F. Bellido, J. C. Moyano, M. Alvarez
Oct 1, 1996
total IgE, and nasal smear. and 35 females with ages ranging from 14 to 66 years (mean 31.1 years). Most of the patients seen had moderate (66.1%) to severe (22.6%) symptoms. There was considerable overlap in the types of rhinitis seen, as shown in Table 1. This was due to the presence of multiple trigger factors. The main groups were idiopathic rhinitis (88.0%), allergic rhinitis (81.2%), food-associated rhinitis (44.4%), emotional or anxiety-induced rhinitis (23. I%), and nonallergic rhinitis with eosinophilia or NARES (10.3%). Significant deviation of the nasal septum was seen in 28.2% of patients. Only 4.3% of patients had nasal polyps. Of the 103 patients with idiopathic rhinitis, only four had purely idiopathic rhinitis. Underlying allergic rhinitis was seen in 82.5% of these patients. A11 the patients with emotional or anxiety-induced rhinitis also fell into this idiopathic group, suggesting that emotional rhinitis is probably part of the spectrum of idiopathic rhinitis and perhaps should not be classified separately. Allergic rhinitis was the main diagnosis in over 80% of our patients. In this group, 89.5% also had symptoms triggered by temperature change as in idiopathic rhinitis, 35.8% by hot, spicy food, and 24.2% by emotion or anxiety. Allergic rhinitis was considered the main diagnosis by convention. In addition, other significant findings in these allergic patients included deviated nasal septum (29.5%). Only one patient had nasal polyps. Food as a cause of rhinitis is an important consideration in our local population because eating is our “national pastime”! Not unexpectedly, 44.4% of patients had rhinitis triggered by various foods. However, most (86.5%) of these 52 patients actually had gustatory rhinitis triggered by hot, spicy food and 21.2% had alcohol-induced rhinitis. Probable true food allergy was seen in only two patients, and one patient had food-additive sensitivity. Still, gustatory rhinitis is an important clinical problem, as the local foods are often hot and spicy. Drug-induced rhinitis was seen in 10 patients, but, of these, eight were related to the ingestion of oral contraceptive pills and only two had rhinitis brought on by aspirin. These last two patients did not have polyps, sinusitis, or asthma. This study showed that the classification of rhinitis is complex because of the presence of multiple trigger factors. Even the new classification by clinical symptoms and simple diagnostic tests suggested by the International Consensus Report on Rhinitis (2) is still unsatisfactory, resulting in huge overlaps between the different groups. Perhaps rhinitis should be viewed as a continuous spectrum with different presentations rather than specific entities which can be neatly classified. Our treatment should therefore be individually tailored to control the presenting symptoms.