Nicht-allergische Rhinitis: Epidemiologie, Diagnostik und Therapie

Zusammenfassung

Die nicht-allergische Rhinitis umfasst eine heterogene Gruppe von Erkrankungen, denen eine nicht-IgE-vermittelte Pathophysiologie zugrunde liegt. In der vorliegenden Übersichtsarbeit werden die typischen Vertreter dieser Gruppe mit Häufigkeit und Symptomatik aufgezeigt, Empfehlungen zur sensitiven und rationalen Diagnostik vermittelt und die therapeutischen Optionen auf der Basis der aktuellen wissenschaftlichen Literatur vorgestellt. Der häufigste Subtyp ist die nicht-allergische Rhinopathie, auch idiopathische Rhinitis oder vasomotorische Rhinitis genannt. Die Rhinitis medicamentosa ist weiterhin ein klinisch relevantes Problem, für das ein Stufenschema zur Entwöhnung vorgestellt wird.

Abstract

Non-allergic rhinitis is a heterogenous group of medical diseases without an IgE-mediated pathophysiology. In this review, typical subgroups are presented with data regarding their frequency, clinical symptoms and recommendations for an effective and efficient diagnostic and therapeutic approach are indicated. The most common subtype is the non-allergic rhinopathy, also known as idiopathic or vasomotoric rhinitis. Because medication induced rhinitis is still a frequent clinical problem, a step wise approach to wean the patient is presented.

Schlüsselwörter

Epidemiologie - Prävalenz - Nicht-allergische Rhinitis - Nicht-allergische Rhinopathie - Gemischte Rhinitis - Nebenwirkungen - Rhinitis medicamentosa

Key words

epidemiology - prevalence - non-allergic rhinopathy - mixed rhinitis - side effects - rhinitis medicamentosa

