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Nonallergic rhinitisBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/nonallergic-rhinitis/DS00809
Nonallergic rhinitis involves chronic sneezing or having a congested, drippy nose with no apparent cause. The symptoms of nonallergic rhinitis are similar to those of hay fever (allergic rhinitis), but there's no identified allergic reaction involved. Nonallergic rhinitis can affect children and adults, but is more common after age 20.
Although nonallergic rhinitis is more annoying than harmful, it can make you miserable. Triggers of nonallergic rhinitis symptoms vary and can include certain odors or irritants in the air, changes in the weather, 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.
If you have nonallergic rhinitis, you probably have symptoms that come and go year-round. You may have constant symptoms, symptoms that last for hours or symptoms that last for days. Signs and symptoms of nonallergic rhinitis may include:
- Stuffy nose
- Runny nose
- Mucus (phlegm) in the throat (postnasal drip)
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 of nonallergic rhinitis 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
Nonallergic rhinitis occurs when blood vessels in your nose expand (dilate), filling the nasal lining with blood and fluid. There are several possible causes of this abnormal expansion of the blood vessels or inflammation in the nose. But, whatever the trigger, the result is the same — swollen nasal membranes and congestion.
Many things can trigger the nasal swelling in nonallergic rhinitis — some resulting in short-lived symptoms while others cause chronic problems. Nonallergic rhinitis triggers include:
- 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 may 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. A common cause of nonallergic rhinitis is a viral infection — a cold or the flu, for example. This type of nonallergic rhinitis usually clears up after a few weeks, but can cause lingering mucus in the throat (postnasal drip). Sometimes, this type of rhinitis can become chronic, causing ongoing discolored nasal discharge, facial pain and pressure (sinusitis).
- Foods and beverages. Nonallergic rhinitis may occur when you eat, especially when eating hot or spicy foods. Drinking alcoholic beverages also may cause the membranes inside your nose to swell, leading to nasal congestion.
- Certain medications. Some medications can cause nonallergic rhinitis. These include aspirin, ibuprofen (Advil, Motrin IB, others), and high blood pressure (hypertension) medications, such as beta blockers. Nonallergic rhinitis can also 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. Changes in hormones due to pregnancy, menstruation, oral contraceptive use or other hormonal condition such as hypothyroidism can cause nonallergic rhinitis.
- Stress. Emotional or physical stress can trigger nonallergic rhinitis in some people.
Factors that may increase your risk of nonallergic rhinitis include:
- Exposure to irritants. If you're exposed to smog, exhaust fumes or tobacco smoke — to name a few — you may be at increased risk of developing nonallergic rhinitis.
- Being older than age 20. Unlike allergic rhinitis, which usually occurs before age 20, often in childhood, 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 aircraft fuel or jet exhaust, solvents, or other chemicals and fumes from decomposing organic material such as compost.
- Having certain health problems. A number of chronic health conditions can cause or worsen rhinitis, such as hypothyroidism and chronic fatigue syndrome.
Complications from nonallergic rhinitis include:
- Nasal polyps. These are soft, noncancerous (benign) growths that develop on the lining of your nose or sinuses due to chronic inflammation. Small polyps may not cause problems, but larger ones can block the airflow through your nose, making it difficult to breathe.
- Chronic sinusitis. Prolonged nasal congestion due to nonallergic rhinitis may increase your chances of developing sinusitis — an infection or inflammation of the membrane that lines the sinuses. When sinusitis lasts for longer than 12 consecutive weeks, it's referred to as chronic sinusitis. Sinusitis causes pain, tenderness and swelling around your eyes, cheeks, nose or forehead.
- Middle ear infections. Increased fluid and nasal congestion may lead to middle ear infections.
- Interrupted daily activities. Nonallergic rhinitis can be disruptive. You may be less productive at work or school, and you may need to take time off because of symptom flares or doctor visits.
Preparing for your appointment
Here's some information to help you prepare for your appointment.
What you can do
- Be aware of any pre-appointment restrictions. 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.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins or supplements you're taking.
- Write down questions to ask your doctor.
Preparing a list of questions for your doctor will help you make the most of your time together. List your questions from most important to least important. For nonallergic rhinitis, some basic questions to ask your doctor include:
- What is likely causing my symptoms or condition?
- Other than the most likely cause, what are other possible causes for my symptoms or condition?
- What tests do I need?
- Is my condition likely temporary or chronic?
- What is the best course of action?
- What are the alternatives to the primary approach you're suggesting?
- I have these other health conditions. How can I best manage them together?
