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Nonallergic rhinitis, characterized by symptoms such as sneezing, nasal congestion, and a runny nose, can be a chronic condition with an unclear underlying cause. While its symptoms may resemble those of allergic rhinitis (hay fever), it’s important to note that nonallergic rhinitis is not driven by allergies.
This condition can affect individuals of all ages, but it tends to be more prevalent in adults, particularly those over the age of 20. The triggers for nonallergic rhinitis can vary from person to person and may include:
- Airborne irritants like dust and fumes.
- Changes in weather.
- Certain medications.
- Consumption of hot or spicy foods.
- Underlying chronic health conditions.
Medical professionals typically begin by ruling out allergies as the cause of symptoms. Therefore, you may undergo skin or blood tests to determine if you have allergic rhinitis.
Symptoms
Nonallergic rhinitis symptoms often fluctuate year-round and may include a congested or runny nose, sneezing, throat mucus, and occasional coughing.
Notably, nonallergic rhinitis rarely leads to the itching of the nose, eyes, or throat, which is a common allergy symptom such as in hay fever.
Causes
The precise cause of nonallergic rhinitis remains unknown, but experts have identified that it occurs due to the dilation of blood vessels in the nasal passages. These expanded blood vessels lead to swelling in the nasal tissue, resulting in symptoms like congestion and excessive mucus production. While the exact triggers can vary, they all contribute to this common outcome:
- Irritants in the air: Nonallergic rhinitis can be initiated by exposure to airborne irritants such as dust, smog, cigarette smoke, and strong odors like perfumes. Chemical fumes, which individuals may encounter in certain occupational settings, can also induce these symptoms.
- Dietary factors: Consumption of hot and spicy foods can trigger nonallergic rhinitis. Additionally, alcohol intake can lead to swelling of the nasal tissues, resulting in nasal congestion.
- Weather: Fluctuations in temperature and humidity levels can prompt inflammation in the nasal lining, causing a runny or congested nose.
- Infections: Viral illnesses like the common cold or the flu are frequent culprits behind nonallergic rhinitis.
- Medications: Certain medications, including aspirin, ibuprofen, beta blockers used for high blood pressure, sedatives, antidepressants, birth control pills, and drugs for erectile dysfunction, can induce nonallergic rhinitis. Overuse of decongestant nasal sprays or drops can lead to a specific type known as rhinitis medicamentosa.
- Hormonal changes: Nonallergic rhinitis may be associated with hormonal fluctuations, such as those occurring during pregnancy, menstrual cycles, or the use of birth control methods. Hypothyroidism, a condition resulting from insufficient thyroid hormone production, can also serve as a trigger.
- Sleep-related factors: Certain sleeping positions, particularly lying on one’s back, can exacerbate nonallergic rhinitis. Additionally, nocturnal acid reflux can act as a trigger during sleep.
Risk factors
Factors that can increase your susceptibility to nonallergic rhinitis include:
- Age over 20: Nonallergic rhinitis is more commonly observed in individuals aged 20 and above. This sets it apart from allergic rhinitis, which often manifests in individuals younger than 20.
- Exposure to unclean air: Inhaling certain types of polluted air, such as smog, exhaust fumes, and tobacco smoke, can elevate the risk of developing nonallergic rhinitis.
- Prolonged use of nasal sprays or drops: It is advisable to avoid extended use of over-the-counter decongestant drops or sprays containing oxymetazoline (brands like Afrin and Dristan) for more than a few days. Overuse may lead to a worsening of nasal congestion, a phenomenon known as rebound congestion.
- Underlying health conditions: Certain chronic health conditions, such as diabetes and hypothyroidism (insufficient thyroid hormone production), can either cause nonallergic rhinitis or exacerbate its symptoms.
- Pregnancy or menstruation: Hormonal changes during pregnancy or menstrual cycles can exacerbate nasal congestion in individuals susceptible to nonallergic rhinitis.
- Occupational exposure to fumes: Some professions entail exposure to fumes from materials and chemicals, which can trigger or worsen nonallergic rhinitis. Common triggers include construction materials and various chemicals. Additionally, exposure to compost fumes can also contribute to the condition.
