The clinical presentation of rhinitis somewhat varies depending on the underlying cause, but all patients report nasal congestion and rhinorrhea in the initial stages of the disease. One of the most common subtypes, allergic rhinitis, can be further classified into seasonal, perennial, and occupational, each manifesting by nasal complaints, but also constitutional symptoms - malaise, fatigue, and headaches [1]. Persistent need for mouth breathing and sneezing may be encountered as well, while chronic symptoms often cause frequent rubbing of the nose and the appearance of an "allergic crease" across the nasal bridge due to persistent irritation [2]. Exposure to a specific allergen during a particular time of the year (tree pollens in the spring or grass pollens in the summer), an environmental irritant (tobacco, formaldehyde, hair spray, etc) or an indoor allergen (dust mites, molds) can induce typical symptoms and lead to their prolongation in the absence of a diagnosis and appropriate therapy [1] [3]. Allergic conjunctivitis, eczema, and even asthma may accompany rhinitis in such patients [1]. On the other hand, infectious pathogens (both bacterial and viral) can present with nasal obstruction, frequent and recurrent epistaxis and purulent rhinorrhea in the setting of a bacterial infection [4]. Atrophic rhinitis, another form of non-allergic inflammation of the nasal mucosa, can cause a chronic cough, excessive mucus production (known as the nasal drip), and dryness, while patients frequently complain of nasal crusting, as well as dense and thick secretions that induce the need to clear the throat [5]. Furthermore, it is not uncommon for patients to suffer from chronic inflammation of the nasal and sinus mucosa (known as chronic rhinosinusitis), in which symptoms last for more than 12 weeks [6]. Vasomotor rhinitis, characterized by an intermittent appearance of chronic watery rhinorrhea and sneezing, is also an important cause of chronic rhinitis, but its etiology remains to be determined [4].

• Fever of Unknown Origin

  […] of unknown origin [FUO] Fever with chills Fever with rigors Hyperpyrexia NOS Persistent fever Pyrexia NOS catarrhal (acute) J00 ICD-10-CM Diagnosis Code J00 Acute nasopharyngitis [common cold] 2016 2017 2018 2019 Billable/Specific Code Applicable To [icd10data.com]

• Anosmia

  Four of eight patients with anosmia subjectively improved whereas the other four patients felt unchanged. [ncbi.nlm.nih.gov]

  Clinical features : Commonly seen in females and starts around puberty. Foul smell from the nose. Marked anosmia (merciful anosmia) Nasal obstruction Epistaxis when the crusts are removed. Nasal cavity full of greenish or greyish black dry crusts [slideshare.net]

  Medicine Click here for Patient Education Rhinitis is inflammation of the nasal mucous membrane, with resultant nasal congestion, rhinorrhea, and variable associated symptoms depending on etiology (eg, itching, sneezing, watery or purulent rhinorrhea, anosmia [msdmanuals.com]

  Eustachian tubes connect the middle ears to the back of the throat Chronic ear infection, known as otitis media Loss of smell or anosmia Asthma Obstructive sleep apnea Both types of rhinitis are associated with: Decreased production at work Increased [webmd.com]

• Loud Snoring

  The use of BR had no effect on sleep quality, arousal-index apnoea-hypopnoea-index or snoring loudness. Snoring frequency was significantly lowered by BR (173 /-29 snores x h(-l)), compared with placebo (258 /-34 snores x h(-1); p 0.016). [ncbi.nlm.nih.gov]

The diagnosis can often be made solely through obtaining a thorough patient history and performing a detailed physical examination, as the clinical presentation is highly specific for rhinitis [1] [2] [4]. Patients should be asked about the timing and onset of symptoms that may reveal seasonal or occupational factors that can provoke them, while the use of medications is important as well since drug-induced rhinitis is also described in the literature [1]. Angiotensin-converting enzyme (ACE) inhibitors, phentolamine, methyldopa, prazosin, beta blockers, oral contraceptives, chlorpromazine, decongestants and nonsteroidal anti-inflammatory drugs (NSAIDs) are all potential causes of medication-induced rhinitis [1]. A full ear, nose, and throat (ENT) exam (with a particular emphasis on anterior rhinoscopy and observation of discharge) can confirm the diagnosis. Pale, pink, or bluish swelling of the nasal mucosa and accompanying watery eye discharge and conjunctival swelling are highly suggestive of allergic rhinitis [2]. Conversely, purulent nasal secretion strongly points to a bacterial etiology, in which case cultivation of the smear may be recommended. Apart from clinical criteria, percutaneous and immunoglobulin E (IgE) testing for allergens are frequently employed in the setting of chronic rhinitis [1], while imaging studies, such as computed tomography (CT) and upper airway endoscopy, may be quite important if the diagnosis remains unresolved [3].

• Lymphocytic Infiltrate

  For the lymphocytic infiltrate, there was no difference between infected and not infected patients with allergic rhinitis (p 1.0). [ncbi.nlm.nih.gov]

  For the lymphocytic infiltrate, there was no difference between infected and not infected patients with allergic rhinitis ( p 1.0). [scielo.br]

1. Quillen DM, Feller DB. Diagnosing rhinitis: allergic vs. nonallergic. Am Fam Physician. 2006;73(9):1583-1590.
2. Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR, et al. Clinical practice guideline: Allergic rhinitis. Otolaryngol Head Neck Surg. 2015;152(1):S1-43.
3. Tran NP, Vickery J, Blaiss MS. Management of Rhinitis: Allergic and Non-Allergic. Allergy Asthma Immunol Res. 2011;3(3):148-156.
4. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
5. Pinto JM, Jeswani S. Rhinitis in the geriatric population. Allergy Asthma Clin Immunol. 2010;6(1):10.
6. Schroer B, Pien LC. Nonallergic rhinitis: common problem, chronic symptoms. Cleve Clin J Med. 2012;79(4):285-293.