In nonallergic rhinitis, the inside of the nose becomes inflamed or swollen, causing cold-like symptoms, such as itchiness, blocked nose, runny nose, and sneezing. Symptoms can resemble those of an allergy, such as hay fever, but there is no sign of an allergic reaction.
Allergic rhinitis can be caused by an allergy. In other cases, it is called nonallergic rhinitis.
The symptoms of nonallergic and allergic rhinitis are similar, but the causes are different.
People with nonallergic rhinitis may have a runny nose that does not seem to get better, or they may have recurring symptoms.
If a person has rhinitis, the blood vessels inside the nose expand, causing the lining of the nose to swell.
This stimulates the mucus glands in the nose, causing it to become congested and “drippy.”
Nonallergic rhinitis affects children and adults alike. Women may be more prone to nasal congestion during menstruation and pregnancy.
The Greek word “rhinos” means “nose,” and “-itis” means “inflammation.”
There are different types of nonallergic rhinitis.
Infectious rhinitis, or viral rhinitis, is caused by an infection, such as the common cold or flu. The lining of the nose and throat become inflamed when a virus attacks the area. Inflammation triggers mucus production, and this causes sneezing and a runny nose.
Vasomotor rhinitis happens when the blood vessels in the nose are too sensitive, and there is abnormal nerve control of the blood vessels in the nose. This leads to inflammation.
Normally, the contraction and expansion of blood vessels inside the nose help to control the flow of mucus. If the blood vessels are oversensitive, certain environmental triggers can cause them to dilate. This causes congestion and overproduction of mucus.
Triggers include chemical irritants, perfumes, paint fumes, smoke, changes in humidity, a drop in temperature, consumption of alcohol, spicy foods and mental stress.
Atrophic rhinitis happens when the membranes inside the nose, called turbinate tissue, become thinner and harder, causing the nasal passages to widen and become drier.
Turbinate tissue refers to the tissue that covers three ridges of bone inside the nose. It helps to keep the inside of the nose moist, it protects against bacteria, it helps to regulate air pressure when breathing in, and it contains nerve endings that give the sense of smell.
When the turbinate tissue thins, it is easier for bacteria to grow in the nasal cavity. Therefore, loss of turbinate tissue increases the chance of nose surgery or an infection.
In atrophic rhinitis, crusts form inside the nose, and they may smell bad. If the person tries to remove them, bleeding may occur. There may be a loss of sense of smell.
Loss of turbinate tissue happens with age. It can also result from complications of nose surgery or an infection.
Atrophic rhinitis most often occurs in people who have gone through multiple nasal surgeries, or it can be a complication of a single procedure.
Rhinitis medicamentosa is caused by the use of drugs. This can be the overuse of nasal decongestants, beta blockers, aspirin or cocaine.
Nasal decongestants reduce the swelling of the blood vessels inside the nose. If used for more than a week, they can cause the nose to become inflamed again, even if the original problem, say, a cold, has gone.
The signs and symptoms of nonallergic rhinitis include:
- a blocked or runny nose
- nasal pressure
- nasal pain
- postnasal drip, with phlegm, or mucus, in the throat.
Nonallergic rhinitis does not usually involve an itchy nose, eyes, or throat. These are symptoms of allergic rhinitis.
A number of factors can increase the chance of having nonallergic rhinitis.
Irritants, such as tobacco smoke, smog, exhaust fumes, airplane fuel, solvents, and some other substances increase the risk.
Eating spicy foods can cause allergic rhinitis.
Females are more susceptible during menstruation and pregnancy.
Certain health conditions, including lupus, cystic fibrosis, some hormonal disorders, and asthma increase the chance of developing nonallergic rhinitis.
Viral rhinitis has similar symptoms to a cold or flu.
Vasomotor rhinitis has similar symptoms to allergic rhinitis, so the doctor may have to eliminate allergy as a possible cause.
Allergy can be detected through a skin prick test or a patch test, to check for a reaction. A blood test can detect antibody levels.
If there is no allergic reaction, the doctor may diagnose vasomotor rhinitis.
In atrophic rhinitis, the nasal crusting, widening of the nasal passages, foul smell and loss of sense of smell are signs that the doctor will look out for.
A CT scan may be used to confirm a diagnosis and to check for changes in the nasal cavities. A CT scan or a nasal endoscopy can also rule out sinusitis.
In the case of rhinitis medicamentosa, the doctor will ask the patient about the use of nasal decongestants and other medications.
The infection that causes viral rhinitis usually goes away on its own, without needing medical treatment. Nasal decongestants may help to reduce swelling and a blocked nose.
A person with vasomotor rhinitis should try to avoid exposure to the environmental triggers that are causing it. Corticosteroid nasal sprays may help reduce inflammation and congestion.
If the patient does not respond to treatment, the doctor may try:
- antihistamine nasal sprays, even though the condition is not an allergy
- anticholinergics nasal sprays to help widen the airways, ease breathing, and reduce the production of mucus
- sodium cromoglicate nasal spray to reduce inflammation and mucus production
- saline solution irrigation, to relieve crusting and dryness in atrophic rhinitis
- antibiotics, in the case of infection
A patient with rhinitis medicamentosa needs to stop using the nasal spray. The following tips may help:
- Avoid using the spray on the good nostril. It will eventually open up, and then the individual can then stop using it on the other nostril, too.
- Some types of antihistamine may help.
Home or natural remedies for relieving rhinitis include the following:
- rinsing the inside of the nose with a saline solution instead of a decongestant spray to irrigate or clean the nose
- preparing a steam inhalation by putting a few drops of tea tree oil in a bowl of hot water
- running a humidifier to prevent the air in the room from becoming dry
- avoiding environmental triggers, such as smoke, that may aggravate symptoms
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Nonallergic rhinitis is not preventable, but patients who are diagnosed with it are advised to avoid the things that trigger symptoms, if they are known.
In cases of atrophic rhinitis, routine nasal lavage and lubrication can prevent the formation of crusts and help to keep the nasal lining moist.
Daily irrigation of the nasal passages is good preventive practice.