• Literatur

• 1 Lund V, Aaronson A, Bousquet J. International Consensus Report on the diagnosis and management of rhinitis. International Rhinitis Management Working Group. Allergy 1994; 49: 1-34
• 2 Settipane RA, Kaliner MA Chapter 14 Nonallergic rhinitis. Am J Rhinol Allergy 2013; 27 (Suppl. 01) S48-S51
• 3 Molgaard E, Thomsen SF, Lund T, Pedersen L, Nolte H, Backer V. Differences between allergic and nonallergic rhinitis in a large sample of adolescents and adults. Allergy 2007; 62: 1033-1037
• 4 Klimek L, Bardenhewer C, Spielhaupter M, Harai C, Becker K, Pfaar O. Lokale allergische Rhinitis auf Alternaria alternata: Nachweis bei Patienten mit persistierender nasaler Symptomatik. HNO 2015; 63: 364-372
• 5 Jang TY, Kim YH. Nasal provocation test is useful for discriminating allergic, nonallergic, and local allergic rhinitis. Am J Rhinol Allergy 2015; 29: e100-e104
• 6 Settipane RA, Charnock DR. Epidemiology of rhinitis: allergic and nonallergic. Clin Allergy Immunol 2007; 19: 23-34
• 7 Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, Lang DM, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph CC, Schuller D, Spector SL, Tilles SA. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol 2008; 122: S1-S84
• 8 Baraniuk JN, Shusterman DJ. Nonallergic rhinitis. New York, London: Informa Healthcare; 2008
• 9 Bachert C, van Cauwenberge P, Olbrecht J, van Schoor J. Prevalence, classification and perception of allergic and nonallergic rhinitis in Belgium. Allergy 2006; 61: 693-698
• 10 Settipane RA, Lieberman P. Update on nonallergic rhinitis. Ann Allergy Asthma Immunol 2001; 86: 494-507 507-498
• 11 Berger WE, Schonfeld JE. Nonallergic rhinitis in children. Clin Allergy Immunol 2007; 19: 197-207
• 12 Settipane GA, Klein DE. Non allergic rhinitis: demography of eosinophils in nasal smear, blood total eosinophil counts and IgE levels. N Engl Reg Allergy Proc 1985; 6: 363-366
• 13 Kaliner MA, Baraniuk JN, Benninger M, Bernstein JA, Lieberman P, Meltzer EO, Naclerio RM, Settipane RA, Farrar JR. Consensus Definition of Nonallergic Rhinopathy, Previously Referred to as Vasomotor Rhinitis, Nonallergic Rhinitis, and/or Idiopathic Rhinitis. World Allergy Organ J 2009; 2: 119-120
• 14 Bernstein JA. Allergic and mixed rhinitis: Epidemiology and natural history. Allergy and asthma proceedings: the official journal of regional and state allergy societies 2010; 31: 365-369
• 15 Gomez F, Rondon C, Salas M, Campo P. Local allergic rhinitis: mechanisms, diagnosis and relevance for occupational rhinitis. Curr Opin Allergy Clin Immunol 2015; 15: 111-116
• 16 Campo P, Rondon C, Gould HJ, Barrionuevo E, Gevaert P, Blanca M. Local IgE in non-allergic rhinitis. Clinical and experimental allergy. Journal of the British Society for Allergy and Clinical Immunology 2015; 45: 872-881
• 17 Carney AS, Powe DG, Huskisson RS, Jones NS. Atypical nasal challenges in patients with idiopathic rhinitis: more evidence for the existence of allergy in the absence of atopy? Clinical and experimental allergy. Journal of the British Society for Allergy and Clinical Immunology 2002; 32: 1436-1440
• 18 Rondon C, Romero JJ, Lopez S, Antunez C, Martin-Casanez E, Torres MJ, Mayorga C, R-Pena R, Balnca M. Local IgE production and positive nasal provocation test in patients with persistent nonallergic rhinitis. The Journal of allergy and clinical immunology 2007; 119: 899-905
• 19 Wedback A, Enbom H, Eriksson NE, Moverare R, Malcus I. Seasonal non-allergic rhinitis (SNAR) – a new disease entity? A clinical and immunological comparison between SNAR, seasonal allergic rhinitis and persistent non-allergic rhinitis. Rhinology 2005; 43: 86-92
• 20 Berger WE, Schonfeld JE. Nonallergic rhinitis in children. Curr Allergy Asthma Rep 2007; 7: 112-116
• 21 Lindberg S, Malm L. Comparison of allergic rhinitis and vasomotor rhinitis patients on the basis of a computer questionnaire. Allergy 1993; 48: 602-607
• 22 Boulet LP. Cough and upper airway disorders in elite athletes: a critical review. Br J Sports Med 2012; 46: 417-421
