Nonallergic rhinitis

The symptoms of nonallergic rhinitis are similar to those of hay fever (allergic rhinitis), but there’s no allergic reaction involved. A common problem, nonallergic rhinitis affects both children and adults.

Although nonallergic rhinitis is more annoying than harmful, it can make you miserable. Triggers of nonallergic rhinitis symptoms vary from person to person 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 allergy 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.

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 after eating hot or spicy foods. Drinking alcoholic beverages, such as beer and wine, also may cause the membranes inside your nose to swell, leading to nasal congestion.
  • Certain medications. Some medications can cause nonallergic rhinitis. These include nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (Advil, Motrin, 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 a hormonal condition such as hypothyroidism can cause nonallergic rhinitis.
  • Stress. Emotional or physical stress can trigger nonallergic rhinitis in some people.

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.

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.  There are no specific, definite tests used to diagnose nonallergic rhinitis.

In some cases, your doctor may have you try a medication and see whether your symptoms improve.

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. If you’re allergic to a particular allergen, you 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.

Your doctor will also want to be sure your symptoms aren’t caused by a sinus problem such as 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.

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:

  • Oral decongestants. Available over-the-counter or by prescription, examples include pseudoephedrine-containing drugs (Sudafed, Actifed, others) and phenylephrine (Neo-Synephrine, others). These medications help narrow the blood vessels, reducing congestion in the nose.
  • 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.
  • Antihistamine nasal sprays. Try a prescription antihistamine spray such as azelastine (Astelin, Optivar). While oral antihistamines don’t seem to help nonallergic rhinitis, antihistamine in the form of a nasal spray may reduce symptoms of nonallergic rhinitis.
  • 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 symptom.
  • 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.
  • Decongestant nasal sprays. These include oxymetazoline (Afrin, Nostrilla, 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.

Over-the-counter oral antihistamines, such as diphenhydramine (Benadryl), clemastine (Tavist) and loratadine (Claritin), typically don’t work nearly as well for nonallergic rhinitis as they do for allergic rhinitis.

In rare cases, surgical procedures may be an option to treat complicating problems such as a deviated nasal septum or persistent nasal polyps.

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.