Nonallergic Rhinitis

  1. Definition: nasal symptoms of rhinitis-obstruction/congestion, rhino rhea (runny nose), and hyperirritability without being able to identify an allergen.
  2. Frequency: Of all patients with rhinitis 43% have pure allergic rhinitis, 23% have pure no allergic rhinitis, and 34% have mixed rhinitis.
  3. Types of no allergic rhinitis
    1. Vasomotor: Year around nasal congestion with drainage more common then itching and sneezing. Negative skin tests and blood IgE. Unknown cause
    2. Chronic Sinusitis: Inflammation or chronic infection of the sinuses. Diagnosis of >8 weeks symptoms or 4 episodes/yr and pos CT scan. Symptoms and signs are nasal congestion, discharge, headache, facial pain or pressure and smell disturbance, bad breath, and sometimes cough
    3. Anatomical nasal obstruction: deviated septum, enlarged turbinated, polyps, tumor, or adenoid enlargement.
    4. Nonallergic rhinitis with eosinophilia syndrome: profuse watery discharge, sneezing spells and itching. Looks like allergic rhinitits with allergic cells, but no positive skin or blood tests.
    5. Drug induced rhinitis: Many drugs for hypertension cause dryness or stuffiness, and topical decongestants like Neosynephrine or Afrin or cocaine can cause rebound congestion which leads to chronic abuse.
    6. Hormonal: Pregnancy, oral contraceptives or other estrogens.
    7. Physical (cold air), chemical (fumes), and irritant (spicy foods) induced: commonly associated with hyperreactivity due to another nasal disorder.
  4. Treatment
    1. Congestion - this symptom which can lead to or cause infection, facial pain, and headaches is best treated with topical steroids, oral decongestants (D) or Sudafed or in long standing (not adequately treated) cases, surgery.
    2. Runny nose - this symptom is best treated with Atrovent, or Astelin or first generation antihistamines like chlortrimaton.
    3. Non specific treatments like saline lavage is very helpful and in this chronic condition, can be done like brushing the teeth.
    4. Avoidance of irritants like smoke, and fragrance in laundry products, scented candles, and air fresheners is often overlooked