A 30-year-old female presents with perennial nasal congestion, rhinorrhea, and sneezing that are worse on exposure to cold air, perfume, and spicy food but she has negative skin prick tests and normal serum IgE. Nasal cytology shows absence of eosinophils. The most likely diagnosis is:
- A Non-allergic rhinitis (vasomotor rhinitis) — idiopathic neurogenic nasal hyperreactivity ✓
- B Allergic rhinitis (house dust mite sensitization with false negative skin tests)
- C NARES (non-allergic rhinitis with eosinophilia syndrome)
- D Drug-induced rhinitis (rhinitis medicamentosa)
Explanation
Vasomotor rhinitis (idiopathic/non-allergic non-eosinophilic rhinitis) is characterized by perennial nasal symptoms triggered by non-allergenic stimuli such as temperature changes, strong odors, spicy food, and smoke, with negative allergy tests and absent nasal eosinophilia. It is thought to involve dysregulation of the autonomic nervous system innervating nasal mucosa (predominantly parasympathetic overactivity). NARES has eosinophilia on nasal smear. Allergic rhinitis requires positive skin prick test or specific IgE. Rhinitis medicamentosa is from topical decongestant overuse.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.