Non-allergic rhinitis (NAR) is a condition that causes chronic sneezing, congestion, or runny nose but isn’t caused by an allergy.

Allergic rhinitis is inflammation of the inside of the nose caused by an allergen, such as pollen, dust, mould, or skin from animals.

Although non-allergic rhinitis isn’t usually harmful, it can be irritating and affect quality of life. Around 30 per cent of the Western population suffer from NAR.

How is it diagnosed?

Non-allergic rhinitis can be difficult to diagnose, as there is no specific test to confirm the condition. If blood test results suggest you don’t have an allergy, you may be diagnosed with non-allergic rhinitis.

According to the NHS, possible nasal tests include:

  • an endoscope – a thin tube with a light and video camera at one end – may be inserted up your nose
  • a nasal inspiratory flow test – measures the air flow when you inhale through your nose
  • a computerised tomography (CT) scan – a type of scan that uses X-rays and a computer to create detailed images of the inside of the nose.

How is it treated?

If NAR is diagnosed, patients should receive nasal sprays, antihistamines, eye drops and oral decongestants.

How is NAR connected to reflux?

NAR has symptoms similar to gastro-oesophageal reflux disease (GORD/GERD) and respiratory diseases.

The backflow of gastric contents including acid and pepsin into the oesophagus and beyond can cause similar symptoms, such as hoarseness, throat clearing and postnasal drip.

When reflux reaches beyond the oesophagus, respiratory-like symptoms are experienced, often leading to misdiagnosis.

But there is limited data available associating NAR and GERD.

Study into NAR using Peptest

To determine and evaluate the potential association between GERD and NAR, researchers from RD Biomed at Castle Hill Hospital in Hull teamed up with clinicians at Nanjing Medical University in China.

They used the Peptest reflux diagnostic kit to test the saliva of patients with suspected NAR.

Thirty-one patients with negative CT sinus scans and allergen skin prick tests were recruited from ENT (ear, nose and throat) outpatient visits. These patients were presenting typical clinical NAR symptoms and underwent nasal endoscopy, but the results showed little evidence of NAR.

All participants completed a Reflux Disease Questionnaire (RDQ) – a questionnaire in which subjects are asked to report the frequency and severity of their upper gastrointestinal symptoms.

The mean RDQ score of the patients was considerably lower than the limit to determine GERD.

But using Peptest to analyse saliva and sputum samples, Pepsin was detected in all the NAR patients. Samples taken after a meal showed the most frequent detection – demonstrating a clear association between reflux disease and patients presenting with non-allergic rhinitis.

What this means?

The exact cause of NAR has yet to be established and no strong link has ever been established between NAR and reflux disease possibly because the use of Reflux Disease Questionnaires (RDQ) is not a sensitive enough method to diagnose airway reflux with scores archived that are considerably lower than the scores to determine GERD.

This can result in patients being misdiagnosed for both GERD and airway reflux resulting in patients not receiving the correct treatments.

In this study, patients presenting with non-allergic rhinitis (NAR) were able to receive the correct treatment.

Professor Peter Dettmar explains: “The symptom profiles of NAR patients are similar and can be confused with those of patients presenting with reflux. Our study in China found that in some cases patients presenting with particular symptoms were treated by the ENT/Respiratory clinic as NAR patients.”

“However, many of these patients did not respond to treatment because they were actually suffering from reflux and needed reflux treatment. The Reflux Diagnostic Questionnaire produced scores in the NAR patient population of 5.16 whereas for GERD diagnosis patients need a score of 12. This clearly demonstrates the low sensitivity of these questionnaires in this instance.”

“Using Peptest, which detects pepsin – a biomarker for reflux – the mis-diagnosed NAR patients were able to receive reflux medication to manage their symptoms.”

The study Pepsin as a biomarker of reflux in NAR patients was recently presented at the 28th European Respiratory Society (ERS) International Congress in Paris