Differences and Similarities between Allergic and Nonallergic Rhinitis in a Large Sample of Adult Patients with Rhinitis SymptomsDi Lorenzo G.a · Pacor M.L.d · Amodio E.c · Leto-Barone M.S.a · La Piana S.b · D’Alcamo A.a · Ditta V.a, b · Martinelli N.d · Di Bona D.b
aDipartimento di Medicina Interna e Specialistica DIMIS, Università degli Studi di Palermo, bDipartimento di Biopatologia e Metodologie Biomediche, Università degli Studi di Palermo, cDipartimento di Scienze per la Promozione della Salute G. D’Alessandro, Sezione di Igiene, Università degli Studi di Palermo, Palermo, dDipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Verona, Verona, Italia
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Background: Allergic rhinitis (AR) and nonallergic rhinitis (NAR) may present with different clinical and laboratory characteristics. Methods: A total of 1,511 consecutive patients, aged 18–81 years, diagnosed with rhinitis, 56% females and 44% males, underwent complete allergic evaluation including skin prick test, blood eosinophil counts, nasal eosinophil counts, peak nasal inspiratory flow (PNIF) measurement and evaluation of nasal symptoms using a visual analog scale (VAS). Results: A total of 1,107 patients (73%)had AR, whereas 404 (27%) had NAR. Patients with NAR were older and predominantly female. A higher nasal eosinophils count was associated with AR and a lack of clinical response to antihistamines. AR patients had more sneezing and nasal pruritus, whereas NAR was characterized mainly by nasal obstruction and rhinorrhea. AR patients had more severe symptoms and recurrent conjunctivitis, whereas NAR patients had slightly more frequent episodes of recurring headaches as well as olfactory dysfunction. PNIF, blood eosinophil counts and VAS of nasal symptoms were higher in patients with AR. In a final logistic regression model, 10 variables were statistically different between AR and NAR: age [OR 0.97 (95% CI 0.96–0.98)], sneezing [OR 4.09 (95% CI 2.78–6.00)], nasal pruritus [OR 3.84 (95% CI 2.60–5.67)], mild symptoms [OR 0.21 (95% CI 0.09–0.49)], intermittent/severe nasal symptoms [OR 3.66 (95% CI 2.06–6.50)], VAS [OR 1.06 (95% CI 1.04–1.08)], clinical response to antihistamines [OR 22.59 (95% CI 13.79–37.00)], conjunctivitis [OR 4.49 (95% CI 2.86–7.05)], PNIF [OR 1.01 (95% CI 1.00–1.01)] and nasal eosinophil counts [OR 1.14 (95% CI 1.10–1.18)]. Receiver operating characteristic analysis showed high predictive accuracy for a model including these variables independently of the diagnosis of AR/NAR (cutoff <0.74). Conclusions: We showed that the several clinical and laboratory parameters reported above may help to reinforce or exclude the diagnosis of AR obtained with skin prick test.
© 2011 S. Karger AG, Basel
- Mygind N: Clinical investigation of allergic rhinitis and allied conditions. Allergy 1979;34:195–208.
Bousquet J, Van Cauwenberge P, Khaltaev N, Aria Workshop Group, World Health Organization: Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol 2001;108(suppl):S147–S334.
- Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al: Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008;63(suppl 86):8–160.
- Bousquet J, Fokkens W, Burney P, Durham SR, Bachert C, Akdis CA, et al: Important research questions in allergy and related diseases: nonallergic rhinitis: a GA2LEN paper. Allergy 2008;63:842–853.
- 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.
- Mølgaard 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.
- Di Lorenzo G, Pacor ML, Pellitteri ME, Morici G, Di Gregoli A, Lo Bianco C, Ditta V, Martinelli N, Candore G, Mansueto P, Rini GB, Corrocher R, Caruso C: Randomized placebo-controlled trial comparing fluticasone aqueous nasal spray in mono-therapy, fluticasone plus cetirizine, fluticasone plus montelukast and cetirizine plus montelukast for seasonal allergic rhinitis. Clin Exp Allergy 2004;34:259–267.
