The Sensitive Nose: Allergic and Non-allergic Causes

Abstract Purpose of Review The purpose of this review is to categorize and describe allergic and nonallergic causes, pathophysiology, subtypes, and treatment options for symptomatic nasal inflammation and rhinitis in general. Recent Findings Intranasal corticosteroids and antihistamines along with allergen immunotherapy are the standard of care for allergic rhinitis. While intranasal anticholinergics and corticosteroids are treatment options for non-allergic rhinitis. Both subtypes may benefit from surgical treatment with posterior nerve ablation/neurectomy and/or inferior turbinate reduction. Randomized control trials and meta-analyses on biologics and allergen extract adjuvants for allergic rhinitis, as well as capsaicin, acoustic resonance therapy, and inferior turbinate injection for nonallergic rhinitis are ongoing. Summary In patients with symptomatic nasal congestion and rhinorrhea, thorough history and allergy testing can often elucidate a cause for rhinitis. Various treatment options exist for allergic and non-allergic rhinitis patients with symptoms refractory to pharmacotherapy, including allergen immunotherapy, surgical procedures, and even non-medicated acoustic therapy.