Non-Allergic Rhinitis

What is Rhinitis?

Rhinitis is a term that means irritation or inflammation of the nasal passages. It occurs when the nose makes too much mucus – which is used to trap substances such as dust, pollen, pollution and germs. Rhinitis can be caused by many things, from a cold to allergies to changes in weather.

Common symptoms include:

  • Runny nose
  • Stuffy nose
  • Sneezing
  • Itchy eyes
  • Loss of smell
  • Drainage in the back of the throat (post-nasal drip)
  • Cough (because of the draining)

Is all Rhinitis the same?

No. There are different types of rhinitis: allergic (known as hay fever) that is caused by an allergic reaction; non-allergic, which can be caused by many different things; and infectious, which is caused by a cold or other infection.

While many symptoms are the same for both types, unique symptoms include:

Allergic Rhinitis

  • Itchy eyes and/or nose, runny nose, lots of sneezing.
  • Usually occurs during certain seasons when allergens are common (such as spring or autumn).
  • May be year-round due to pets, dust mite and/or moulds.

Non-Allergic Rhinitis

  • Little or no itchiness or sneezing; mostly nasal blockage.
  • May occur year-round.
  • More common in adults than children.

Infectious Rhinitis

  • Occurs after a cold or other respiratory infection.
  • Symptoms improve within a few weeks, although a cough may linger.

About half of people with rhinitis have both allergic and non-allergic types and both can be made worse if you have a cold. An allergist can determine what type of rhinitis you have and recommend treatment that will work best for you.

Could my symptoms be caused by something other than Rhinitis?

Yes, there are other causes of these symptoms. For example, sinusitis is an inflammation of the sinus cavities. It is not the same as rhinitis, although the sinus cavities open into the nasal passages so the symptoms may be similar.

Following are some signs that your symptoms may be caused by something other than rhinitis:

  • Nasal congestion or runny nose that is always on the same side of the nose
  • Inability to smell
  • Repeated heavy nosebleeds
  • Mucous that is very thick, contains pus or has a bad odour
  • Severe headaches or facial pain
  • Sneezing that is caused by sudden exposure to sunlight or other bright light
  • Nose stuffiness when lying down, occurring on the side you are lying on
  • Increased nasal congestion with pressure in the armpit of the opposite side
  • Sneezing when exposed to extreme heat, cold air or water
  • Chest tightness when you breathe in cold air
  • Congestion during ovulation in the menstrual cycle
  • Sneezing after meals when you are full
  • Sneezing following sex or orgasm

Your allergist can determine whether you have rhinitis or if something else is causing your symptoms. Your allergist will begin by asking you questions about your medical history, lifestyle, including work environment, habits, frequency and severity of your symptoms and medications you have tried.

Your allergist may do a skin test by applying small amounts of an allergen on your skin to rule out allergic rhinitis. In some cases, a blood test may be done. These tests will help determine the cause of your symptoms and will help direct treatment.

What causes Non-Allergic Rhinitis?

Allergic rhinitis is caused by an allergy to something, while infectious rhinitis is the result of a respiratory infection. Non-allergic rhinitis can be due to a wide variety of things that do not relate to allergies that “trigger” your symptoms.

The most common triggers of non-allergic rhinitis are:

  • Chemicals, pollutants and strong odours such as perfumes, cleaning products, car and diesel fumes, air fresheners, newsprint, and tobacco smoke.
  • Weather, such as changes in air pressure and temperature or cold, dry air.
  • Eating hot food, especially steamy soup or spicy foods.
  • A physical condition or injury, such as a deviated septum (when the cartilage that divides the two halves of your nose is off-centre), collapsed nasal valve or enlarged adenoids (tissue behind the nasal cavity that is part of the immune system).
  • Pregnancy, which can cause nasal congestion in the last month or two, likely due to hormone changes.
  • Medicine, including drugs to treat blood pressure, erectile dysfunction, prostate enlargement, depression, birth control and non-steroidal anti-inflammatories such as aspirin or ibuprofen.
  • Decongestants, which can cause rebound congestion when they are used for a long time.

How is Non-Allergic Rhinitis treated?

If you are diagnosed with non-allergic rhinitis, your allergist may recommend one of more treatments, including:

Reducing exposure to triggers, such as:

  • Tobacco smoke.
  • Fireplaces and wood-burning stoves (or be sure they are well-vented).
  • Outdoor pollution, by staying inside when levels are high and keeping your windows closed.
  • Home cleaning supplies with harsh chemicals such as formaldehyde, ammonia, sodium lauryl sulphate, D-limonene or sodium hypochlorite as well as those that are sprayed. Simpler cleaners are better, such as baking soda, lemon juice, olive oil and vinegar.
  • Scented products such as strong perfumes, air fresheners, scented candles and highly fragrant fresh flowers.

Nasal rinsing and irrigation with salt water one to two times a day. Options include:

  • Saline solution available over the counter (easier to use but less effective)
  • Home-made solution of ½ teaspoon of salt in eight ounces sterilized water per nostril (do not use tap water, which can introduce bacteria into the nose) and non-iodized salt, using a squeeze bottle or Neti pot. Using it in the shower may be easier. Be sure to keep the device clean by rinsing with water and vinegar afterward and letting it air dry.

Medicines, including:

  • Nasal sprays such as:
  • Corticosteroids – available over the counter or by prescription can treat congestion, runny nose, sneezing or swelling.
  • Antihistamines – available by prescriptions only can reduce congestion, runny nose, sneezing and postnasal drip.
  • A combination of corticosteroid and antihistamine in one device, available by prescription only.
  • An anticholinergic (ipratropium bromide) – available by prescription only, may be prescribed when a severe runny nose is the main symptom.
  • Capsaicin, an active ingredient in chilli peppers, is not FDA-approved, but is available over the counter.
  • Oral decongestants – available over the counter, can relieve congestion.

Your allergist will discuss which medications are the most appropriate for your nasal problems.

It is especially important to talk to an Allergist if:

  • Your allergies are causing symptoms such as sinus infections, nasal congestion or difficulty breathing.
  • You experience hay fever or other allergy symptoms several months out of the year.
  • Antihistamines and over-the-counter medications do not control your allergy symptoms or create unacceptable side effects, such as drowsiness.
  • Your allergies or asthma are interfering with your ability to carry out day-to-day activities.
  • You sometimes must struggle to catch your breath or feel tightness in your chest.
  • You often wheeze or cough, especially at night or after exercise.
  • You previously have been treated for asthma, but still have frequent attacks even though you are taking asthma medication.
  • You have had reactions to foods, medications or stinging insects.

Working with your allergist, you can find relief from your allergy, asthma and non-allergic rhinitis symptoms.