Pathogenic mechanisms of idiopathic nonallergic rhinitis

James N Baraniuk, James N Baraniuk

Abstract

: Idiopathic nonallergic rhinitis (iNAR) has been difficult to define because of the long differential diagnosis of rhinopathy in the absence of allergic rhinitis. iNAR has traditionally been a diagnosis of exclusion with no clear unifying pathophysiology. Increased sensitivity to triggers such has climate changes, cold air, tobacco smoke, strong odors, and perfumes have been thought to be characteristic, but recent studies do not support this hypersensitivity hypothesis. New investigations of the local nasal environment and systemic "functional" syndromes have offered new insights into this condition. iNAR may be a heterogenous disorder that includes (1) anatomic abnormalities requiring nasal endoscopy for diagnosis, (2) incipient, local atopy (entopy), (3) dysfunction of nociceptive nerve sensor and ion channel proteins, and (4) autonomic dysfunction as found in chronic fatigue syndrome and other functional disorders.

Figures

Figure 1
Figure 1
TRP thermometer and aromatherapy. The various TRP ion channels respond to different temperatures, chemicals, osmolarity, and other physical stimuli. The chemicals include many spices. The channels may respond to a large number of other chemical structures. Heterotetramers of these TRP proteins may vastly increase the variety of stimuli that can lead to trigeminal nerve depolarization.
Figure 2
Figure 2
Hypertonic saline nasal provocation responses in CFS (thick line), normal (thin dark line), AR, and AS. A, Perceptions such as "Drip" (sensation of nasal discharge) were equivalent in CFS, AR, and AS and significantly higher than normal. B, Whereas the normal group had a significant dose response for axon response-mediated secretion of mucin, there was no dose dependence for the CFS group. AS indicates acute sinusitis.
Figure 3
Figure 3
Sensations of congestion (A) and rhinorrhea (B) induced by 8 triggers in NAR (bars with diagonal lines), AR (white bars), potAt (positive allergy skin tests with minimal symptoms; gray bars), and NoRh (black bars). Mean ± 95% CI. CI indicates confidence interval; NAR, nonallergic rhinitis; NoRh, no rhinitis; potAt, potential atopy.

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