Diagnosis
To determine if you have nonallergic rhinitis, your healthcare provider will conduct a thorough evaluation, which may include:
- Physical examination: Your healthcare provider will perform a physical examination and inquire about your symptoms.
- Symptom assessment: They will assess common symptoms associated with nonallergic rhinitis, such as:
- Nasal congestion (stuffy nose).
- Runny nose or postnasal drip (mucus dripping down the back of your throat).
- Exclusion of other causes: Your provider will perform tests to rule out other potential causes of your symptoms, such as allergies or sinus issues.
- Medication trial: In some cases, your healthcare provider may recommend trying a specific medication to see if your symptoms improve.
- Allergy testing: If allergies are suspected, your healthcare provider may recommend allergy testing to ensure that your symptoms are not allergy-related. These tests may include:
- Skin test: A skin test involves pricking your skin with tiny amounts of common allergens found in the environment, such as dust mites, mold, pollen, and pet dander. If you are allergic to any of these substances, your skin may develop raised bumps at the pricked sites.
- Blood test: A blood test can detect allergies by measuring the levels of immunoglobulin E (IgE) antibodies in your blood. Elevated IgE levels can indicate the presence of allergies that trigger allergy symptoms.
- Sinus evaluation: To determine if your symptoms are related to sinus problems, your healthcare provider may recommend:
- Nasal endoscopy: This procedure involves using a thin, flexible tool called an endoscope, equipped with a camera, to examine the inside of your nasal passages. The endoscope is gently inserted through your nostrils to provide a close-up view of your nasal structures.
- Computed tomography (CT) scan: A CT scan utilizes X-rays to create detailed images of your sinuses. These images provide a comprehensive view of your sinus anatomy and can help identify any structural issues or abnormalities.
In some instances, symptoms may be triggered by both allergic and nonallergic factors. A comprehensive assessment, including these tests, will aid your healthcare provider in determining the most appropriate diagnosis and treatment plan for your specific condition.
Treatment
Treatment options for nonallergic rhinitis vary depending on the severity of your symptoms. For mild cases, you may find relief through home remedies and avoiding triggers. However, if your symptoms are more severe, medications can help alleviate them. Consider the following treatment options:
- Saline nasal sprays: Saline nasal sprays, which contain a mixture of salt and water, can provide moisture to the nasal passages. They also help in thinning mucus and soothing the nasal lining. These sprays are available over the counter, but you can also try nasal irrigation at home using a saline or saltwater solution to flush out irritants and mucus effectively.
- Antihistamine nasal sprays: Antihistamines, commonly used to treat allergies, can also be effective in managing nonallergic rhinitis symptoms. Your healthcare provider may prescribe antihistamine nasal sprays like azelastine (Astepro, Astepro Allergy) or olopatadine hydrochloride (Patanase).
- Oral antihistamines: While oral antihistamines such as diphenhydramine (Benadryl), cetirizine (Zyrtec Allergy), fexofenadine (Allegra Allergy), and loratadine (Alavert, Claritin) are often used for allergies, they may not work as effectively for nonallergic rhinitis.
- Ipratropium nasal spray: This prescription nasal spray can help alleviate symptoms of a runny or drippy nose. However, it may have side effects like nosebleeds and nasal dryness.
- Decongestants: Decongestants can narrow blood vessels in the nose, reducing congestion. They are available over the counter or by prescription. However, they can have side effects like increased blood pressure, palpitations, and restlessness. Examples include pseudoephedrine (Sudafed 24 Hour) and phenylephrine.
- Steroids: Steroid medications can be used to prevent and treat inflammation associated with certain types of nonallergic rhinitis. Steroid nasal sprays, available over the counter, include fluticasone (Flonase Allergy Relief) and triamcinolone (Nasacort Allergy 24 Hour). Stronger steroid sprays may require a prescription. Possible side effects include dry nose or throat, nosebleeds, and headaches.
In some cases, your healthcare provider may recommend surgery to address underlying issues that contribute to nonallergic rhinitis. For instance, nasal growths called polyps may need to be removed, or surgery may be necessary to correct a deviated septum, which is when the nasal partition is off-center or crooked.