• 23 Lourenco O, Fonseca AM, Taborda-Barata L. Asthma is more frequently associated with non-allergic than allergic rhinitis in Portuguese patients. Rhinology 2009; 47: 207-213
• 24 Ramey JT, Bailen E, Lockey RF. Rhinitis medicamentosa. Journal of investigational allergology & clinical immunology 2006; 16: 148-155
• 25 Buttner L, Achilles N, Bohm M, Shah-Hosseini K, Mosges R.. Efficacy and tolerability of bromelain in patients with chronic rhinosinusitis–a pilot study. B-Ent 2013; 9: 217-225
• 26 Stewart M, Ferguson B, Fromer L. Epidemiology and burden of nasal congestion. Int J Gen Med 2010; 3: 37-45
• 27 Brandt D, Bernstein JA. Questionnaire evaluation and risk factor identification for nonallergic vasomotor rhinitis. Ann Allergy Asthma Immunol 2006; 96: 526-532
• 28 Raphael G, Raphael MH, Kaliner M. Gustatory rhinitis: a syndrome of food-induced rhinorrhea. The Journal of allergy and clinical immunology 1989; 83: 110-115
• 29 Hauswald B, Yarin YM. Moderne Diagnostik und Therapie der Rhinitis allergica. Laryngo-Rhino-Otologie 2015; 94: 331-345
• 30 Rondon C, Fernandez J, Canto G, Blanca M. Local allergic rhinitis: concept, clinical manifestations, and diagnostic approach. J Investig Allergol Clin Immunol 2010; 20: 364-371
• 31 Rondon C, Campo P, Herrera R, Blanca-Lopez N, Melendez L, Canto G, Torres MJ, Blanca M. Nasal allergen provocation test with multiple aeroallergens detects polysensitization in local allergic rhinitis. J Allergy Clin Immunol 2011; 128: 1192-1197
• 32 Gogniashvilli G, Steinmeier E, Mlynski G, Beule AG. Physiologic and pathologic septal deviations: subjective and objective functional rhinologic findings. Rhinology 2011; 49: 24-29
• 33 Garcia GJ, Bailie N, Martins DA, Kimbell JS. Atrophic rhinitis: a CFD study of air conditioning in the nasal cavity. J Appl Physiol 2007; 103: 1082-1092
• 34 Beule AG. Funktionen und Funktionsstörungen der respiratorischen Schleimhaut der Nase und der Nasennebenhöhlen. Laryngo-Rhino-Otologie 2010; 89 (Suppl. 01) S15-S34
• 35 Mlynski G, Beule A. Diagnostik der respiratorischen Funktion der Nase. HNO 2008; 56: 81-99
• 36 Moore EJ, Kern EB. Atrophic rhinitis: a review of 242 cases. Am J Rhinol 2001; 15: 355-361
• 37 Kim YH, Jang TY. Proposed diagnostic standard using visual analogue scale and acoustic rhinometry in nasal provocation test in allergic patients. Auris Nasus Larynx 2011; 38: 340-346
• 38 Airaksinen L, Tuomi T, Vanhanen M, Voutilainen R, Toskala E. Use of nasal provocation test in the diagnostics of occupational rhinitis. Rhinology 2007; 45: 40-46
• 39 Wandalsen GF, Mendes AI, Sole D. Objective improvement in nasal congestion and nasal hyperreactivity with use of nasal steroids in persistent allergic rhinitis. Am J Rhinol Allergy 2010; 24: 32-36
• 40 Sanico AM, Philip G, Proud D, Naclerio RM, Togias A. Comparison of nasal mucosal responsiveness to neuronal stimulation in non-allergic and allergic rhinitis: effects of capsaicin nasal challenge. Clinical and experimental allergy: journal of the British Society for Allergy and Clinical Immunology 1998; 28: 92-100
• 41 van Rijswijk JB, Blom HM, Fokkens WJ. Idiopathic rhinitis, the ongoing quest. Allergy 2005; 60: 1471-1481
• 42 Bernstein JA, Salapatek AM, Lee JS, Nelson V, Wilson D, D´Angelo P, Tsitoura D, Murdoch R, Patel D. Provocation of nonallergic rhinitis subjects in response to simulated weather conditions using an environmental exposure chamber model. Allergy and asthma proceedings: The official journal of regional and state allergy societies 2012; 33: 333-340
• 43 Amodu EJ, Fasunla AJ, Akano AO, Daud Olusesi A. Chronic rhinosinusitis: correlation of symptoms with computed tomography scan findings. Pan Afr Med J 2014; 18: 40
• 44 Nazri M, Bux SI, Tengku-Kamalden TF, Ng KH, Sun Z. Incidental detection of sinus mucosal abnormalities on CT and MRI imaging of the head. Quant Imaging Med Surg 2013; 3: 82-88
• 45 Bunnag C, Jareoncharsri P, Tansuriyawong P, Bhothisuwan W, Chantarakul N. Characteristics of atrophic rhinitis in Thai patients at the Siriraj Hospital. Rhinology 1999; 37: 125-130
