Nonallergic rhinitis

Nonallergic rhinitis involves chronic sneezing or a congested, drippy nose with no apparent cause. Nonallergic rhinitis symptoms are similar to those of hay fever (allergic rhinitis), but with none of the usual evidence of an allergic reaction.

Nonallergic rhinitis can affect children and adults. But it's more common after age 20. Triggers of nonallergic rhinitis symptoms vary and can include certain odors or irritants in the air, weather changes, some medications, certain foods, and chronic health conditions.

A diagnosis of nonallergic rhinitis is made after an allergic cause is ruled out. This may require allergy skin or blood tests.

Symptoms

If you have nonallergic rhinitis, you probably have symptoms that come and go year-round. Signs and symptoms of nonallergic rhinitis might include:

• Stuffy or runny nose
• Sneezing
• Mucus in the throat
• Cough

Nonallergic rhinitis doesn't usually cause itchy nose, eyes or throat — symptoms associated with allergies such as hay fever.

When to see a doctor

See your doctor if:

• Your symptoms are severe
• You have signs and symptoms that aren't relieved by over-the-counter medications or self-care
• You have bothersome side effects from over-the-counter or prescription medications for rhinitis

Causes

The exact cause of nonallergic rhinitis is unknown.

Experts do know that nonallergic rhinitis occurs when blood vessels in your nose expand and fill the nasal lining with blood and fluid. There are many possible causes, including the nerve endings in the nose being overly responsive, similar to the way the lungs react in asthma.

Whatever the trigger, the result is the same — swollen nasal membranes, congestion or excessive mucus.

There are many triggers of nonallergic rhinitis, including:

• Environmental or occupational irritants. Dust, smog, secondhand smoke or strong odors, such as perfumes, can trigger nonallergic rhinitis. Chemical fumes, such as those you might be exposed to in certain occupations, also can be to blame.
• Weather changes. Temperature or humidity changes can trigger the membranes inside your nose to swell and cause a runny or stuffy nose.
• Infections. Viral infections such as a cold or the flu commonly cause nonallergic rhinitis.
• Foods and beverages. Nonallergic rhinitis can occur when you eat, especially when eating hot or spicy foods. Drinking alcoholic beverages also can cause the membranes inside your nose to swell, leading to nasal congestion.

• Certain medications. Medications that can cause nonallergic rhinitis include aspirin, ibuprofen (Advil, Motrin IB, others) and high blood pressure medications, such as beta blockers.

  Nonallergic rhinitis also can be triggered in some people by sedatives, antidepressants, oral contraceptives or drugs used to treat erectile dysfunction. Overuse of decongestant nasal sprays can cause a type of nonallergic rhinitis called rhinitis medicamentosa.

• Hormone changes. Hormonal changes due to pregnancy, menstruation, oral contraceptive use or other hormonal conditions such as hypothyroidism may cause nonallergic rhinitis.
• Sleeping on your back, sleep apnea and acid reflux. Lying on your back at night while you sleep can cause nonallergic rhinitis, as can obstructive sleep apnea or acid reflux.

Risk factors

Factors that can increase your risk of nonallergic rhinitis include:

• Exposure to irritants. If you're exposed to irritants such as smog, exhaust fumes or tobacco smoke, you may be at increased risk of developing nonallergic rhinitis.
• Being older than age 20. Unlike allergic rhinitis, which usually occurs before age 20, nonallergic rhinitis occurs after age 20 in most people.
• Prolonged use of decongestant nasal drops or sprays. Using over-the-counter decongestant nasal drops or sprays (Afrin, Dristan, others) for more than a few days can actually cause more-severe nasal congestion when the decongestant wears off, often called rebound congestion.
• Being female. Due to hormonal changes, nasal congestion often gets worse during menstruation and pregnancy.
• Occupational exposure to fumes. In some cases, nonallergic rhinitis is triggered by exposure to an airborne irritant in the workplace (occupational rhinitis). Some common triggers include construction materials, solvents, or other chemicals and fumes from decomposing organic material such as compost.
• Certain health problems. Several chronic health conditions can cause or worsen nonallergic rhinitis, such as hypothyroidism, chronic fatigue syndrome and diabetes.

