Division of Immunology/Allergy Section, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0563, USA.
Curr Opin Allergy Clin Immunol. 2013 Aug;13(4):410-6. doi: 10.1097/ACI.0b013e3283630cd8.
The purpose of this review is to briefly discuss methods for classifying Nonallergic rhinitis (NAR), the current understanding of its immunopathogenesis, scientific evidence-based treatment options along with anecdotal clinical experience for selecting different treatment regimens for these challenging patients.
NAR also known as idiopathic rhinitis, irritant-induced rhinitis and vasomotor rhinitis is a heterogeneous condition that has been classified many different ways, but currently there is no consensus on definition for this condition due to its poorly elucidated mechanism(s) of action. A typical patient presents with nasal congestion, postnasal drainage with or without a cough associated with, to a lesser extent, some degree of sneezing, itching, and rhinorrhea. Recent studies have proposed more specific approaches for characterizing rhinitis subtypes. It is speculated that this condition is due to an autonomic imbalance resulting in an overactive parasympathetic and perhaps an underactive sympathetic nervous system. Our poor understanding of NAR mechanism(s) of action has significantly hindered progress in developing novel therapies for this condition.
Further investigation is required to understand the neurogenic signaling pathways that lead to this aberrant response. Until we have selective therapies for NAR, treatment requires selecting the medication or combination of medications best suited to the symptomatic needs of the patient.
本文旨在简要讨论非变应性鼻炎（NAR）的分类方法，目前对其免疫发病机制的理解，以及基于科学证据的治疗选择，并结合对这些具有挑战性的患者的治疗方案选择的临床经验。
NAR 也称为特发性鼻炎、刺激性鼻炎和血管运动性鼻炎，是一种异质性疾病，已经有许多不同的分类方法，但由于其作用机制尚未阐明，目前对此类疾病尚无共识的定义。典型的患者表现为鼻塞、鼻后滴注，伴有或不伴有咳嗽，打喷嚏、瘙痒和流涕的程度较轻。最近的研究提出了更具体的方法来描述鼻炎亚型。据推测，这种情况是由于自主神经失衡导致副交感神经过度活跃，而交感神经系统可能不活跃。我们对 NAR 作用机制的理解不足，严重阻碍了为这种疾病开发新疗法的进展。
需要进一步研究以了解导致这种异常反应的神经信号通路。在我们有针对 NAR 的选择性治疗方法之前，治疗需要选择最适合患者症状需求的药物或药物组合。
