Nonallergic Rhinitis Therapy

Chronic nonallergic rhinitis (NAR) is a heterogenous syndrome with 8 classified subtypes, each with different underlying etiologies. Inflammatory-mediated and neurogenic mechanisms likely play an important role in the pathophysiology of this disease. Treatment can be challenging and is usually less effective in comparison to allergic rhinitis. The subtype of NAR and underlying pathophysiology should drive treatment decision-making. Intranasal corticosteroids and topical antihistamines are the most effective treatment for inflammatory-mediated forms of NAR. The combination of these two medications may be more effective than each individual drug in refractory cases. Ipratropium bromide is a topical anticholinergic which is most efficacious for the symptom of rhinorrhea. There is promise for topical capsaicin treatment in NAR but better quality studies are needed to further elucidate this form of therapy. There is no strong evidence for decongestants or saline rinses for NAR, but they may be useful as an adjunct therapy.