Allergic and non-allergic rhinitis

Allergies, including allergic rhinitis, affect an estimated 40 million to 50 million people in the United States. Some allergies may interfere with day-to-day activities or lessen the quality of life.

An allergist has specialized training and expertise in managing allergies, allergic rhinitis and asthma. They can develop a plan for rhinitis treatment. The goal will be to enable you to lead a life that is as normal and symptom-free as possible.

Rhinitis symptoms

Rhinitis is a term describing the symptoms produced by nasal irritation or inflammation. Symptoms of rhinitis are due to blockage or congestion. They include:

  • Runny nose
  • Itching
  • Sneezing
  • Stuffy nose due to blockage or congestion

Skin testing is the quickest, easiest, and most sensitive way of making the diagnosis.

These symptoms are the nose's natural response to inflammation and irritation. They are often associated with itching of the eyes.

The nose normally produces mucus to trap substances (like dust, pollen and pollution) and germs (bacteria and viruses). Mucus flows from the front of the nose and drains down the back of the throat. When too much mucus is made, it can cause a runny nose from the front or post-nasal drip from the back. Cough is the natural response to clearing the throat from post-nasal drip.

Itching, sneezing, and other symptoms can be responses to:

  • Allergic reactions
  • Chemical exposures including cigarette smoke
  • Temperature changes
  • Infections
  • Other factors

In most people, nasal congestion goes from side to side of the nose in a cycle several hours long. Some people may notice this nasal cycle more than others, especially if their nasal passages are narrow. Strenuous exercise or changes in head position can affect nasal congestion. Severe congestion can result in facial pressure and pain, as well as dark circles under the eyes.


Rhinitis treatment

When no specific cure is available for your chronic rhinitis, options include ignoring your symptoms, avoiding or decreasing exposure to irritants or allergens to the extent practical, and taking medications for symptom relief.

Once allergic rhinitis is diagnosed, treatment options include avoidance, medication and immunotherapy (allergy shots).

Avoidance - A single ragweed plant may release 1 million pollen grains in just one day. The pollen from ragweed, grasses and trees is so small that the wind may carry it miles from its source. Mold spores, which grow outdoors in fields and on dead leaves, also are everywhere and may outnumber pollen grains in the air even when the pollen season is at its worst.

While it's difficult to escape pollen and molds, here are some ways to lessen exposure.

  • Keep windows closed and use air-conditioning in the summer, if possible. Automobile air conditioners help, too.
  • Don't hang clothing outdoors to dry. Pollen may cling to towels and sheets.
  • The outdoor air usually is most heavily saturated with pollen and mold between 5 a.m. and 10 a.m., so early morning is a good time to limit outdoor activities.
  • Wear a pollen mask (such as a NIOSH rated 95 filter mask) when mowing the lawn, raking leaves or gardening, and take appropriate medication beforehand.

Medication

When avoidance measures don't control symptoms, medication may be the answer. Medications help to reduce nasal congestion, runny nose, sneezing and itching. They are available in many forms, including tablets, nasal sprays, eye drops and liquids. Some medications may cause side effects, so it is best to consult your allergist if there's a problem.


Can allergic rhinitis cause other problems?

Some known complications include ear infections, sinusitis, recurrent sore throats, cough, headache, altered sleep patterns, fatigue, irritability and poor school performance. Occasionally, children may develop altered facial growth and orthodontic problems.


Are all cases of rhinitis caused by allergy?

Rhinitis may result from many causes other than allergy. Not all rhinitis symptoms are the result of allergies. Below are listed the three most common causes of rhinitis with some of their characteristics.


Rhinitis Type Common Name Allergic Sensitivity Causes Duration Of Symptoms
Allergic Hay fever Yes Dust mites, animals, pollens, molds, cockroaches Perennial and/or seasonal
Infectious Colds or flu No Viruses Three to seven days, sometimes longer
Non-allergic Irritant No Smoke, air pollution, exhaust fumes, aerosol sprays, fragrance, paint fumes, etc. Perennial and/or following exposure

What are other causes of rhinitis?

Not all hay fever symptoms in the nasal passage are caused by allergy or infection. Similar symptoms can be caused by mechanical blockage, use of certain medications, irritants, temperature changes or other physical factors. In fact, one third or more of people who have year-round nose symptoms do not have allergies. Rhinitis can also be a feature of other diseases and medical conditions.

Drug-induced nasal congestion can be caused by birth control pills and other female hormone preparations, certain blood pressure medications, and prolonged use of over-the-counter decongestant nasal sprays.

Decongestant nasal sprays work quickly and effectively, but they change how the nasal passages normally work. After a few weeks of use, nasal tissues swell after the medication wears off. The only thing that seems to relieve the obstruction is more of the medicine, but the medication's effect lasts shorter lengths of time. Permanent damage to the nasal tissues may result. The medical term for this condition is rhinitis medicamentosa. Consultation with a physician and prescription medication to "get off" the decongestant nasal sprays is often necessary.

Cocaine also alters how the nasal passages normally work, causing a condition identical to, or even more severe than that produced by decongestant nasal sprays. If you use cocaine, it is important to tell your physician so that appropriate therapy can be prescribed.

How We Can Help

Dr. Paluvoi may begin by taking a detailed history, looking for clues in your lifestyle that will help pinpoint the cause of your symptoms. You'll be asked about your work and home environments, your eating habits, your family's medical history, the frequency and severity of your symptoms, and miscellaneous matters, such as if you have pets. Then, you may require some tests. Skin testing is the easiest, most sensitive and generally least expensive way of making the diagnosis. Another advantage is that results are available immediately. In rare cases, it also may be necessary to do a special IgE allergy blood test for specific allergens.

American Academy of Allergy Asthma and Immunology
American College of Allergy, Asthma, and Immunology