Description

• 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.

Epidemiology

Prevalence

• 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].

Risk Factors

• Nasal hypersensitivity is common in both allergic and nonallergic rhinitis.
• Persistent allergic rhinitis is a risk factor for developing sudden temperature change–related rhinitis even in the absence of allergen exposure (2)[B].

General Prevention

Trigger avoidance

Commonly Associated Conditions

• Allergic rhinitis
• Nonallergic rhinitis
• Asthma
• Sinusitis