What is true about the types of rhinitis in a 67-year-old female patient presenting with symptoms of nasal congestion, itching, and sneezing?

From the Guidelines

Nonallergic rhinitis (NAR) is a condition that can occur at any age, but its prevalence increases with age, making it a significant consideration in older adults like the 67-year-old female patient presenting with symptoms of nasal congestion, itching, and sneezing. The diagnosis of rhinitis, whether allergic or non-allergic, is primarily based on the patient's history and physical examination, as noted in the study by 1. Allergic rhinitis typically presents with symptoms such as itching, sneezing, and nasal congestion, which may be seasonal or perennial, triggered by specific allergens like pollen, dust mites, or pet dander. However, at this age, non-allergic rhinitis becomes increasingly common and can present similarly, with vasomotor rhinitis being a subtype that is particularly prevalent in older adults, as discussed in 1. Key elements of the history in patients presenting with rhinitis include exposure-associated itching of the nose, palate, or eyes, sneezing, nasal congestion, sniffling, clear rhinorrhea, and postnasal drip, as outlined in 1. Medication-induced rhinitis should also be considered, especially if the patient takes beta-blockers, NSAIDs, or other medications that can cause nasal symptoms as side effects. Initial treatment might include intranasal corticosteroids like fluticasone or antihistamines such as loratadine, with nasal saline irrigation providing symptomatic relief regardless of rhinitis type, as suggested by the management strategies discussed in 1 and 1. Proper diagnosis may require allergy testing to differentiate between allergic and non-allergic causes, which is important because management strategies differ based on the underlying type of rhinitis. Some of the key points to consider in the diagnosis and management of rhinitis in older adults include:

• The prevalence of non-allergic rhinitis increases with age
• Vasomotor rhinitis is a common subtype of non-allergic rhinitis in older adults
• Medication-induced rhinitis should be considered in the differential diagnosis
• Intranasal corticosteroids and antihistamines are potential treatment options
• Nasal saline irrigation can provide symptomatic relief regardless of rhinitis type.

From the FDA Drug Label

Astelin® Nasal Spray is indicated for the treatment of the symptoms of seasonal allergic rhinitis such as rhinorrhea, sneezing, and nasal pruritus in adults and children 5 years and older, and for the treatment of the symptoms of vasomotor rhinitis, such as rhinorrhea, nasal congestion and postnasal drip in adults and children 12 years and older.

The statement that Nonallergic rhinitis (NAR) is a condition of adulthood and is more common in the older adult is true about the types of rhinitis.

• Key points:
  • The drug label does not provide information on the prevalence of allergic rhinitis (AR) in older adults.
  • The label indicates that Astelin Nasal Spray is used to treat symptoms of both seasonal allergic rhinitis and vasomotor rhinitis in adults, but does not provide information on the age distribution of these conditions.
  • Vasomotor rhinitis, a type of nonallergic rhinitis, is mentioned as being treated with Astelin Nasal Spray in adults, which supports the idea that nonallergic rhinitis can be a condition of adulthood 2.

From the Research

Types of Rhinitis

• Nonallergic rhinitis (NAR) is a diverse syndrome characterized by symptoms of rhinitis that are not the result of IgE-mediated events 3.
• NAR is the most common of the nonallergic rhinitis subtypes, comprising at least two-thirds of all nonallergic rhinitis sufferers 3.
• The prevalence of nonallergic rhinitis has been observed to be one-third that of allergic rhinitis, affecting ~7% of the U.S. population or ~22 million people 3.
• Allergic rhinitis (AR) is the most prevalent and most frequently recognized form of rhinitis, but nonallergic rhinitis (NAR) is also very common, affecting millions of people 4.

Age Distribution of Rhinitis

• Nonallergic rhinitis (NAR) is more common in older adults, with some studies suggesting that it is a condition of adulthood 3, 5.
• There is no clear evidence to suggest that allergic rhinitis (AR) is more common in older adults, with some studies suggesting that it is more common in younger adults 3, 4.
• One study suggests that NAR is most common between ages 10 and 39, declining after age 40, but this is not supported by other studies 3, 5.

Characteristics of Nonallergic Rhinitis

• Nonallergic rhinitis (NAR) includes a heterogeneous group of conditions, involving various triggers and distinct pathophysiologies 4, 5.
• NAR may occur in the absence of defined triggers, and the diagnosis is purely clinical, relying on a detailed history and physical exam 3.
• Treatment of NAR should be individualized to the patient's underlying pathophysiology and/or symptoms, and is often empiric 3, 5.