- Are there restrictions I need to follow?
- Should I see a specialist?
- Is there a generic alternative to the medicine you're prescribing?
- Are there brochures or other printed materials I can take with me? What websites do you recommend?
Don't hesitate to ask other questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, including:
- Have you had a cold or other illness recently?
- When did you begin having symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- What medications have you tried for your symptoms, and has anything helped?
- Do your symptoms worsen when you eat spicy foods, drink alcohol or take certain medications?
- Are you typically exposed to fumes, chemicals or other airborne irritants?
Tests and diagnosis
Nonallergic rhinitis is diagnosed based on your symptoms and ruling out other causes, especially allergies. Your doctor will perform a physical examination and ask questions about your symptoms. He or she may also recommend certain tests. There are no specific, definite tests used to diagnose nonallergic rhinitis.
Your doctor is likely to conclude your symptoms are caused by 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 may 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, 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 looks 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 laboratory, where it can be tested for evidence of sensitivity to specific allergens.
In some cases, rhinitis may be caused by both allergic and nonallergic causes.
Ruling out sinus problems
Your doctor will also 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 may be causing your symptoms, you may need an imaging test to view your sinuses.
- Nasal endoscopy. This test involves looking at the inside of your nasal passages. This is done 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.
- Computerized tomography (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.
Treatments and drugs
Treatment of nonallergic rhinitis depends on how much it bothers you. For mild cases, home treatment and avoiding triggers may 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 may suggest a prescription corticosteroid nasal spray, such as fluticasone (Flonase) or mometasone (Nasonex). Corticosteroid medications help prevent and treat inflammation associated with some types of nonallergic rhinitis. Possible side effects include indigestion, nausea, headache and bodily pains.
- Antihistamine nasal sprays. Try a prescription antihistamine spray such as azelastine (Astelin, Astepro) and olopatadine hydrochloride (Patanase). While oral antihistamines don't seem to help nonallergic rhinitis, antihistamine in the form of a nasal spray may reduce symptoms of nonallergic rhinitis. Side effects may include a bitter taste in your mouth, headache and fatigue.
- Anti-drip anticholinergic nasal sprays. The prescription drug ipratropium (Atrovent) 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 may include a bitter taste in your mouth and drying of the inside of your nose.
- Oral decongestants. Available over-the-counter or by prescription, examples include pseudoephedrine-containing drugs (Sudafed) and phenylephrine (Afrin, Neo-Synephrine, others). These medications help narrow the blood vessels, reducing congestion in the nose. Possible side effects include high blood pressure, insomnia, loss of appetite, heart pounding (palpitations), anxiety and restlessness.
- Decongestant nasal sprays. These include oxymetazoline (Afrin, others). Don't use these medications for more than three or four days, as they can cause congestion to come back with even worse symptoms when you stop using them. Other possible side effects include headache, insomnia and feeling nervous.
Over-the-counter oral antihistamines, such as diphenhydramine (Benadryl) and loratadine (Claritin), typically don't work nearly as well for nonallergic rhinitis as they do for allergic rhinitis.
In some cases, surgical procedures may be an option to treat complicating problems, such as a deviated nasal septum or persistent nasal polyps.
Some studies have shown repeated applications of capsaicin — the ingredient responsible for the heat in hot peppers — to the inside of the nose to be effective. But nasal saline, corticosteroid nasal sprays or antihistamine nasal sprays are the usually recommended initial treatments.
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, bulb syringe or neti pot to irrigate your nasal passages. This home remedy, called nasal lavage, can help to keep your nose free of irritants. When used daily, this is one of the most effective treatments for nonallergic rhinitis. 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. Set up a humidifier in your work or sleep location. Or breathe in the steam from a warm shower to help loosen the mucus in your nose and clear your head of stuffiness.
- Stay hydrated. Drink plenty of liquids, such as water, juice or noncaffeinated tea. Avoid caffeinated beverages, which can cause dehydration and aggravate your symptoms.
Coping and support
In addition to making you miserable, nonallergic rhinitis symptoms can interfere with your day-to-day routine, including work or school. Side effects of medications can sometimes make these problems worse.
- Get help for your symptoms early.
- If treatment isn't working, see your doctor.
In many cases, there's no way to avoid the underlying conditions that cause nonallergic rhinitis. However, if you already have it, you can take steps to reduce your symptoms and prevent flare-ups:
- Avoid your triggers. If you can identify things that cause or worsen your symptoms, avoiding them can make a big difference.
- Don't overuse nasal decongestants. Using these medications for more than a few days at a time can actually 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.
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