Rhinitis Diagnosis and Management Strategies

Rhinitis encompasses a spectrum of conditions characterised by nasal inflammation, rhinorrhoea, sneezing, congestion and nasal itch. It is broadly subdivided into allergic rhinitis (AR), non-allergic rhinitis (NAR) and mixed phenotypes, with further distinction offered by endotypes defined by underlying immunological or neurogenic mechanisms. Accurate classification hinges on a combination of clinical history, physical examination and targeted diagnostic tests, including skin prick testing, serum allergen-specific IgE assays and nasal allergen challenge. Emerging biomarkers and in vivo provocation tests have refined diagnostic precision, revealing phenotypes such as local allergic rhinitis (LAR) in patients without systemic atopy. Management strategies are tailored according to phenotype and severity. General measures include environmental control and avoidance of triggers; pharmacotherapy spans second-generation antihistamines, intranasal corticosteroids and anticholinergics; and surgical interventions are reserved for refractory structural or polypoid disease. Allergen immunotherapy remains the only disease-modifying treatment for AR and has shown promise in LAR. Novel approaches under investigation encompass biologic agents targeting IgE and type 2 cytokines, neuro-modulatory therapies for idiopathic rhinitis and precision medicine guided by endotype-specific biomarkers.

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Rhinitis Diagnosis and Management Strategies publication trend

The graph below shows the total number of articles in rhinitis diagnosis and management strategies across all publications each year (not limited to Nature Index journals).

Technical terms

Allergic rhinitis (AR): IgE-mediated nasal inflammation in response to inhaled allergens.

Local allergic rhinitis (LAR): Phenotype with nasal specific IgE production and positive nasal provocation despite negative systemic atopy tests.

Nasal allergen challenge (NAC): Controlled intranasal application of allergen to confirm local reactivity and diagnosis.

Allergen immunotherapy: Repeated administration of specific allergens to induce tolerance and modify disease course.

Basophil activation test (BAT): Ex vivo assay measuring basophil surface markers after allergen exposure to detect sensitisation.

References

1. Review of Rhinitis: Classification, Types, Pathophysiology. Journal of Clinical Medicine (2021).
2. Nasal allergen‐neutralizing antibodies correlate closely with tolerated intranasal allergen challenge dose following grass pollen subcutaneous immunotherapy in patients with local allergic rhinitis. Allergy (2024).
3. Diagnosis and Treatment of Local Allergic Rhinitis. Pathogens (2022).
4. Diagnostic Tools in Allergic Rhinitis. Frontiers in Allergy (2021).