Guideline sources The following summarized guidelines for the evaluation and management of vasomotor rhinitis are prepared by our editorial team based on guidelines from the American Academy of Allergy, Asthma & Immunology (AAAAI/ACAAI 2020). 1 Guidelines 1. Classification and risk stratification Severity assessment: consider using a validated instrument (such as scoring system, scale, or questionnaire) to help determine the severity of rhinitis and to monitor the degree of disease control. C 2. Diagnostic investigations Clinical examination: Elicit a complete detailed history and perform physical examination in patients presenting with symptoms of rhinitis. B Review all current medications in patients presenting with symptoms of rhinitis to assess whether drug-induced rhinitis may be present. A 3. Medical management Intranasal antihistamines: https://web.pathway.md/diseases/rec8VlHIiD7vUkIHr 1/2 6/29/23, 3:24 AM Vasomotor rhinitis Pathway Offer intranasal antihistamines as first-line monotherapy in patients with non-allergic rhinitis. A Consider offering intranasal antihistamines as first-line therapy in patients with non-allergic rhinitis. C Intranasal corticosteroids: Consider offering intranasal corticosteroids as first-line therapy in patients with non-allergic rhinitis. C Consider offering a combination of intranasal corticosteroids and intranasal antihistamines in patients with moderate or severe non-allergic rhinitis resistant to pharmacologic monotherapy. C Intranasal anticholinergics: Consider offering intranasal ipratropium in patients with non-allergic rhinitis having rhinorrhea as their main nasal symptom. C Consider adding intranasal ipratropium in patients taking intranasal corticosteroids and having persistent rhinorrhea. C Intranasal decongestants: consider offering intranasal decongestants for short-term and for intermittent or episodic therapy of nasal congestion. C Show 2 more Oral leukotriene receptor antagonists: do not use oral leukotriene receptor antagonists in patients with non-allergic rhinitis. D Oral decongestants: Be cautious when using oral decongestants in older adult and < 4 years old pediatric patients, and in patients of any age having a history of cardiac arrhythmia, angina pectoris, cerebrovascular disease, uncontrolled hypertension, bladder outlet obstruction, glaucoma, hyperthyroidism, or Tourette's syndrome. B Avoid using oral decongestants during the first trimester of pregnancy. D References 1. Mark S Dykewicz, Dana V Wallace, David J Amrol et al. Rhinitis 2020 A practice parameter update. J Allergy Clin Immunol. 2020 Oct;146 4 721 767. Open https://web.pathway.md/diseases/rec8VlHIiD7vUkIHr 2/2