{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T18:29:01Z","timestamp":1791916141685,"version":"4.3.4"},"reference-count":39,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2019,11,19]],"date-time":"2019-11-19T00:00:00Z","timestamp":1574121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Chronic rhinitis (CR) is divided into two main categories: allergic rhinitis (AR) and nonallergic rhinitis (NAR). These conditions are more recognizable to an experienced clinician, as they can be more clearly demarcated diagnostically. However, an additional 30% to 50% of patients with CR might have an overlap of NAR and AR, referred to as mixed rhinitis (MR). Progress in elucidating the pathophysiologic mechanisms behind MR and NAR has been made in the past several years, and there are now several guidelines published to assist the clinician in accurately diagnosing AR, NAR, and MR. Clinical history and subjective symptoms can provide clues for differentiating AR from MR and NAR, but allergy testing is recommended to confirm these conditions. Progress in accurately diagnosing patients with CR will be made as studies incorporate subjective (i.e., validated questionnaires such as the irritant index questionnaire (IIQ), medication responsiveness, and quality-of-life tools) and objective (i.e., nasal cytologic testing, nasal provocation, and biomarkers) methods characterizing rhinitis subtypes.<\/jats:p>","DOI":"10.3390\/jcm8112019","type":"journal-article","created":{"date-parts":[[2019,11,19]],"date-time":"2019-11-19T11:30:17Z","timestamp":1574163017000},"page":"2019","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Allergic and Mixed Rhinitis: Diagnosis and Natural Evolution"],"prefix":"10.3390","volume":"8","author":[{"given":"Justin C.","family":"Greiwe","sequence":"first","affiliation":[{"name":"Bernstein Allergy Group 8444 Winton Road, Cincinnati, OH 45231, USA"},{"name":"Department of Internal Medicine, Division of Immunology\/Allergy Section, The University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML#563, Cincinnati, OH 45267-0563, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan A.","family":"Bernstein","sequence":"additional","affiliation":[{"name":"Bernstein Allergy Group 8444 Winton Road, Cincinnati, OH 45231, USA"},{"name":"Department of Internal Medicine, Division of Immunology\/Allergy Section, The University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML#563, Cincinnati, OH 45267-0563, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,11,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"391","DOI":"10.2500\/ajra.2016.30.4391","article-title":"Combination therapy in allergic rhinitis: What works and what does not work","volume":"30","author":"Greiwe","year":"2016","journal-title":"Am. J. Rhinol. Allergy"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Bernstein, J.A. (2018). Chapter 3: Nonallergic vasomotor rhinitis. Rhinitis and Related Upper Respiratory Conditions: A Clinical Guide, Springer.","DOI":"10.1007\/978-3-319-75370-6"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1016\/S1081-1206(10)62896-7","article-title":"Update on nonallergic rhinitis","volume":"86","author":"Settipane","year":"2001","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"365","DOI":"10.2500\/aap.2010.31.3380","article-title":"Allergic and mixed rhinitis: Epidemiology and natural history","volume":"31","author":"Bernstein","year":"2010","journal-title":"Allergy Asthma Proc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S2","DOI":"10.1067\/mai.2001.115569","article-title":"Allergic rhinitis: Definition, epidemiology, pathophysiology, detection, and diagnosis","volume":"108","author":"Skoner","year":"2001","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.jaip.2013.03.014","article-title":"Headache and facial pain: Differential diagnosis and treatment","volume":"1","author":"Bernstein","year":"2013","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1177\/0333102413512031","article-title":"Chronic rhinitis and its association with headache frequency and disability in persons with migraine: Results of the American Migraine Prevalence and Prevention (AMPP) Study","volume":"34","author":"Martin","year":"2014","journal-title":"Cephalalgia"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1111\/j.1398-9995.2008.01715.x","article-title":"Important research questions in allergy and related diseases: Nonallergic rhinitis: A GA2LEN paper","volume":"63","author":"Bousquet","year":"2008","journal-title":"Allergy"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1007\/s11882-015-0511-7","article-title":"Neural abnormalities in nonallergic rhinitis","volume":"15","author":"Bernstein","year":"2015","journal-title":"Curr. Allergy Asthma Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"215","DOI":"10.2500\/ajra.2014.28.4059","article-title":"Azelastine desensitization of transient receptor potential vanilloid 1: A potential mechanism explaining its therapeutic effect in nonallergic rhinitis","volume":"28","author":"Singh","year":"2014","journal-title":"Am. J. Rhinol. Allergy"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1016\/j.jaci.2006.09.013","article-title":"The role of the nervous system in rhinitis","volume":"118","author":"Sarin","year":"2006","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1016\/j.jaci.2013.08.026","article-title":"Capsaicin treatment reduces nasal hyperreactivity and transient receptor potential cation channel subfamily V, receptor 1 (TRPV1) overexpression in patients with idiopathic rhinitis","volume":"133","author":"Alpizar","year":"2014","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"AB134","DOI":"10.1016\/j.jaci.2012.12.1145","article-title":"Anti-histaminergic responses on TRPV1 channels","volume":"131","author":"Singh","year":"2013","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.anai.2012.06.013","article-title":"Clinical characteristics of chronic rhinitis patients with high vs. low irritant trigger burdens","volume":"109","author":"Bernstein","year":"2012","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_15","unstructured":"Dykewicz, M.S., Ledford, D.K., Settipane, R.A., and Lieberman, P. (1999, January 16). The broad spectrum of rhinitis: Etiology, diagnosis, and advances in treatment. Proceedings of the National Allergy Advisory Council Meeting (NAAC), St. Thomas, U.S. Virgin Islands."