What Is Nonallergic Rhinitis?
Nonallergic rhinitis describes a set of symptoms that are similar to those of nasal allergies and hay fever but happen without a known cause. There are several types of nonallergic rhinitis, but vasomotor is the most common. It's often the term used when doctors can find no clear allergies or infectious diseases causing your nasal symptoms. While the triggers of nonallergic rhinitis are not fully understood, it's believed that people who have it are more reactive to smaller amounts of substances or changes in their environment than is normally the case.
Nonallergic Rhinitis Symptoms
Nonallergic rhinitis causes symptoms that are very similar to those of allergies, such as:
- Postnasal drip
- Runny nose
Sneezing
- Stuffy nose
- Partial loss of smell
- Cough
- Fullness in the ears
- Itchy eyes or nose
Nonallergic Rhinitis Causes
Unlike allergic rhinitis, nonallergic rhinitis does not involve the immune system. About 58 million Americans have allergic rhinitis. By comparison, 19 million have nonallergic rhinitis. Usually, it startsin adulthood, and symptoms canlast year-round. Often, what causes nonallergic rhinitis is unknown. And the condition is often confirmed only after other conditions such as allergic rhinitis or infection are ruled out.
Environmental irritants are common triggers of nonallergic rhinitis. Some are found in the home, and others are more common in the workplace.
Nonallergic rhinitis and asthma
Like rhinitis, asthma can be either allergic or nonallergic. As with nonallergic rhinitis, nonallergic asthma can be caused by medication and environmental triggers. You can have asthma along with either allergic or nonallergic rhinitis. Both conditions can cause inflammation — asthma in the lungs and nonallergic rhinitis in the nose. Doctors believe that these patterns of inflammation link the two, and studies have shown that people with nonallergic rhinitis are at a greater risk of developing asthma.
Use of certain medications
Some medications can trigger nonallergic rhinitis. Examples include:
- Nonsteroidal anti-inflammatory drugs(NSAIDs), such as aspirin and ibuprofen
- Oral contraceptives
Blood pressure medicines such as ACE inhibitors and beta-blockers
Antidepressants
- Tranquilizers
- Drugs used to treat erectile dysfunction
Environmental triggers
These environmental triggers often cause asthma, too:
- Car exhaust
- Chlorine
- Cigarette smoke
- Cleaning solutions
- Glues
- Hair spray
- Latex
- Laundry detergents
- Metal salts
- Perfume
- Smog
- Wood dust
Foods and beverages may also be triggers. Examples include:
- Hot foods such as soup
- Spicy foods
- Alcoholic beverages, especially beer and wine
Several things can make you more likely to have nonallergic rhinitis:
Exposure to irritants. Things such as tobacco smoke, car exhaust, and smog can raise your chances of nonallergic rhinitis.
Exposure to fumes.Chemicals that give off fumes, such as solvents or paint, can trigger nonallergic rhinitis.
Using decongestant sprays or nose drops. If you use over-the-counter nasal decongestant sprays or drops for more than a few days at a time, your nasal congestion can get worse after they wear off. This is called “rebound congestion.”
Being older than age 20. Nonallergic rhinitis happens in most people after age 20.
Being female. Nasal congestion tends to worsen during your period or when you're pregnant.
Long-term health problems. Some lingering health problems, such as chronic fatigue syndrome, an underactive thyroid, or gastroesophageal reflux disease (GERD) can cause nonallergic rhinitis or make it worse.
Stress. Both physical and emotional stress can make you more prone to rhinitis problems.
Other causes
- Illegal drugs. Cocaine and other snorted street drugs often cause chronic nonallergic rhinitis.
- Weather changes. Sudden changes in weather or temperature can trigger nonallergic rhinitis. Skiers, for instance, often develop a runny nose. Some people can be affected by any cold exposure. In some cases, people even start sneezing after leaving a cold, air-conditioned room.
- Hormonal changes. Nonallergic rhinitis often happens during periods of hormonal imbalance. For instance, it may happen during puberty, menstruation, or pregnancy. It usually starts during the second month of pregnancy and lasts until childbirth. Hormonal conditions, such as hypothyroidism, can also trigger symptoms.
