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Non-allergic rhinitis

Non-allergic rhinitis occurs when the lining of the inside of the nose becomes swollen and inflamed.

Non-allergic rhinitis occurs when the lining of the inside of the nose becomes swollen and inflamed, usually because of swollen blood vessels and an accumulation of fluid in the tissues of the nose.

This swelling blocks the nasal passages and stimulates the mucus glands in the nose, resulting in the typical symptoms of a blocked or runny nose.

Some of the main causes of non-allergic rhinitis are described below.

Infection

In many cases, rhinitis develops as the result of an infection attacking the lining of the nose and throat.

This is usually a viral infection, such as a cold, but bacterial or fungal infections can also occasionally cause rhinitis.

Environmental triggers

In some people, rhinitis appears to develop as a result of environmental triggers, such as:

  • smoke
  • perfume
  • paint fumes
  • changes in the weather, such as a drop in temperature
  • alcohol
  • spicy food
  • stress

The medical term for rhinitis caused by environmental triggers is vasomotor or autonomic rhinitis. The exact cause of this type of rhinitis is unknown, but it is believed to occur in people who have very sensitive nasal blood vessels.

Medications and drugs

Rhinitis can sometimes occur as a result of using certain medications, including:

Rhinitis can also occur as a result of cocaine misuse.

Overuse of nasal decongestants

Nasal decongestant sprays work by reducing the swelling of the blood vessels in your nose. However, if they are used for longer than five to seven days at a time, they can cause the lining of your nose to swell up again, even after the cold or allergy that originally caused the problem has passed.

If you use more decongestants in an attempt to reduce the swelling, it is likely to make the problem worse.

The medical term for rhinitis caused by the overuse of nasal decongestants is rhinitis medicamentosa.

Hormonal imbalance

Non-allergic rhinitis can also be caused by hormonal changes due to pregnancy, puberty or taking hormone medication – such as hormone replacement therapy (HRT) or the contraceptive pill.

Having an underactive thyroid gland (hypothyroidism) can also sometimes cause rhinitis.

It is thought that hormones play a role in the enlargement of the nasal blood vessels that can lead to rhinitis.

Tissue damage

Inside your nose, there are three ridges of bone covered by a layer of tissue. These layers of tissue are called turbinates. A type of rhinitis called atrophic rhinitis can occur if the turbinates become damaged.

Most cases of atrophic rhinitis in the UK occur when the turbinates are damaged or removed during surgery (sometimes it is necessary to surgically remove turbinates if they are obstructing your airflow). 

Turbinates play an important role in the functioning of your nose, such as keeping the inside of your nose moist and protecting the body from being infected with bacteria. If they are damaged or removed, the remaining tissue can become inflamed, crusty, and prone to infection.



Content Supplied by NHS Choices

Non-allergic rhinitis

If you have non-allergic rhinitis, there is a risk you could develop further problems.

If you have non-allergic rhinitis, there is a risk you could develop further problems.

These can include problems caused by having a blocked or runny nose, such as difficulty sleeping, drowsiness during the daytime, irritability and problems concentrating.

The inflammation associated with non-allergic rhinitis can also lead to further conditions, such as nasal polyps, sinusitis and middle ear infections. These are described below.

Nasal polyps

Nasal polyps are fleshy swellings that grow from the lining of your nose or sinuses (the small cavities above and behind your nose), which are caused by inflammation of the membranes of the nose and sometimes as a result of rhinitis.

They have also been linked with an increased risk of other conditions, such as asthma that develops later in life.

Nasal polyps are shaped like teardrops when they are growing and they look like a grape on a stem when fully grown. They vary in size and can be a yellow, grey or pink. They can grow on their own or in clusters and usually affect both nostrils.

If nasal polyps grow large enough, or in clusters, they can:

  • interfere with your breathing
  • reduce your sense of smell
  • block your sinuses, leading to sinusitis (see below)

Small nasal polyps can be shrunk using steroid nasal sprays so they do not cause an obstruction in your nose. Large polyps may need to be surgically removed.

Read more about treating nasal polyps.

Sinusitis

Sinusitis is a common complication of rhinitis. It is where sinuses become inflamed or infected.

The sinuses naturally produce mucus, which usually drains into your nose through small channels. However, if these drainage channels are inflamed or blocked (for example, because of rhinitis or nasal polyps), the mucus cannot drain away and it may become infected.

Common symptoms include:

  • severe facial pain around your cheeks, eyes or forehead
  • toothache
  • a blocked or runny nose – your nose may produce a green or yellow mucus
  • a high temperature (fever)

Symptoms of sinusitis can be relieved using over the counter painkillers, such as paracetamol, ibuprofen or aspirin. These will help reduce the pain and fever.

However, these medications are not suitable for everyone so you should make sure you check the leaflet that comes with them before you take them. For example, children under 16 years of age should not take aspirin, and ibuprofen is not recommended for people with asthma or a history of certain stomach conditions, such as stomach ulcers. Speak to your GP or pharmacist if you are unsure.

Antibiotics may also be recommended if your sinuses become infected with bacteria. In cases of long-term (chronic) sinusitis, surgery may be needed to improve the drainage of your sinuses.

Read more about treating sinusitis.

Middle ear infections

Middle ear infections (otitis media) can also develop as a complication of nasal problems, including non-allergic rhinitis.

These infections may occur because rhinitis can cause a problem with the Eustachian tube at the back of the nose. If this tube (which connects the back of the nose and the middle ear) does not function properly, then fluid may accumulate in the middle ear (behind the ear drum) and this fluid can then become infected.

There is also the possibility of infection at the back of the nose spreading to the ear through the Eustachian tube.

Symptoms of a middle ear infection can include:

Most ear infections clear up within a couple of days, although paracetamol or ibuprofen can be used to relieve pain and a high temperature. Antibiotics may also be used if the symptoms persist or are particularly severe.

Read more about treating middle ear infections.



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