Complications

Nonallergic rhinitis might be linked to:

• Nasal polyps. These are soft, noncancerous (benign) growths that develop on the lining of your nose or sinuses due to chronic inflammation. Small polyps might not cause problems. But larger polyps can block the airflow through your nose, making it difficult to breathe.
• Sinusitis. Prolonged nasal congestion due to nonallergic rhinitis can increase your chances of developing an infection or inflammation of the membrane that lines the sinuses (sinusitis).
• Interrupted daily activities. Nonallergic rhinitis can be disruptive. You might be less productive at work or school. You also might need to take time off because of symptom flares or doctor visits.

Prevention

If you already have nonallergic rhinitis, you can take steps to reduce your symptoms and prevent flare-ups:

• Avoid your triggers. If you can identify what causes or worsen your symptoms, avoiding your triggers can make a big difference.
• Don't overuse nasal decongestants. Using these medications for more than a few days at a time can worsen your symptoms.
• Get treatment that works. If treatment isn't working, see your doctor. Your doctor can make changes that do a better job preventing or reducing your symptoms.

Diagnosis

Your doctor will diagnose nonallergic rhinitis based on your symptoms and by ruling out other causes, especially allergies. Your doctor will perform a physical exam and ask questions about your symptoms.

He or she might recommend certain tests, although there are no definite tests for nonallergic rhinitis. Your doctor is likely to decide that you have nonallergic rhinitis if you have nasal congestion, a runny nose or postnasal drip and tests for other conditions don't reveal an underlying cause such as allergies or a sinus problem.

In some cases, your doctor might have you try a medication and see whether your symptoms improve.

Ruling out an allergic cause

In many cases, rhinitis is caused by an allergic reaction. The only way to be sure rhinitis isn't caused by allergies is through allergy testing, which may involve skin or blood tests.

• Skin test. To find out whether your symptoms might be caused by a certain allergen, your skin is pricked and exposed to small amounts of common airborne allergens, such as dust mites, mold, pollen, and cat and dog dander. If you're allergic to a particular allergen, you'll likely develop a raised bump (hive) at the test location on your skin. If you're not allergic to any of the substances, your skin will look normal.
• Blood test. A blood test can measure your immune system's response to common allergens by measuring the amount of certain antibodies in your bloodstream, known as immunoglobulin E (IgE) antibodies. A blood sample is sent to a medical lab, where it can be tested for evidence of sensitivity to specific allergens.

In some cases, rhinitis may be caused by both allergic and nonallergic triggers.

Ruling out sinus problems

Your doctor will want to be sure your symptoms aren't caused by a sinus problem related to a deviated septum or nasal polyps. If your doctor suspects a sinus problem, you might need an imaging test to view your sinuses.

• Nasal endoscopy. This test involves looking at the inside of your nasal passages with a thin, fiber-optic viewing instrument called an endoscope. Your doctor will pass the fiber-optic endoscope through your nostrils to examine your nasal passages and sinuses.
• CT scan. This procedure is a computerized X-ray technique that produces images of your sinuses that are more detailed than those produced by conventional X-ray exams.

Treatment

Treatment of nonallergic rhinitis depends on how much it bothers you. For mild cases, home treatment and avoiding triggers might be enough. For more-bothersome symptoms, certain medications may provide relief, including:

• Saline nasal sprays. Use an over-the-counter nasal saline spray or homemade saltwater solution to flush the nose of irritants and help thin the mucus and soothe the membranes in your nose.

• Corticosteroid nasal sprays. If your symptoms aren't easily controlled by decongestants or antihistamines, your doctor might suggest a nonprescription corticosteroid nasal spray, such as fluticasone (Flonase Allergy Relief) or triamcinolone (Nasacort Allergy 24 Hour). Prescription nasal sprays also are available.

