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Non-allergic rhinitis

Non-allergic rhinitis is inflammation of the inside of the nose that is not caused by an allergy.

Non-allergic rhinitis is inflammation of the inside of the nose that is not caused by an allergy.

Rhinitis caused by an allergen, such as pollen, is a separate condition known as allergic rhinitis.

Symptoms of non-allergic rhinitis can include:

  • a runny or blocked nose
  • sneezing (although this is less severe than in allergic rhinitis)
  • mild irritation or discomfort in and around your nose
  • reduced sense of smell

Rarely, non-allergic rhinitis can also cause a crust to develop inside the nose, which may produce a foul-smelling odour and can cause bleeding if you try to remove it.

When to see your GP

You should see your GP if you have symptoms of non-allergic rhinitis and the condition is affecting your quality of life.

Non-allergic rhinitis can be difficult to diagnose because there is no test to confirm the condition. Your GP will first ask about your symptoms and medical history.

They may then carry out a blood test to check if you have an allergy or they may refer you to a hospital clinic for further investigation which may include more specific tests for allergies (including a ‘skin prick test’). If the test results suggest you do not have an allergy, you may be diagnosed with non-allergic rhinitis.

Read more about diagnosing non-allergic rhinitis.

What causes non-allergic rhinitis?

In non-allergic rhinitis, the inflammation is usually the result of swollen blood vessels and a build-up 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.

There are several possible causes of non-allergic rhinitis which can be divided into ‘external’ or ‘internal’ factors. External factors include viral infections (such as a cold) that attack the lining of the nose and throat, and environmental factors, such as cold weather or exposure to smoke.

Internal factors include hormone imbalances, such as those that occur during pregnancy or puberty, and the use of hormone replacement therapy (HRT) or hormonal contraception.

Read more about the causes of non-allergic rhinitis.

Treating non-allergic rhinitis

Although non-allergic rhinitis is not usually harmful, it can be irritating and affect your quality of life. Treatment will depend on how severe the condition is and what is causing it.

In some cases, avoiding certain triggers and self-care measures, such as rinsing your nasal passages, may help to relieve your symptoms. This can be done using either a home-made solution or a solution made with sachets of ingredients bought from a pharmacy. 

In other cases, medication may be needed, such as a nasal spray containing corticosteroids. These will help to relieve the congestion, but they usually need to be used over a number of weeks to be fully effective.

Before taking any medication for non-allergic rhinitis, always check the leaflet that comes with it because the treatments used are not suitable for everyone. If you are at all uncertain whether you should be using one of these medications, check with your GP or pharmacist.

Read more about treating non-allergic rhinitis.

Further problems

In some cases, non-allergic rhinitis can lead to complications. These include:

  • nasal polyps – abnormal, but benign (non-cancerous) sacs of fluid that grow inside the nasal passages and sinuses
  • sinusitis – an infection caused by nasal inflammation and swelling that prevents mucus draining from the sinuses
  • middle ear infections – infection of part of the ear located directly behind the eardrum

These problems can often be treated with medication, although surgery is sometimes needed in severe or long-term cases.

Read more about the complications of non-allergic rhinitis.



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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.



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Non-allergic rhinitis

You should see your GP if you have symptoms of non-allergic rhinitis and the condition is affecting your quality of life.

You should see your GP if you have symptoms of non-allergic rhinitis and the condition is affecting your quality of life.

Your GP will first ask you about your symptoms, because additional symptoms, such as a cough or muscular aches and pains, would suggest your rhinitis is caused by a viral infection.

Your GP may also ask you about your medical history, such as whether you are taking any medications. This is because rhinitis can sometimes occur as a side effect of certain medications.

Allergy tests

If your symptoms and medical history don't suggest there is any obvious cause of your symptoms, you may need to have further tests to check if your symptoms could be caused by an allergy. This is because the symptoms of allergic rhinitis can be very similar to those of non-allergic rhinitis.

