David Geffen School of Medicine at the University of California, Los Angeles, CA, USA.
Am Fam Physician. 2018 Aug 1;98(3):171-176.
Chronic nonallergic rhinitis encompasses a group of rhinitis subtypes without allergic or infectious etiologies. Although chronic nonallergic rhinitis represents about one-fourth of rhinitis cases and impacts 20 to 30 million patients in the United States, its pathophysiology is unclear and diagnostic testing is not available. Characteristics such as no evidence of allergy or defined triggers help define clinical subtypes. There are eight subtypes with overlapping presentations, including nonallergic rhinopathy, nonallergic rhinitis with nasal eosinophilia syndrome, atrophic rhinitis, senile or geriatric rhinitis, gustatory rhinitis, drug-induced rhinitis, hormonal rhinitis, and occupational rhinitis. Treatment is symptom-driven and similar to that of allergic rhinitis. Patients should avoid known triggers when possible. First-line therapies include intranasal corticosteroids, intranasal antihistamines, and intranasal ipratropium. Combination therapy with decongestants and first-generation antihistamines can be considered if monotherapy does not adequately control symptoms. Nasal irrigation and intranasal capsaicin may be helpful but need further investigation.
慢性非变应性鼻炎包括一组无变应原或感染病因的鼻炎亚型。尽管慢性非变应性鼻炎约占鼻炎病例的四分之一，影响美国 2000 万至 3000 万患者，但它的发病机制尚不清楚，也没有诊断测试。没有过敏或明确诱因的证据等特征有助于定义临床亚型。有八种具有重叠表现的亚型，包括非变应性鼻病、伴鼻嗜酸粒细胞增多综合征的非变应性鼻炎、萎缩性鼻炎、老年或老年鼻炎、味觉性鼻炎、药物性鼻炎、激素性鼻炎和职业性鼻炎。治疗是基于症状的，与变应性鼻炎相似。患者应尽可能避免已知的诱因。一线治疗包括鼻内皮质类固醇、鼻内抗组胺药和鼻内异丙托铵。如果单一疗法不能充分控制症状，可以考虑联合使用减充血剂和第一代抗组胺药。鼻腔冲洗和鼻内辣椒素可能有帮助，但需要进一步研究。