Nonallergic Rhinitis Diagnosis
There isn’t a certain test that tells you if you have nonallergic rhinitis. Your doctor will give you a physical exam and ask you about your symptoms. The only way to be sure that allergies aren’t causing your symptoms is with an allergy test. There are two kinds of tests your doctor might order for you:
Blood test. This measures the amount of immunoglobulin E (IgE) antibodies in your blood to see if your immune system has had a response to certain allergens.
Skin test. Your doctor will prick your skin with a needle and expose it to a small amount of something that causes allergies in many people, such as mold, pollen, or pet dander. If you’re allergic to any of them, you’ll break out in a bump like an insect bite at that place on your skin.
Your doctor will also want to be sure that a problem in your sinuses, such as a growth (polyp) or a deviated septum, isn’t the cause of your symptoms. To check this, they may order one of two imaging tests to look inside your sinuses.
Nasalendoscopy. Your doctor will put a narrow fiber-optic tube called an endoscope into your nostrils to look at your sinuses and nasal passages.
CT scan.This is a computerized X-ray that makes highly detailed pictures of your sinuses.
Nonallergic Rhinitis During Pregnancy
Pregnancy rhinitis, or “pregnancy nose,” happens when you have inflammation in the lining of your nose during pregnancy. A boost in blood flow to your nasal passages and growth of your nasal veins also plays a role in your rhinitis. It tends to happen in your second and third trimesters.
This symptom of pregnancy can be uncomfortable and might also mess with your sleep. This happens because when you lie down, your congestion can get worse. That might make you feel more tired during the day.
If your congestion lasts for a while, it could cause sinusitis (a sinus infection) or an ear infection. It’s a good idea to talk to your doctor if you have pain in your face or ears.
In some cases, pregnancy rhinitis can affect your baby, too. If it affects your quality of life and sleep, it may also impact your baby’s growth and development. However, experts still need to fully understand this link.
To treat pregnancy rhinitis, you won’t be able to use over-the-counter decongestant sprays, as they won't help. In fact, over-the-counter decongestants can make your symptoms worse and lead to a total nasal block over time. It’s best to stay away from these to treat this pregnancy symptom.
To feel better with pregnancy rhinitis, doctors suggest that you:
- Use a humidifier to create more moisture in the air in your house.
- Drink a lot of fluids.
- After you get the go-ahead from your doctor, aim to get daily moderate exercise to lower congestion and help you sleep.
- Raise the head of your bed with pillows or a wedge when you lie down.
- Check with your doctor to see if you can use over-the-counter nasal strips, saline (salt water) sprays, or drops.
- Stay away from things that’ll bother your nose, such as cigarette smoke.
Pregnancyrhinitiswill soon go away after your baby is born. Your symptoms should get better within two weeks of your baby’s birth.
Nonallergic Rhinitis Treatment
Nonallergic rhinitis can't be cured, but its symptoms can be controlled by:
- Avoiding rhinitis triggers
- Using home remedies such as nasal irrigation
- Taking over-the-counter and prescription medications
- Using a bioelectronic sinus device
Allergy shots (immunotherapy) are not used to treat nonallergic rhinitis.
If you have nonallergic rhinitis, it's important to stop smoking. Also, don't allow smoking in your home.
Other ways to reduce exposure to triggers include:
- Avoid wood-burning stoves and fireplaces if they cause symptoms.
- Avoid cleaning products, household sprays, perfumes, and scented products if they cause symptoms.
- Ask family, friends, and coworkers not to use scented products that cause symptoms.
- Avoid any chemical or material that tends to make you sneeze or have a runny nose.
Talk to your doctor about the medications you take. If your nonallergic rhinitis is triggered by a medicine you need, your doctor may suggest a substitute.
Medications for nonallergic rhinitis include:
Nasalantihistamines
Prescription products such as azelastine (Astelin) and olopatadine (Patanase) can relieve symptoms of postnasal drip, congestion, and sneezing within minutes. They’re most effective when used on a regular basis.
Nasalglucocorticoids
Daily use of medications such as budesonide (Rhinocort Allergy), fluticasone(Flonase), or triamcinolone (Nasacort Allergy 24HR) may help relieve symptoms. These nasal sprays are available over the counter. It may take days or weeks to notice the full effects. Sometimes, people benefit from using a combination of nasal antihistamines and nasal glucocorticoids.
