect costs. In practice, in treatment guidelines, and in the literature, discussions of rhinitis as an inflammatory (allergic) disease often eclipse discussions of the nonallergic components, which often contribute to, or are responsible for, a patient's disease. Recommendations for specific diagnostic criteria and treatment options for nonallergic rhinitis are often lacking compared with those addressing allergic rhinitis. Previous guidelines primarily focus on allergic rhinitis and do not provide easy-to-use tools to help primary care practitioners differentiate between, and appropriately treat, the different types of rhinitis. Although it is often difficult and time-consuming clinically to differentiate between the various rhinitis subtypes, this must be done in order to select an appropriate treatment and achieve desirable outcomes. Objective: We sought to develop a useful diagnostic worksheet and treatment algorithm to help clinicians correctly identify rhinitis subtypes and provide the appropriate therapy. Methods: An expert multidisciplinary consensus panel, comprising five allergy and immunology specialists and three ear, nose, and throat specialists with expertise in the diagnosis and treatment of rhinitis, was assembled by the Respiratory & Allergic Disease Foundation (RAD) to discuss a practical clinical approach to rhinitis that considers both inflammatory and noninflammatory elements of the disease. During this meeting, the panel discussed current data and treatment recommendations as well as clinical experiences and challenges in treating rhinitis. Materials to help simplify the diagnosis and management of rhinitis were developed as tools to aid the healthcare practitioner. Results: A rhinitis diagnostic worksheet and treatment algorithm were developed by the authors following the meeting, based on transcripts of the consensus panel's discussions. The diagnostic worksheet can be used to quickly categorize patients as having allergic, nonallergic, or 'mixed' rhinitis using descriptive criteria. Using the treatment algorithm as a guide, the appropriate treatment can then be selected based on the suspected rhinitis subtype. Conclusion: The use of these clinical practice tools may improve the management of rhinitis by helping clinicians to identify both the allergic and nonallergic components of a patient's disease and choose an appropriate treatment.