POSITION PAPER Phenotypes and endotypes of rhinitis and their impact on management: a PRACTALL report N. G. Papadopoulos 1,2 , J. A. Bernstein 3 , P. Demoly 4 , M. Dykewicz 5 , W. Fokkens 6 , P. W. Hellings 7 , A. T. Peters 8 , C. Rondon 9 , A. Togias 10 & L. S. Cox 11 1 Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK; 2 Allergy Department, 2nd Paediatric Clinic, University of Athens, Athens, Greece; 3 Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA; 4 Allergy Department, University Hospital of Montpellier, Montpellier, France; 5 Section of Allergy and Clinical Immunology, Saint Louis University School of Medicine, Saint Louis, MO, USA; 6 Otorhinolaryngology Department, Academic Medical Centre, Amsterdam, The Netherlands; 7 Otorhinolaryngology Department, University Hospitals Leuven, Leuven, Belgium; 8 Division of Allergy-Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; 9 Servicio de Alergologia, Hospital Carlos Haya, Malaga, Spain; 10 National Institute of Allergy and Infectious Diseases, National institute of Health, Bethesda, WA; 11 Nova Southeastern University, Davie, FL, USA To cite this article: Papadopoulos NG, Bernstein JA, Demoly P, Dykewicz M, Fokkens W, Hellings PW, Peters AT, Rondon C, Togias A, Cox LS. Phenotypes and endotypes of rhinitis and their impact on management: a PRACTALL report. Allergy 2015; 70: 474–494. Keywords classification; endotypes; phenotypes; rhini- tis; treatment. Correspondence Nikolaos G. Papadopoulos, Royal Manches- ter Children’s Hospital, 5th Floor (Research), Manchester, M13 9WL, UK. Tel.: +44 (0)161 701 6966 Fax: +44 (0)161 701 6910 and 41, Fidippidou Street, Athens 115 27, Greece. Tel.: +30 (210) 7776964 Fax: +30 (210) 7777693 E-mail: Nikolaos.Papadopoulos@manchester. ac.uk Accepted for publication 16 January 2015 DOI:10.1111/all.12573 Edited by: De Yun Wang Abstract Rhinitis is an umbrella term that encompasses many different subtypes, several of which still elude complete characterization. The concept of phenotyping, being the definition of disease subtypes on the basis of clinical presentation, has been well established in the last decade. Classification of rhinitis entities on the basis of phenotypes has facilitated their characterization and has helped practicing clini- cians to efficiently approach rhinitis patients. Recently, the concept of endotypes, that is, the definition of disease subtypes on the basis of underlying pathophysiol- ogy, has emerged. Phenotypes/endotypes are dynamic, overlapping, and may evolve into one another, thus rendering clear-cut definitions difficult. Neverthe- less, a phenotype-/endotype-based classification approach could lead toward the application of stratified and personalized medicine in the rhinitis field. In this PRACTALL document, rhinitis phenotypes and endotypes are described, and rhi- nitis diagnosis and management approaches focusing on those phenotypes/endo- types are presented and discussed. We emphasize the concept of control-based management, which transcends all rhinitis subtypes. Rhinitis is an umbrella term used to describe nasal symptoms such as nasal congestion/obstruction, rhinorrhea, sneezing, and pruritus resulting from inflammation (‘itis’) and/or dysfunction of the nasal mucosa. Rhinitis is one of the most common medi- cal conditions, with significant morbidity and a considerable financial burden (1). Rhinitis constitutes a risk factor for asthma and is associated with chronic conditions such as rhinosinusitis (2). Besides airway symptoms, the general impact of rhinitis such as sleep impairment, decreased work productivity and school performance, behavioral deviation, and psychological impairment should not be underestimated (3, 4). Different forms of rhinitis are associated with a significant burden. Patients suffering from severe rhinitis experience significant impairment of their quality of life. A recent report suggests that AR is a risk factor for traffic safety (5). Rhinitis can be the result of diverse aetiologies, most com- monly infections and immediate-type allergic responses, but also other triggers including irritants, medications, hormonal imbalance, and neuronal dysfunction. Rhinitis is classically divided into 3 major clinical phenotypes: allergic rhinitis (AR), infectious rhinitis, and nonallergic, noninfectious rhinitis (NAR) (6), with the possibility of a combined (mixed) Allergy 70 (2015) 474–494 © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 474 Allergy