Diagnosis of mixed rhinitis requires a careful history to elicit inciting triggers and diagnostic testing to assess the patient’s allergic status. These patients have sensitizations that account for some but not all of their clinical symptoms. Typically, they also notice increased congestion, drainage with or without sinus pressure/headaches, and ear popping/plugging in response to chemicals, odorants, and changing or extreme weather conditions. Incomplete treatment response to medications designed to treat allergic rhinitis is an important clinical clue that a more complex form of chronic rhinitis exists. Successful treatment of mixed rhinitis first requires recognition that there is a nonallergic component associated with allergic rhinitis. Once this is determined, tailoring treatment using a wide range of medications is required based on the patient’s tolerance of medications that address congestion and drainage will reduce the severity of symptoms, onset of comorbidities like sinusitis, and medical costs. These cases require ongoing medication management to ensure optimum clinical outcomes.
KeywordsMixed rhinitis Nasal congestion Postnasal drainage Nonallergic triggers Allergy rhinitis Irritant index questionnaire Chemicals Odorants Irritants
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