• 46 Hirt R, Paulsen F, Neumann K, Knipping S. Immunhistochemischer Nachweis von Caspase 3 bei verschiedenen Nasenschleimhauterkrankungen des Menschen. Hno 2009; 57: 466-472
• 47 Effat KG, Madany NM. Microbiological study of role of fungi in primary atrophic rhinitis. J Laryngol Otol 2009; 123: 631-634
• 48 Laudien M. Ausgewahlte seltene rhinologische Krankheitsbilder Pathogenese-Klinik-Therapie. Laryngorhinootologie 2015; 94 (Suppl. 01) S272-S287
• 49 Gelardi M, Luigi Marseglia G, Licari A, Landi M, Dell’Albani I, Incorvaia C, Frati F, Quaranta N. Nasal cytology in children: recent advances. Ital J Pediatr 2012; 38: 51
• 50 Gelardi M, Fiorella ML, Russo C, Fiorella R, Ciprandi G. Role of nasal cytology. Int J Immunopathol Pharmacol 2010; 23: 45-49
• 51 Ellis AK, Keith PK. Nonallergic rhinitis with eosinophilia syndrome and related disorders. Clin Allergy Immunol 2007; 19: 87-100
• 52 Quaranta N, Milella C, Iannuzzi L, Gelardi M. A study of the role of different forms of chronic rhinitis in the development of otitis media with effusion in children affected by adenoid hypertrophy. Int J Pediatr Otorhinolaryngol 2013; 77: 1980-1983
• 53 Settipane RA. Demographics and epidemiology of allergic and nonallergic rhinitis. Allergy Asthma Proc 2001; 22: 185-189
• 54 Gelardi M, Passalacqua G, Fiorella ML, Quaranta N. Assessment of biofilm by nasal cytology in different forms of rhinitis and its functional correlations. Eur Ann Allergy Clin Immunol 2013; 45: 25-29
• 55 Gelardi M, Passalacqua G, Fiorella ML, Mosca A, Quaranta N. Nasal cytology: the “infectious spot”, an expression of a morphological-chromatic biofilm. Eur J Clin Microbiol Infect Dis 2011; 30: 1105-1109
• 56 Bachmann G, Nekic M, Michel O. Clinical experience with beta-trace protein as a marker for cerebrospinal fluid. The Annals of otology, rhinology, and laryngology 2000; 109: 1099-1102
• 57 Meco C, Oberascher G, Arrer E, Moser G, Albegger K. Beta-trace protein test: new guidelines for the reliable diagnosis of cerebrospinal fluid fistula. Otolaryngology–head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery 2003; 129: 508-517
• 58 Beule A, Christophersen K, Bremert T, Mlynski BM, Schlüter H, Mlynski GH. Der Nasenzyklus bei Obstruktivem Schlaf-Apnoe-Syndrom: eine vergleichende, prospektive Untersuchung mit Polysomnographie und Langzeit-Flowmetrie. Laryngo-Rhino-Otologie 2004; 83: 5
• 59 Karjalainen A, Martikainen R, Klaukka T, Saarinen K, Uitti J. Risk of asthma among Finnish patients with occupational rhinitis. Chest 2003; 123: 283-288
• 60 Yukselen A, Kendirli SG, Yilmaz M, Altintas DU, Karakoc GB. Correlation between nasal eosinophils and nasal airflows in children with asthma and/or rhinitis monosensitised to house dust mites. Allergol Immunopathol 2014; 42: 50-55
• 61 Kaliner MA. Nonallergic rhinopathy (formerly known as vasomotor rhinitis). Immunol Allergy Clin North Am 2011; 31: 441-455
• 62 Tran NP, Vickery J, Blaiss MS. Management of rhinitis: allergic and non-allergic. Allergy Asthma Immunol Res 2011; 3: 148-156
• 63 Nyenhuis SM, Mathur SK. Rhinitis in older adults. Curr Allergy Asthma Rep 2013; 13: 171-177
• 64 Baccioglu Kavut A, Kalpaklioglu F. Efficacy and safety of once daily triamcinolone acetonide aqueous nasal spray in adults with non-allergic and allergic rhinitis. Allergol Immunopathol 2013; 41: 374-380
• 65 Varricchio A, Capasso M, De Lucia A, Avvisati F, Varricchio AM, Bettoncelli G, Ciprandi G. Intranasal flunisolide treatment in patients with non-allergic rhinitis. Int J Immunopathol Pharmacol 2011; 24: 401-409
• 66 Mygind N, Andersson M. Topical glucocorticosteroids in rhinitis: clinical aspects. Acta Otolaryngol 2006; 126: 1022-1029
• 67 Lee C, Corren J. Review of azelastine nasal spray in the treatment of allergic and non-allergic rhinitis. Expert Opin Pharmacother 2007; 8: 701-709
