Non-allergic rhinitis: a case report and review

The term rhinitis can be used to describe many distinct entities with varying pathogeneses, despite similar presentations. Generally, rhinitis is considered allergic if significant inhalant allergy is diagnosed and is considered non-allergic when symptomatology is perennial or periodic and not IgE mediated. Thus non-allergic rhinitis (NAR) comprises a mixed bag of conditions ranging from vasomotor rhinitis (VMR) to hormonally induced rhinitis.Overall, rhinitis results in significant cost to the world population. In 2002, the direct and indirect costs for allergic rhinitis (AR) were estimated to be $7.3 billion and $4.28 billion, respectively [1]. Given that an estimated 1 in 3 patients with rhinitis are diagnosed with NAR, with 19 million people in the United States alone, it is reasonable to conclude that NAR also results in a significant economic burden [2-4].NAR is a condition primarily seen in adulthood with 70% of cases developing after the age of 20. There is a greater prevalence among females compared to males [5,6], and the overall prevalence of NAR in industrialized countries has ranged from 20-40% [7]. The following case presentation is an example of a patient with typical NAR symptoms who fits the epidemiological profile, but who presented atypically, failed to respond to standard therapy and was subsequently found to have a much more serious underlying condition.A 52 year old African American female presented to our outpatient allergy clinic with a chief complaint of profuse "runny nose" for 1 week. She initially attributed the rhinorrhea to prolonged moth ball exposure in her small office space. Prior to her visit she had been seen by her primary care provider and in the emergency department. Both treated her for allergic rhinitis vs. vasomotor rhinitis with intranasal corticosteroids and oral antihistamines. She also complained of a diffuse headache, imbalance, cough and right ear fullness. She denied any history of previous rhinitis symptoms, eye symp