Rhinitis in the geriatric population

Rhinitis is defined as inflammation of the nasal mucosa and is characterized by symptoms of congestion, rhinorrhea, itching of the nose, postnasal drip, and sneezing[2]. In the geriatric population, a broad interpretation of this symptom complex may also include crusting within the nose, cough, excessive drainage, olfactory loss, and nasal dryness[3,4].Rhinitis can be divided broadly into two major categories: allergic and nonallergic (Appendix 1).Allergic rhinitis is an IgE-mediated inflammation of the nasal passageways triggered by various allergens such as dust, pollens, or molds. Symptoms of allergic rhinitis may be classified as seasonal or perennial. An international working group modified this classification scheme due to potential difficulties in differentiating between seasonal and perennial symptoms and created the Allergic Rhinitis and its Impact on Asthma (ARIA) Report[5]. The ARIA guidelines temporally classify allergic rhinitis as 'intermittent' if symptoms are present less than four days per week or less than four consecutive weeks, or as 'persistent' if symptoms are present more than four days per week and for more than four consecutive weeks. Severity of symptoms is graded as 'mild' if they are present but not troublesome, and as 'moderate/severe' if they lead to sleep disturbance, impairment of daily activities, or impairment of school or work.Nonallergic rhinitis is characterized by non-IgE-mediated symptoms typical of rhinitis, such as congestion and clear rhinorrhea, with less prominence of sneezing and ocular/nasal pruritis[6,7]. The associated symptoms may be perennial or sporadic, lacking a clear seasonality, and may be exacerbated by nonspecific triggers such as odors, food, emotion, or change in atmospheric conditions[5,8,9]. Though no formal classification system exists, nonallergic rhinitis can be further subcategorized; most commonly seen in older patients are the vasomotor, atrophic, gustatory, and medication-induced subtypes[10,11].All