Rhinitis, Cold Air-Induced

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Basics

  • Cold air–induced rhinitis produces nasal symptoms when exposed to cold air.
  • Also known as nasal hyperreactivity and is a form of nonallergic rhinitis

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

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Basics

  • Cold air–induced rhinitis produces nasal symptoms when exposed to cold air.
  • Also known as nasal hyperreactivity and is a form of nonallergic rhinitis

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

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