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Allergic rhinitis - Management
What else might it be?

  • Infective rhinitis. An infective cause for rhinitis is more likely when:
    • There is an acute onset of 1 week or less.
    • There are typical features of an associated upper respiratory tract infection, such as cough, fever, or lymphadenopathy.
  • Irritant rhinitis. An irritant cause for rhinitis is more likely when symptoms follow a known physical or chemical irritant cause of rhinitis:
    • Physical irritant rhinitis may follow changes in temperature and humidity, or exercise.
    • Chemical irritant rhinitis may follow exposure to volatile chemicals and odours.
  • Rarer causes of rhinitis include:
    • Drug-induced rhinitis, which should be considered when symptoms follow the start of treatment with such drugs as angiotensin-converting enzyme inhibitors, beta-blockers, chlorpromazine, aspirin, and nonsteroidal anti-inflammatory drugs. Rebound symptoms may occur when stopping treatment with nasal decongestants.
    • Hormonal rhinitis should be considered when symptoms coincide with pregnancy, starting the oral contraceptive pill, or hypothyroidism.
    • Non-allergic rhinitis with eosinophilia syndrome is diagnosed only when other causes of rhinitis, including allergic rhinitis, have been excluded.
  • Conditions that can mimic the symptoms of rhinitis:
    • Structural or mechanical factors include deviated nasal septum, nasal polyps, hypertrophic turbinates, adenoidal hypertrophy, foreign bodies, and (rarely) nasal tumours.
    • Systemic conditions include primary defects in mucus (e.g. cystic fibrosis), primary ciliary dyskinesia (Kartagener's syndrome), and granulomatous disease (e.g. Wegener's granulomatosis, sarcoidosis).

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