In trying to determine whether someone’s symptoms are work-related, she said, “One simple, most important question is: Do your symptoms get better when you’re away from work? The weekend might not be enough…but what about a vacation? You’re a week away from work.”
Explore This IssueNovember 2014
In discussing the case of a 25-year-old with rhinitis caused by wood dust, panelists recommended using a mask and making sure the building was properly ventilated. Dr. Toskala said she would treat with nasal steroids, but her first choice was more drastic: “If I could make a choice, I would say change his work.”
Local Allergenic Rhinitis
William Reisacher, MD, assistant professor of otorhinolaryngology and the director of allergy within the department of otolaryngology-head and neck surgery at Weill Cornell Medical College in New York, said that in some of the more vexing cases, physicians should consider the possibility of local allergic rhinitis, and it may not be NAR or traditional allergic rhinitis.
He started looking into this condition because he had patients who really looked to him as if they had allergic rhinitis. The patients themselves thought they had allergic rhinitis. But, he said, all of the testing came back negative. “The conversation would go something like this, ‘No, you don’t have allergies.’ ‘Yes, I do have allergies.’ ‘No, you don’t have allergies.’”
“The creation of local IgE can happen right in the nasal mucosa,” he said. “And that’s a switch from previous thinking that it had to occur in the larger lymphoid structures in the body like the spleen and the larger lymph nodes. Now we understand that the mucosa has all the machinery it needs to undergo that process and produce its own specific IgE.”
Tests for local allergic rhinitis include lavage, suction, nasal allergen provocation, surgical biopsy, and mucosal brush biopsy. A 2011 study found that immunotherapy offered benefits similar to those seen in patients with traditional allergic rhinitis.
Amber Luong, MD, PhD, assistant professor of otorhinolaryngology at the University of Texas Medical School in Houston, offered some hope for a more effective way to diagnose nonallergic rhinitis—by monitoring blood flow to the nose after exposure to capsaicin. “The problem is, a diagnosis of exclusion … doesn’t have a very good pre-test probability. You don’t feel that great about that diagnosis.”
The approach involves using optical rhinometry, a procedure in which a patient wears a device that looks like a pair of glasses with an emitter and a sensor that sits across the patient’s nose. This instrument indirectly monitors blood flow in and out of the nose, and that information is used as an indirect measure of nasal congestion.