- Di Lorenzo G, Mansueto P, Pacor ML, Rizzo M, Castello F, Martinelli N, Ditta V, Lo Bianco C, Leto-Barone MS, D’Alcamo A, Di Fede G, Rini GB, Ditto AM: Evaluation of serum s-IgE/total IgE ratio in predicting clinical response to allergen-specific immunotherapy. J Allergy Clin Immunol 2009;123:1103–1110.
- Heinzerling L, Frew AJ, Bindslev-Jensen C, Bonini S, Bousquet J, Bresciani M, Carlsen KH, van Cauwenberge P, Darsow U, Fokkens WJ, Haahtela T, van Hoecke H, Jessberger B, Kowalski ML, Kopp T, Lahoz CN, Lodrup Carlsen KC, Papadopoulos NG, Ring J, Schmid-Grendelmeier P, Vignola AM, Wöhrl S, Zuberbier T: Standard skin prick testing and sensitization to inhalant allergens across Europe – a survey from the GALEN network. Allergy 2005;60:1287–1300.
- Di Lorenzo G, Pacor ML, Mansueto P, Esposito-Pellitteri M, Scichilone N, Ditta V, Lo Bianco C, Leto-Barone MS, Di Fede G, Corrocher R, Mansueto S, Rini GB: Relationship between specific serum IgE to Ascaris lumbricoides and onset of respiratory symptoms in Bangladesh immigrants. Int J Immunopathol Pharmacol 2006;19:629–638.
- Di Lorenzo G, Mansueto P, Melluso M, Candore G, Colombo A, Pellitteri ME, et al: Allergic rhinitis to grass pollen: measurement of inflammatory mediators of mast cell and eosinophils in native nasal fluid lavage and in serum out of and during pollen season. J Allergy Clin Immunol 1997;100:832–837.
- Di Lorenzo G, Drago A, Esposito Pellitteri M, Candore G, Colombo A, Gervasi F, Pacor ML, Purello D’Ambrosio F, Caruso C: Measurement of inflammatory mediators of mast cells and eosinophils in native nasal lavage fluid in nasal polyposis. Int Arch Allergy Immunol 2001;125:164–175.
- Leynaert B, Bousquet J, Neukirch C, Liard R, Neukirch F: Perennial rhinitis: an independent risk factor for asthma in nonatopic subjects: results from the European Community Respiratory Health Survey. J Allergy Clin Immunol 1999;104:301–304.
NAAC: Data presented at The National Allergy Advisory Council Meeting (NAAC) – the broad spectrum of rhinitis: etiology, diagnosis, and advances in treatment. St. Thomas, NAAC, 1999.
- Lindberg S, Malm L: Comparison of allergic rhinitis and vasomotor rhinitis patients on the basis of a computer questionnaire. Allergy 1993;48:602–607.
Togias A: Age relationships and clinical features of nonallergic rhinitis. J Allergy Clin Immunol 1990;85:182.
- Boulet LP, Turcotte H, Laprise C, Lavertu C, Bédard PM, Lavoie A, Hébert J: Comparative degree and type of sensitization to common indoor and outdoor allergens in subjects with allergic rhinitis and/or asthma. Clin Exp Allergy 1997;27:52–59.
- Levine HL, Setzen M, Cady RK, Dodick DW, Schreiber CP, Eross EJ: An otolaryngology, neurology, allergy, and primary care consensus on diagnosis and treatment of sinus headache. Otolaryngol Head Neck Surg 2006;134:516–523.
- Pastorello EA, Incorvaia C, Ortolani C, Bonini S, Canonica GW, Romagnani S, Tursi A, Zanussi C: Studies on the relationship between the level of specific IgE antibodies and the clinical expression of allergy: I. Definition of levels distinguishing patients with symptomatic from patients with asymptomatic allergy to common aeroallergens. J Allergy Clin Immunol 1995;96:580–587.
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