How can I differentiate between allergic rhinitis and non-allergic rhinitis in a primary care setting?

In a primary care setting, differentiating allergic rhinitis from non-allergic rhinitis primarily relies on a detailed clinical history and symptom pattern assessment. Allergic rhinitis typically presents with symptoms such as sneezing, nasal congestion, rhinorrhoea, and nasal itching that are often seasonal or triggered by specific allergens like pollen, dust mites, or animal dander. Patients frequently have a personal or family history of atopic diseases such as asthma, eczema, or other allergies. Symptoms usually correlate with allergen exposure and may improve with allergen avoidance and respond well to intranasal corticosteroids or antihistamines ¹.

Non-allergic rhinitis, by contrast, tends to present with similar nasal symptoms but without a clear allergen trigger or atopic history. It is often perennial and may be associated with irritants such as smoke, strong odors, weather changes, or infections. Unlike allergic rhinitis, non-allergic rhinitis does not involve an IgE-mediated immune response, and allergy testing (skin prick or specific IgE) is typically negative ¹.

In practice, an allergy-focused clinical history is essential, including questions about symptom timing, triggers, family and personal atopy history, and symptom reproducibility. Physical examination may reveal signs of atopy in allergic rhinitis but is often unremarkable in non-allergic rhinitis. If the diagnosis remains uncertain, referral for allergy testing can help confirm allergic rhinitis by identifying specific IgE sensitization ¹,³.

Management response can also aid differentiation: allergic rhinitis symptoms generally improve with intranasal corticosteroids and antihistamines, whereas non-allergic rhinitis may respond less predictably to these treatments and may require alternative approaches such as nasal irrigation or avoidance of irritants ¹,².

Recent literature supports this approach, emphasizing the importance of clinical history and symptom patterns in primary care to distinguish these conditions effectively, as allergy testing is not always necessary initially but can be used selectively (Angier et al., 2010).