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1016\/S1081-1206(10)63546-6","article-title":"Patient-reported symptoms induced by allergic and non-allergic triggers in randomized controlled trials of MP-Azeflu (Dymista) in seasonal allergic rhinitis (SAR) patients","volume":"96","author":"Brandt","year":"2006","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_17","unstructured":"Kaliner, M. (2006). Mixed rhinitis: A new subclass of chronic rhinitis?. Current Review of Rhinitis, Current Medicine. [2nd ed.]."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1159\/000320050","article-title":"Differences and similarities between allergic and nonallergic rhinitis in a large sample of adult patients with rhinitis symptoms","volume":"155","author":"Pacor","year":"2011","journal-title":"Int. Arch. Allergy Immunol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1016\/S1081-1206(10)63546-6","article-title":"Questionnaire evaluation and risk factor identification for nonallergic vasomotor rhinitis","volume":"96","author":"Brandt","year":"2006","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_20","first-page":"1583","article-title":"Diagnosing rhinitis: Allergic vs. nonallergic","volume":"73","author":"Quillen","year":"2006","journal-title":"Am. Fam. Physician"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1648","DOI":"10.3950\/jibiinkoka.99.1648","article-title":"Investigation of \u201canosmic zones\u201d associated with nasal allergy","volume":"99","author":"Higo","year":"1996","journal-title":"Nippon Jibiinkoka Gakkai Kaiho"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1080\/02770900701867579","article-title":"Olfactory receptor gene polymorphisms and nonallergic vasomotor rhinitis","volume":"45","author":"Bernstein","year":"2008","journal-title":"J. Asthma"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/S1081-1206(10)60389-4","article-title":"Investigation of olfactory threshold responses in chronic rhinitis subtypes","volume":"99","author":"Rezvani","year":"2007","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.iac.2015.12.006","article-title":"Nonallergic rhinitis: Diagnosis","volume":"36","author":"Greiwe","year":"2016","journal-title":"Immunol. Allergy Clin. N. Am."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"333","DOI":"10.2500\/aap.2012.33.3579","article-title":"Provocation of nonallergic rhinitis subjects in response to simulated weather conditions using an environmental exposure chamber model","volume":"33","author":"Bernstein","year":"2012","journal-title":"Allergy Asthma Proc."},{"key":"ref_26","first-page":"225","article-title":"Cold dry air provocation is a reliable diagnostic tool in nonallergic rhinitis","volume":"57","author":"Huang","year":"2019","journal-title":"Rhinology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/j.jaci.2012.10.022","article-title":"Reliability, validity, and responsiveness of the Rhinitis Control Assessment Test in patients with rhinitis","volume":"131","author":"Meltzer","year":"2013","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.anai.2009.11.063","article-title":"Psychometric validation of the Rhinitis Control Assessment Test: A brief patient-completed instrument for evaluating rhinitis symptom control","volume":"104","author":"Schatz","year":"2010","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/0091-6749(78)90471-2","article-title":"Reappraisal of intracutaneous tests in the diagnosis of reaginic allergy","volume":"61","author":"Reddy","year":"1978","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1016\/S0091-6749(99)70419-7","article-title":"A comparison of skin prick tests, intradermal skin tests, and RASTs in the diagnosis of cat allergy","volume":"103","author":"Wood","year":"1999","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1016\/j.jaci.2013.10.034","article-title":"Follow-up study in local allergic rhinitis shows a consistent entity not evolving to systemic allergic rhinitis","volume":"133","author":"Campo","year":"2014","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"457","DOI":"10.2500\/ajra.2013.27.3983","article-title":"Characterizing rhinitis subtypes","volume":"27","author":"Bernstein","year":"2013","journal-title":"Am. J. Rhinol. Allergy"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.jaci.2008.06.003","article-title":"The diagnosis and management of rhinitis, an updated practice parameter","volume":"122","author":"Wallace","year":"2008","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1136\/thorax.58.10.901","article-title":"Cough, 1: Chronic cough in adults","volume":"58","author":"Morice","year":"2003","journal-title":"Thorax"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1378\/chest.129.5.1142","article-title":"Causes and clinical features of subacute cough","volume":"129","author":"Kwon","year":"2006","journal-title":"Chest"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1700","DOI":"10.1016\/j.rmed.2009.05.005","article-title":"Postnasal drip and chronic cough: An open interventional study","volume":"103","author":"Macedo","year":"2009","journal-title":"Respir. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1016\/j.mayocp.2013.08.007","article-title":"Chronic cough: An update","volume":"Volume 88","author":"Iyer","year":"2013","journal-title":"Mayo Clinic Proceedings"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.jaip.2018.06.029","article-title":"Chronic rhinitis is a high-risk comorbidity for 30-day hospital readmission of patients with asthma and chronic obstructive pulmonary disease","volume":"7","author":"Singh","year":"2019","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.1111\/all.13200","article-title":"Non-allergic rhinitis: Position paper of the European Academy of Allergy and Clinical Immunology","volume":"72","author":"Hellings","year":"2017","journal-title":"Allergy"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/11\/2019\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:35:38Z","timestamp":1760189738000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/11\/2019"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,19]]},"references-count":39,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2019,11]]}},"alternative-id":["jcm8112019"],"URL":"https:\/\/doi.org\/10.3390\/jcm8112019","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,19]]}}}