Non-Allergic Rhinitis

Are All Cases of Rhinitis Caused by Allergies?

Rhinitis or inflammation of the nose and sinuses, may result from many causes other than allergy. Not all rhinitis symptoms are the result of allergies. The most common condition causing rhinitis is the common cold, an example of infectious rhinitis. Irritant rhinitis or “vasomotor rhinitis” or “non allergic rhinitis describes a group of other causes of rhinitis, with symptoms not caused by infection or allergy. Many people have recurrent or chronic nasal congestion, excess mucus production, either runny nose or post nasal drip, itching, and other nasal symptoms similar to those of allergic rhinitis but the disorder is not caused by allergy.

Triggers of vasomotor rhinitis include any irritant. Strong odors such as cigarette smoke, perfume, hair spray, and other cosmetics, laundry detergents, cleaning solutions, pool chlorine, car exhaust and air pollution are all common triggers. Other irritants are spices used in cooking, alcoholic beverages (particularly beer and wine), aspirin and certain blood pressure medications. Some people are very sensitive to abrupt changes in weather or temperature, humidity or barometric pressure. Skiers often develop a runny nose, but in some people any cold exposure may cause a runny nose. Others start sneezing when leaving a cold, air conditioned room or sitting under forced air. Even high quantities of dust, mold or pollen particles, which are potential allergens, can serve as an irritant trigger in a sensitive person who is not truly allergic. Occasionally, one or two positive skin test may be observed, but they do not match with the history and are not relevant or significant. However, some people have both allergic and vasomotor rhinitis concurrently.

The cause of vasomotor rhinitis is not well understood. In a sufficiently high concentration, many odors will cause nasal irritation in almost anyone. Some people are unusually sensitive to irritation and will have significant nasal symptoms even when exposed to low concentrations of irritants.

Thus, vasomotor rhinitis seems to be an exaggeration of the normal nasal response to irritation, occurring at levels of exposure that don’t bother most people. It occurs more often in smokers and older individuals and women. Although vasomotor rhinitis can’t be cured, symptoms can be kept under control by limiting exposure to substances that cause symptoms and by taking medication when needed. People with vasomotor rhinitis should not smoke or permit smoking in their homes.

Another form of rhinitis is dryness of the nasal tissue.  It can be a normal effect of aging or a characteristic of a nasal condition associated with a foul smelling nasal discharge. Rhinitis also can be a feature of endocrine disease, like hypothyroidism, or can occur during pregnancy caused by hormonal changes. Alcoholic beverages can cause the blood vessels in the nose to enlarge temporarily and produce significant nasal congestion.

How Do You Know What Kind of Rhinitis You Have?

Consult your physician. Sometimes several conditions can coexist in the same person. In a single individual, allergic rhinitis could be complicated by vasomotor rhinitis, septal deviation (curvature of the bone separating the two sides of the nose) or nasal polyps or infections. Any of these conditions will be made worse by catching a cold. Nasal symptoms caused by more than one problem can be difficult to treat, often requiring the cooperation of an allergist-immunologist and an otolaryngologist (a physician specializing in the ears, nose and throat). Most infections are relatively short-lived, with symptoms improving at three to seven days. Colds can be caused by any one of over 200 viruses. Children, particularly young children in school or day care centers, may have from eight to 12 colds each year. Fortunately, the frequency of colds lessens after immunity results from exposure to many viruses.

Colds usually begin with a sensation of congestion, rapidly followed by runny nose and sneezing. Over the next few days, congestion becomes more prominent, the nasal mucus may become discolored, and there may be a slight fever and cough. Cold symptoms resolve within a couple of weeks, although a cough may sometimes persist. Cold symptoms that last longer may be due to other causes, such as chronic rhinitis or sinusitis.

What are other causes of rhinitis? Not all 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. 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 decongestant nasal sprays.