Rhinitis, Cold Air-Induced
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- Cold air–induced rhinitis produces nasal symptoms when exposed to cold air.
- Also known as nasal hyperreactivity and is a form of nonallergic rhinitis
- Nasal hyperreactivity is an increased sensitivity to everyday nonspecific external stimuli.
- Cold air–induced rhinitis can occur in chronic allergic and nonallergic rhinitis and those with no nasal disease.
- Symptoms include rhinorrhea, nasal congestion, postnasal drainage, and nasal burning, within minutes after exposure to cold air.
- Symptoms resolve soon after exposure is eliminated.
- Overall epidemiology of rhinitis conditions is difficult to assess due to challenges in classifying rhinitis.
- Prevalence of cold air sensitivity in nonallergic chronic rhinitis is not known (1)[C].
- Rhinitis is a very common disorder affecting 20–40% of the Western population (2)[C].
- Most ENT clinics report a 50–50 division between allergic and nonallergic patients (2)[C].
- Can occur in those with or without nasal disease
- Nonallergic rhinitis presents later in life than allergic rhinitis, with 70% of patients presenting after 20 years of age.
- The prevalence of nonallergic rhinitis in children is not well studied.
Etiology and Pathophysiology
- Exact mechanism of cold air–induced rhinitis pathophysiology is uncertain. TRP ion channels appear to be involved.
- A major function of the nose is to warm and humidify inhaled air (1)[C].
- As the nose warms and humidifies air, the nasal mucosa loses heat and water (1)[C].
- Nasal mucosa has a dense subepithelial capillary network, allowing for exchange of heat and water to humidify air.
- Cold air–induced rhinorrhea is a state of mucosal hyperresponsiveness.
- Mechanism of action is through activation of mast cell and sensory nerve stimulation, which generates a cholinergic secretory response.
- Cholinergic stimulation causes anterior glandular activation, producing predominately rhinorrhea (3)[C].
- The associated rhinorrhea appears to be largely the result of glandular parasympathetic stimulation, as it is partially blocked by atropine (4)[A].
- Physical stimulus causes mast cell activation.
- Activation of mast cells causes release of inflammatory mediators, which take part in mediating nasal congestion (4)[A].
- Blocking mast cell products with antihistamine does not alter clinical response to cold air.
- Symptoms may reflect activation of a compensating mechanism to restore mucosal hemostasis (1)[C].
Commonly Associated Conditions
- Allergic rhinitis
- Nonallergic rhinitis