Nasalipratropium
Ipratropium bromide (Atrovent) is considered the best treatment for the watery nasal discharge that comes from eating and drinking certain foods and beverages.
Decongestants
Oral decongestant medications, such as pseudoephedrine, may help relieve congestion. But these are not generally recommended unless nasal antihistamines and nasal glucocorticoids don’t help. Decongestant nasal sprays containing oxymetazoline (Afrin) and phenylephrine (Neo-synephrine) should not be used for more than two to three days at a time. Doing so can cause overuse (rebound) congestion.
Nasal irrigation
Many people with nonallergic rhinitis benefit from performing nasal irrigation. This refers to rinsing of the nostrils with a saltwater (saline) solution one or more times a day. Over-the-counter products for doing this include bulb syringes, neti pots, and bottle sprayers. During each irrigation, rinse each nostril with at least 200 milliliters (about 3/4 cup) of commercially or home-prepared solution.
It's important to note that, according to the CDC, if you are irrigating, flushing, or rinsing your sinuses, use distilled, sterile, or previously boiled water to make the irrigation solution. It’s also important to rinse the irrigation device after each use and leave it open to air dry. When performed once or twice a day, nasal irrigation may especially help treat postnasal drip. It's also a helpful technique to clear the sinuses before using medicated nasal sprays.
In some cases, surgery to remove nasal polyps or correct a deviated septum can improve the way medications for nonallergic rhinitis work. Surgery is only considered as a treatment by itself when other treatments have failed to reduce symptoms.
Nonallergic Rhinitis Complications
Nonallergic rhinitis can cause just as much misery as allergic rhinitis. It can also be associated with the same complications, such as:
- Sinusitis, which is inflammation or swelling of the tissue that lines the sinuses
- Eustachian tube dysfunction (affecting the tubes that connect the middle ears to the back of the throat)
- Chronic ear infection, known as otitis media
- Loss of smell
- Asthma
- Obstructive sleep apnea
Both types of rhinitis are associated with:
- Decreased production at work
- Increased doctor visits
- Side effects from treatment, such as drowsiness, nosebleeds, and nasal dryness
Because the two are so similar, it's often necessary to perform allergy tests and blood tests to tell them apart.
Nonallergic Rhinitis Prevention
If you have nonallergic rhinitis, you can’t always stop your symptoms, but there are steps you can take to make them less likely to happen:
- Stay away from your triggers: If you know what things set off your symptoms, you can feel your best by avoiding them.
- Ease up on using nasal decongestants: You might be tempted to go to them for relief, but if you use nasal decongestant sprays for longer than a few days, your symptoms will come back even worse than before.
- Talk to your doctor: If your current treatment isn’t working, your doctor can find a new treatment plan that will help.
Takeaways
Nonallergic (vasomotor) rhinitis occurs when you have allergy-like symptoms, but they're not due to any known allergy-causing substances. Rather, you may have nasal and other symptoms that are triggered by your environment, medications, or hormonal changes. While allergies are seasonal, symptoms of nonallergic rhinitis happen year-round. Similar to allergies, you'll get nonallergic rhinitis symptoms whenever you're exposed to a trigger. Symptoms include a stuffy and runny nose, sneezing, a reduced sense of smell, and postnasal drip.
Nonallergic Rhinitis FAQs
Is there a cure for nonallergic rhinitis?
No, but you can manage your symptoms by avoiding your triggers or treating your symptoms with over-the-counter or prescription medicines.
What is the most common cause of nonallergic rhinitis?
The most common causes of nonallergic rhinitis are environmental triggers that don't involve allergies, such as changes in weather, perfume, cigarette and tobacco smoke, auto emissions, and strong scents like chlorine.
How to differentiate between allergic and nonallergic rhinitis
Your doctor will rule out allergic rhinitis if you're tested for allergies and have none. Nasal endoscopy can help determine if you have polyps in your nose (benign growths on your sinuses or in your nasal passages), which can trigger nonallergic rhinitis. Other tests to tell the difference include a CT scan and a nasal inspiratory flow test, which looks for any blockages in your nasal passages.
Can rhinitis be cured?
No, but you can manage allergic rhinitis with medication. If medications don't work or you have another issue with your sinuses and nasal passages causing the symptoms, surgery may be considered.
