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NON-ANATOMIC CONDITIONS MASQUERADING AS ALLERGIC RHINITIS

This group of illnesses includes those disorders that are not due either to allergic causes or to some abnormality of the anatomy of the nose.

Atrophic Rhinitis
More common in women for reasons that are not clear, this is a disorder in which the lining of the nose becomes chronically inflamed and thinned and large numbers of scabs accumulate on the lining membrane of the nose. Patients with this problem are most bothered by two symptoms: a characteristic sensation of nasal congestion in spite of a wide-open nasal passageway, and a foul odor, called ozena, that comes from the nose. Ozena is caused by a bacterial infection of the lining of the nose.
Atrophic rhinitis is uncomfortable to have and difficult to treat. The cause of atrophic rhinitis is not known, although a causative role for bacteria, chemical fumes, cigarette smoke, and viral agents all have been suggested.

Cold Air Rhinitis
You’ve probably walked down a cold, windy street and experienced mild nasal congestion, runny nose, and occasional sneezing. This is such a common experience that most of us consider it to be normal. However, some people experience severe nasal symptoms on exposure to cold air. In these people, mast cells release the same mediators that they would if the person had been exposed to something to which they were allergic, causing these people to experience symptoms very similar to severe allergic rhinitis. However, this is not an allergy because cold is not an allergen and no IgE antibodies are involved.

Eosinophilic Non-allergic Rhinitis (E-NAR) Syndromes
When a physician makes a smear of your nasal mucus to examine under a microscope, he or she is looking to see what type(s) of cells are present as a means of differentiating one form of rhinitis from another. The eosinophil, a red-staining cell easily seen in nasal smears, is one cell doctors always look for. Although common in each of the three types of allergic rhinitis and frequently called “allergy cells,” they also appear in the nasal mucus of a group of non-allergic rhinitis syndromes called the eosinophilic non-allergic rhinitis syndromes (E-NAR syndromes).
The symptoms of E-NAR syndromes are no different from those of the other forms of non-allergic rhinitis, and can include nasal congestion, runny nose, and sneezing. These syndromes are likely to be seen in patients who also happen to suffer from asthma, chronic sinus infections, nasal polyps, or have severe reactions to aspirin.
While only your doctor can distinguish the subtleties between one form of eosinophilic rhinitis from another, you should be aware that these forms of nasal dysfunction exist and can be identified by a nasal smear. It is also important that you and your doctor know that a nasal smear full of eosinophils does not always mean that you are allergic, a misconception held by many physicians and patients.
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