Perennial Rhinitis and Post Nasal Drip

  • Charmi Patel
  • Punita PondaEmail author

Practical Points

  • Risk factors for developing allergic rhinitis include: (1) family history of atopy, (2) serum IgE >100 IU/mL before age 6, (3) higher socioeconomic class and (4) presence of a positive skin prick test

  • Early-phase responses include mast cell preformed mediators such as histamine, tryptase, chymase, kininogenase, heparin and newly formed mediators such as prostaglandin D2 and cys leukotrienes

  • Late-phase response mediators include cytokines IL-1β, IL-4, IL-5, IL-13 and products of eosinophils such as major basic protein, eosinophilic cationic protein, hypohalides and leukotrienes

  • Nasal corticosteroids, oral and nasal antihistamines are typically well tolerated and efficacious in pediatric patients with allergic rhinitis

  • Centrally-acting, first-generation antihistamines should be avoided due to sedation or in children, paradoxical excitation


Mixed rhinitis Alpha-blockers Calcium channel blockers Histamine Tryptase Prostaglandin 


  1. 1.
    Settipane RA. Rhinitis: a dose of epidemiological reality. Allergy Asthma Proc. 2003;24(3):147–54.PubMedGoogle Scholar
  2. 2.
    Settipane RA, Charnock DR. Epidemiology of rhinitis: allergic and nonallergic. Clin Allergy Immunol. 2007;19:23–34.PubMedGoogle Scholar
  3. 3.
    Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, Lang DM, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph CC, Schuller D, Spector SL, Tilles SA. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol. 2008;122(2):S1–S84.CrossRefGoogle Scholar
  4. 4.
    Varghese M, Glaum MC, Lockey RF. Drug-induced rhinitis. Clin Exp Allergy. 2010;40(3):381–4.CrossRefGoogle Scholar
  5. 5.
    Anagnostou K, Swan KE, Brough H. The use of antihistamines in children. Paediatr Child Health. 2016;26(7):310–3.CrossRefGoogle Scholar
  6. 6.
    de Leon J, Michele Nikoloff D. Paradoxical excitation on diphenhydramine may be associated with being a CYP2D6 ultrarapid metabolizer: three case reports. CNS Spectr. 2008;13(2):133–5.CrossRefGoogle Scholar
  7. 7.
    Salerno SM, Jackson JL, Berbano EP. Effect of oral pseudoephedrine on blood pressure and heart rate: a meta-analysis. Arch Intern Med. 2005;165(15):1686–94.CrossRefGoogle Scholar
  8. 8.
    Mortuaire G, de Gabory L, François M, Massé G, Bloch F, Brion N, Jankowski R, Serrano E. Rebound congestion and rhinitis medicamentosa: nasal decongestants in clinical practice. Critical review of the literature by a medical panel. Eur Ann Otorhinolaryngol Head Neck Dis. 2013;130(3):137–44.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Allergy and ImmunologyDepartment of Medicine, Albany Medical Center, Albany Medical CollegeAlbanyUSA
  2. 2.Division of Allergy and Immunology, Cohen Children’s Hospital of New YorkDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellGreat NeckUSA

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