• 68 Lieberman P, Meltzer EO, LaForce CF, Darter AL, Tort MJ. Two-week comparison study of olopatadine hydrochloride nasal spray 0.6% versus azelastine hydrochloride nasal spray 0.1% in patients with vasomotor rhinitis. Allergy Asthma Proc 2011; 32: 151-158
• 69 Meltzer EO. An overview of current pharmacotherapy in perennial rhinitis. J Allergy Clin Immunol 1995; 95: 1097-1110
• 70 Broms P, Malm L. Oral vasoconstrictors in perennial non-allergic rhinitis. Allergy 1982; 37: 67-74
• 71 Bronsky EA, Druce H, Findlay SR, Hampel FC, Kaiser H, Ratner P, Valentine MD, Wood CC. A clinical trial of ipratropium bromide nasal spray in patients with perennial nonallergic rhinitis. J Allergy Clin Immunol 1995; 95: 1117-1122
• 72 Grossman J, Banov C, Boggs P, Bronsky EA, Dockhorn RJ, Druce H, Findlay SR, Georgitis JW, Hampel FC, Kaiser H. Use of ipratropium bromide nasal spray in chronic treatment of nonallergic perennial rhinitis, alone and in combination with other perennial rhinitis medications. J Allergy Clin Immunol 1995; 95: 1123-1127
• 73 Gevorgyan A, Segboer C, Gorissen R, van Drunen CM, Fokkens W. Capsaicin for non-allergic rhinitis. Cochrane Database Syst Rev 2015; 7: CD010591
• 74 Dykewicz MS, Fineman S, Skoner DP, Nicklas R, Lee R, Blessing-Moore J, Li JT, Bernstein IL, Berger W, Spector S, Schuller D. Diagnosis and management of rhinitis: complete guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. American Academy of Allergy, Asthma, and Immunology. Ann Allergy Asthma Immunol 1998; 81: 478-518
• 75 Neher A, Gstottner M, Thaurer M, Augustijns P, Reinelt M, Schobersberger W. Influence of essential and fatty oils on ciliary beat frequency of human nasal epithelial cells. Am J Rhinol 2008; 22: 130-134
• 76 Zenner H. Praktische Therapie von Hals-Nasen-Ohren-Krankheiten. 2. Aufl. Stuttgart, New York: Schattauer; 2008: 494
• 77 Varghese M, Glaum MC, Lockey RF. Drug-induced rhinitis. Clin Exp Allergy 2010; 40: 381-384
• 78 Elwany S, Abdel-Salaam S. Treatment of rhinitis medicamentosa with fluticasone propionate – an experimental study. Eur Arch Otorhinolaryngol 2001; 258: 116-119
• 79 Ferguson BJ, Paramaesvaran S, Rubinstein E. A study of the effect of nasal steroid sprays in perennial allergic rhinitis patients with rhinitis medicamentosa. Otolaryngol Head Neck Surg 2001; 125: 253-260
• 80 Doshi J. Rhinitis medicamentosa: what an otolaryngologist needs to know. Eur Arch Otorhinolaryngol 2009; 266: 623-625
• 81 Graf P, Hallen H. One-week use of oxymetazoline nasal spray in patients with rhinitis medicamentosa 1 year after treatment. J Otorhinolaryngol Relat Spec 1997; 59: 39-44
• 82 Graf P. Rhinitis medicamentosa: a review of causes and treatment. Treat Respir Med 2005; 4: 21-29
• 83 Hytonen ML, Back LJ, Malmivaara AV, Roine RP. Radiofrequency thermal ablation for patients with nasal symptoms: a systematic review of effectiveness and complications. Eur Arch Otorhinolaryngol 2009; 266: 1257-1266
• 84 Kaymakci M, Gur OE, Ozdem C. Nasal obstruction: comparison of radiofrequency with lateral displacement of the inferior turbinate and radiofrequency alone. J Pak Med Assoc 2014; 64: 33-37
• 85 Deenadayal DS, Kumar MN, Sudhakshin P, Hameed S. Radiofrequency reduction of inferior turbinates in allergic and non allergic rhinitis. Indian J Otolaryngol Head Neck Surg 2014; 66: 231-236
• 86 Prasanna A, Murthy PS. Vasomotor rhinitis and sphenopalatine ganglion block. J Pain Symptom Manage 1997; 13: 332-338
• 87 Douglas R, Wormald PJ. Pterygopalatine fossa infiltration through the greater palatine foramen: where to bend the needle. Laryngoscope 2006; 116: 1255-1257
• 88 el-Guindy A. Endoscopic transseptal vidian neurectomy. Arch Otolaryngol Head Neck Surg 1994; 120: 1347-1351
• 89 Lobo CJ, Hartley C, Farrington WT. Closure of the nasal vestibule in atrophic rhinitis – a new non-surgical technique. J Laryngol Otol 1998; 112: 543-546
• 90 Leong SC. The clinical efficacy of surgical interventions for empty nose syndrome: A systematic review. Laryngoscope 2015; 125: 1557-1562
• 91 Ghosh SK. Rhinoplasty in atrophic rhinitis. J Indian Med Assoc 2012; 110: 246-247