Non-allergic rhinitis in children: Epidemiological aspects, pathological features, diagnostic methodology and clinical management

Table 1 Classifications of non-allergic rhinitis by World Allergy Organization and European Academy of Allergy and Clinical Immunology[23,24]

WAO	EAACI
Drug-induced rhinitis	Drug-induced rhinitis
Local a-adrenergic agonists (“rhinitis medicamentosa”: Excessive use of nasal decongestants); systemic a- and b-antagonists; aspirin; phosphodiesterase (PDE) V inhibitors; ACE inhibitors; calcium channel blockers; antipsychotics
Gustatory rhinitis	Gustatory rhinitis
Anterior rhinorrhea and/or post-nasal drip after eating, especially hot or spicy foods
Hormonal-induced rhinitis	Hormonal rhinitis
Rhinitis of pregnancy and menstrual cycle-associated rhinitis
NARES	NARES
Presence of eosinophilia in the nasal secretions
Occupational rhinitis	Occupational non-allergic rhinitis
Irritant-induced rhinitis and corrosive rhinitis
Senile rhinitis	Rhinitis of the elderly
Persistent watery rhinorrhea without any identifiable trigger
Atrophic rhinitis	Atrophic rhinitis
Primary or secondary (extensive surgery, chronic granulomatous disorders, other)
Non-allergic rhinopathy	Idiopathic rhinitis
Nasal congestion and/or rhinorrhea triggered by irritants and/or weather changes, but also chronic without identifiable triggers
Cerebral spinal fluid leak	Cold air-induced rhinitis
Persistent rhinorrhea after cranio-facial trauma or facial/sinus surgery	Rhinorrhea and/or nasal congestion and/or burning triggered by cold and/or windy condition

NARES: Non-allergic rhinitis with eosinophilia syndrome; WAO: World Allergy Organization; EAACI: European academy of allergy and clinical immunology.

Table 2 Recommendation for the treatment of pediatric non-allergic rhinitis, according to nasal cytology

	NARES	NARESMA	NARMA	NARNE
Topical anti-histamines	1	1	1	2
Systemic anti-histamines	1	1	1	2
Topical corticosteroids	1	1	1	1
Systemic corticosteroids	1	1	1	2
Ipratropium bromide	2	2	2	2
Anti-leukotrienes	1	1	1	2
Cromones	3	3	3	2
Nasal decongestant	3, 4	3, 4	3, 4	3, 4
Nasal saline irrigation	1	1	1	1

1: Recommended; 2: Not recommended; 3: Uncertain recommendation; 4: Permitted in children younger than 12 years, according to the dosage and for no more than 10-14 d. NARES: Non-allergic rhinitis with eosinophilia syndrome; NARMA: NAR with mast cells; NARNE: NAR with neutrophils; NARESMA: NAR with eosinophils and mast cells.