Rhinitis - Nonallergic (Pediatric)

Definition

Nonallergic rhinitis in children is inflammation of the nasal mucosa not caused by IgE-mediated allergic mechanisms, presenting with chronic nasal congestion, rhinorrhea, sneezing, or postnasal drip.

Epidemiology

• Less common than allergic rhinitis but can affect school-aged children
• Often begins in early childhood and persists into adolescence
• No significant gender predilection
• Prevalence varies based on environmental exposures and local irritants
• May coexist with allergic rhinitis (mixed rhinitis)

Etiology

• Irritants: tobacco smoke, air pollution, strong odors, perfumes
• Infections: post-viral rhinitis following upper respiratory tract infections
• Hormonal factors: puberty or obesity-related
• Medications: chronic use of nasal decongestants (rebound rhinitis), beta-blockers
• Structural abnormalities: septal deviation, adenoid hypertrophy
• Autonomic dysfunction: vasomotor rhinitis

Pathophysiology

• Hyperresponsiveness of nasal mucosa to nonallergic stimuli
• Dysregulated autonomic nervous system leading to increased vascular permeability
• Chronic inflammation without IgE-mediated mast cell activation
• Mucosal edema, increased mucus production, and nasal obstruction
• Persistent symptoms may lead to secondary sinusitis or eustachian tube dysfunction
• Repeated triggers maintain mucosal hypersensitivity