Chronic rhinitis (CR) is common with up to 30% of the population affected, with a significant impact on quality of life. CR includes several phenotypes with different pathogenesis including allergy, autoimmune, age, occupation, pregnancy, neurogenic and drugs. Such variation means that different treatments might be necessary. Endotype classifications exist but lack scientific basis and are subjective to a degree. The authors conducted a six-month single centre prospective study. Patients who had received steroids, antibiotics, decongestants or antihistamines recently were excluded. Recruited subjects were asked to complete a visual analogue score. Fractional exhaled nitric oxide (FeNO), serum immunoglobulin (Ig) E and IgE in nasal secretions were measured, a nasal allergen provocation test was performed, as was histological assessment of mucosal samples for inflammatory cells including eosinophils. A total of 259 patients were included with 20 controls. The authors used 12 markers to formulate six clusters of patients with chronic rhinitis: allergic rhinitis without asthma; allergic rhinitis with asthma; nonallergic rhinitis with eosinophilia syndrome (NARES) without asthma; local allergic rhinitis; NARES with asthma; and idiopathic rhinitis. This has the potential to allow individualised treatment for patients depending on their endotype. However, the study excluded patients who were on decongestants which means exclusion of some drug-induced rhinitis, and study subjects were relatively young which means that rhinitis of the elderly was not included. Additionally, occupation, pregnancy status and hormonal treatments were not included in the clustering process.
Chronic rhinitis endotypes
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