Rhinitis can be divided into allergic and nonallergic rhinitis (Table 79-1). Nonallergic rhinitis describes a group of nasal diseases in which there is no evidence of allergic etiology. It can be divided further into nonanatomic and anatomic etiologies. The most common form of nonallergic rhinitis in children is infectious rhinitis, which may be acute or chronic. Acute infectious rhinitis (the common cold) is caused by viruses, including rhinoviruses and coronaviruses, and typically resolves within 7 to 10 days (see Chapter 102). An average child has three to six common colds per year, with the most affected being younger children and children attending day care. Infection is suggested by the presence of sore throat, fever, and poor appetite, especially with a history of exposure to others with colds. Chronic infectious rhinosinusitis, or sinusitis, should be suspected if there is mucopurulent nasal discharge with symptoms that persist beyond 10 days (see Chapter 104). Classic signs of acute sinusitis in older children include facial tenderness, tooth pain, headache, and fever. Classic signs are usually not present in young children who may present with postnasal drainage with cough, throat clearing, halitosis, and rhinorrhea. The character of the nasal secretions with infectious rhinitis varies from purulent to minimal or absent. Coexistence of middle ear disease, such as otitis media or eustachian tube dysfunction, may be additional clues of infection.
Nonallergic, noninfectious rhinitis (formerly known as vasomotor rhinitis) can manifest as rhinorrhea and sneezing in children with profuse clear nasal discharge. Exposure to irritants, such as cigarette smoke and dust, and strong fumes and odors, such as perfumes and chlorine in swimming pools, can trigger these nasal symptoms. Nonallergic rhinitis with eosinophilia syndrome is associated with clear nasal discharge and eosinophils on nasal smear and is seen infrequently in children. Cold air (skier’s nose), hot/spicy food ingestion (gustatory rhinitis), and exposure to bright light (reflex rhinitis) are examples of physical rhinitis. Treatment with topical ipratropium before exposure may be helpful.
Rhinitis medicamentosa, which is due primarily to overuse of topical nasal decongestants, such as oxymetazoline, phenylephrine, or cocaine, is not a common condition in younger children. Adolescents or young adults may become dependent on these over-the-counter medications. Treatment requires discontinuation of the offending decongestant spray, topical corticosteroids, and, frequently, a short course of oral corticosteroids.
The most common anatomic problem seen in young children is obstruction secondary to adenoidal hypertrophy, which can be suspected from symptoms such as mouth breathing, snoring, hyponasal speech, and persistent rhinitis with or without chronic otitis media. Infection of the nasopharynx may be secondary to infected hypertrophied adenoid tissue.