Diagnosing Vasomotor Rhinitis (Nonallergic Rhinitis)

How Is Nonallergic Vasomotor Rhinitis Diagnosed?

Vasomotor rhinitis [vey-zoh-moh-ter ruy-nahy-tis] (nonallergic rhinitis) is a chronic condition that causes nasal congestion, runny nose, postnasal drip, or sneezing without a systemic allergic cause. The term “vasomotor rhinitis” is often used for nonallergic rhinopathy, one subtype of nonallergic rhinitis; nonallergic rhinitis also includes other subtypes, such as medication-induced, hormonal, gustatory, occupational, and age-related rhinitis. Vasomotor Rhinitis (Nonallergic Rhinitis) is not usually dangerous, but it can cause uncomfortable symptoms that may affect sleep and quality of life.

There is no single test that confirms vasomotor rhinitis (nonallergic rhinitis). Diagnosis is based mainly on the pattern of symptoms, possible triggers, a medical history, and an examination, while ruling out allergic rhinitis, infection, chronic rhinosinusitis, medication effects, and structural problems. Allergy and nonallergic triggers can occur together (mixed rhinitis). Tests are selected according to the person’s symptoms and examination findings; they do not determine a “stage” of the condition. Primary care clinicians often make the initial diagnosis. An allergist or otolaryngologist (ear, nose, and throat doctor) may be involved when the diagnosis is uncertain, symptoms are persistent or severe, or specialized testing is needed.

Here are the examinations, tests, and procedures used to diagnose vasomotor rhinitis (nonallergic rhinitis):

• Medical history: Your doctor will ask when the symptoms began, whether they are persistent or intermittent, and whether they are linked to weather changes, smoke, odors, exercise, spicy foods, workplace exposures, pregnancy or hormonal changes, or lying down. The review should also cover recent infections, prior nasal or sinus surgery, and medicines that can cause or worsen rhinitis, including overuse of decongestant nasal sprays.
• Physical examination: The doctor will examine the nose and throat for swelling, discharge, crusting, polyps, or signs of infection and may look for a deviated septum or another structural cause of obstruction. Findings can support the assessment, but they are not specific enough to diagnose nonallergic rhinitis by themselves.
• Allergy testing: Skin-prick testing or a blood test for allergen-specific immunoglobulin E (IgE) may be used when the history suggests allergy or the diagnosis is unclear. Negative results support a nonallergic diagnosis, but some people have both allergic and nonallergic rhinitis, and test results must be interpreted together with the clinical history.
• Nasal endoscopy: An otolaryngologist may pass a thin endoscope through the nostril to inspect areas that are difficult to see during a routine examination. Endoscopy is usually reserved for persistent, severe, one-sided, or otherwise atypical symptoms, or when polyps, chronic rhinosinusitis, bleeding, or a structural problem is suspected; it does not by itself confirm vasomotor rhinitis.
• Nasal provocation testing: This specialized testing is not routinely needed. In selected cases, a clinician may expose the nasal lining to a suspected allergen under controlled conditions to evaluate possible local allergic rhinitis when standard allergy tests are negative. Challenge tests using nonallergic triggers are used mainly in specialist or research settings.
• CT scan: A CT scan of the sinuses is not routinely required to diagnose nonallergic rhinitis. It may be ordered when chronic rhinosinusitis, a mass, or another structural problem is suspected, or when symptoms do not improve as expected.

These examinations and selected tests can support a diagnosis of vasomotor rhinitis (nonallergic rhinitis) by identifying the symptom pattern and excluding other causes. No test measures a stage of vasomotor rhinitis (nonallergic rhinitis). The clinician may instead assess which symptoms are most troublesome, how often they occur, their effect on daily life, and whether a specific subtype or mixed allergic and nonallergic rhinitis is likely.

Persistent nasal symptoms should be evaluated by a healthcare provider, especially when the cause is unclear or symptoms interfere with sleep or daily activities. If you suspect you have vasomotor rhinitis (nonallergic rhinitis), a clinician can review possible triggers and other causes and recommend appropriate treatment. Seek prompt medical care for one-sided obstruction or discharge, recurrent nosebleeds, facial swelling, severe pain, fever, vision changes, or clear watery drainage after a head injury.