  Corticosteroid medications help prevent and treat inflammation associated with some types of nonallergic rhinitis. Possible side effects include nasal dryness, nosebleeds, headaches and throat dryness.

• Antihistamine nasal sprays. Try a prescription antihistamine spray such as azelastine (Astelin, Astepro) or olopatadine hydrochloride (Patanase). While oral antihistamines don't seem to help nonallergic rhinitis, nasal sprays containing an antihistamine might reduce symptoms.
• Anti-drip anticholinergic nasal sprays. The prescription drug ipratropium is often used as an asthma inhaler medication. But it's now available as a nasal spray and can be helpful if a runny, drippy nose is your main complaint. Side effects can include nosebleeds and drying of the inside of your nose.
• Decongestants. Available over-the-counter or by prescription, examples include pseudoephedrine-containing drugs (Sudafed 12 Hour) and phenylephrine (Neo-Synephrine, others). These medications help narrow the blood vessels, reducing congestion in the nose. Possible side effects include high blood pressure, heart pounding (palpitations) and restlessness.

Over-the-counter oral antihistamines, such as diphenhydramine (Benadryl), cetirizine (Zyrtec Allergy), fexofenadine (Allegra Allergy) and loratadine (Alavert, Claritin), typically don't work nearly as well for nonallergic rhinitis as they do for allergic rhinitis.

In some cases, surgical procedures might be an option to treat complicating problems, such as a deviated nasal septum or persistent nasal polyps.

Lifestyle and home remedies

Try these tips to help reduce discomfort and relieve the symptoms of nonallergic rhinitis:

• Rinse your nasal passages. Use a specially designed squeeze bottle — such as the one included in saline kits — a bulb syringe or a neti pot to irrigate your nasal passages. This home remedy, called nasal lavage, can help keep your nose free of irritants. When used daily, this is one of the most effective treatments for nonallergic rhinitis.

  To prevent infection, use water that's distilled, sterile, previously boiled and cooled, or filtered using a filter with an absolute pore size of 1 micron or smaller to make up the irrigation solution. Also be sure to rinse the irrigation device after each use with similarly distilled, sterile, previously boiled and cooled, or filtered water and leave open to air-dry.

• Blow your nose. Regularly and gently blow your nose if mucus or irritants are present.
• Humidify. If the air in your home or office is dry, set up a humidifier in your work or sleep location. Be sure to regularly clean the humidifier according to the manufacturer's instructions. You can also breathe in the steam from a warm shower to help loosen the mucus in your nose and clear your head of stuffiness.
• Drink liquids. Drinking plenty of liquids, including water, juice and caffeine-free tea, can help loosen the mucus in your nose. Avoid caffeinated beverages.

Alternative medicine

Some small studies have shown that repeated applications of capsaicin — the ingredient responsible for the heat in hot peppers — to the inside of the nose can ease nasal congestion. Larger studies are needed.

Preparing for an appointment

Here's some information to help you prepare for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do in advance, such as not taking medicine for your congestion beforehand.

Make a list of:

• Your symptoms, including any that seem unrelated to the reason for which you scheduled the appointment, and when they began
• Key personal information, including recent illnesses, major stresses or recent life changes
• All medications, vitamins or supplements you take, including doses
• Questions to ask your doctor

For nonallergic rhinitis, some basic questions to ask your doctor include:

• What's the most likely cause of my symptoms?
• What tests do I need?
• Is my condition likely temporary or long lasting?
• What treatments are available, and which do you recommend for me?
• I have other health conditions. How can I best manage these conditions together?
• Are there brochures or other printed materials I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, including:

• Do you have symptoms all the time or do they come and go?
• How severe are your symptoms?
• Does anything seem to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• What medications have you tried for your symptoms? Has anything helped?
• Do your symptoms worsen when you eat spicy foods, drink alcohol or take certain medications?
• Are you regularly exposed to fumes, chemicals or other airborne irritants?

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