Non-allergic non-infectious perennial rhinitis. Pathogenesis and treatment

Rhinitis is a very common disorder. Most people suffer from an infectious rhinitis at least once a year. The symptoms usually disappear within a week. The patients with chronic rhinitis pose a much greater problem. At least 10 % of the general population are affected by a chronic allergic or non-allergic non-infectious rhiilltis (l). The impact of the nasal complaints such as in rhinitis is often underestimated. Bousquet and Juniper demonstrated that the impact of the disease on the quality of life is greater in rhinitis than in asthma patients (2-4). There is no generally accepted system for the definition, classification and terminology of rhinitis (5). A distinction can be made between rhinitis of known and unknown etiology. Known causes for rhinitis can be subdivided in mechanical Jactors (e.g. septal deviation, foreign body,), injections (viral, bacterial, fungal), miscellaneous causes (e.g. rhinitis medicarnentosa, pregnancy, cystic fibrosis) and allergy. Syndromes of unknown etiology include non-allergic non-infectious perennial rhinitis (NANIPER), nasal polyposis and nonallergic rhinitis with eosinophilia (NARES). The subject of this thesis is the pathogenesis and treatment of NANIPER. As this teml suggests the disorder is diagnosed through the exclusion of the known causes for rhinitis. Available studies are often difficult to compare. Different authors use different methods to exclude "the known causes". The patients are sometimes presented in a study as NANIPER patients without further specification. The way in which an allergic pathogenesis is excluded varies from skin prick tests, senllu testing for specific IgE, total IgE, nasal provocation tests or a combination of these methods. To exclude infection some authors rely on the history (chronicity of the illness, lack of purulent secretions and or the classic symptoms of acute rhinosinusitis), some rely on laboratory parameters (sedimentation rate, white blood cell count, nasal smears), others use negative radiological findings (noffilal sinus X-ray or CATscan), all with or without the use of a nasal symptom score.

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