Your GP may carry out a blood test to check if you have an allergy that could be causing your symptoms, or they may refer you to a hospital allergy clinic for more specific tests.

One of the main tests you may have at an allergy clinic is a ‘skin prick test’. This is where your skin is pricked with a tiny amount of a suspected allergen to see if it reacts by becoming red, raised and itchy.

If the test results suggest you do not have an allergy, you may be diagnosed with non-allergic rhinitis.

Read more about allergy tests.

Further tests

In some cases, it may be necessary to have further tests in hospital to help diagnose non-allergic rhinitis and check for any complications, such as nasal polyps or sinusitis.

Specifically, examination with an endoscope is usually necessary. This is a thin tube with a light source and video camera at one end, which is inserted up your nose and gives an excellent view of the internal part of the nose.

Other tests may include:

  • a nasal inspiratory flow test – where a small device is placed over your mouth and nose and measures the air flow when you inhale through your nose
  • computerised tomography (CT) scan – a type of scan that uses X-rays and a computer to create detailed images of the inside of the body

CT scans are regularly used before nasal surgery to help plan treatment.



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Non-allergic rhinitis

Treatment for non-allergic rhinitis often depends on what it causing the condition.

Treatment for non-allergic rhinitis often depends on what is causing the condition.

In some cases, such as when rhinitis is caused by a viral infection, treatment may not be necessary. This is because the infection responsible for the condition will normally clear up within a week or two.

Avoiding triggers

If it is thought that something specific is triggering your symptoms, you may be advised to try to avoid possible triggers. For example, it may help to avoid exposure to smoky or polluted environments.

If your rhinitis is believed to be caused by a medication you are taking, such as beta-blockers, your GP may be able to prescribe an alternative medication to see if it helps reduce your symptoms. Do not stop taking any prescribed medication unless advised by a doctor.

Some cases of non-allergic rhinitis are caused by overusing nasal decongestant sprays. In these cases, the best treatment is to stop using these sprays. However, this can be difficult, particularly if you have been using them for some time.

It can help to start by not using the spray in your least congested nostril first. After seven days this nostril should open up, at which point you should try to stop using the spray in your other nostril. It may also help to rinse your nose using a salt water solution and take antihistamine tablets that cause drowsiness to reduce night-time congestion and help you sleep.

Some specialists look to gradually switch your spray from a decongestant (which is harmful in the long term) to a steroid spray (which generally can be used for longer periods).

Cleaning the nasal passages

In many cases of non-allergic rhinitis, rinsing your nasal passages with a salt water solution can be helpful. This is known as nasal irrigation or nasal douching.

Rinsing your nasal passages helps wash away any excess mucus or irritants inside your nose, which can reduce inflammation and relieve your symptoms.

Nasal irrigation can be done using either a home-made solution or a solution made with sachets of ingredients bought from a pharmacy. Small syringes or pots (which often look like small horns or teapots) are also available to help flush the solution around the inside of your nose.

To make the solution at home, mix a teaspoon of salt and a teaspoon of bicarbonate of soda into a pint of boiled water that has been left to cool to around body temperature (do not attempt to rinse your nose while the water is still hot). To rinse your nose:

  • standing over a sink, cup the palm of one hand and pour a small amount of the solution into it
  • sniff the water into one nostril at a time
  • repeat this until your nose feels comfortable (you may not need to use all of the solution)

While you do this, some solution may pass into the throat through the back of the nose. Although the solution is harmless if swallowed, try to spit out as much of it as possible.

Nasal irrigation can be carried out several times a day and a fresh solution should be made each time.

Nasal sprays

Various types of nasal spray are available to help relieve the symptoms of non-allergic rhinitis. These include:

  • antihistamine nasal sprays – these help to relieve congestion and a runny nose by reducing inflammation
  • corticosteroid nasal sprays – like antihistamines, these work by reducing inflammation
  • anticholinergic nasal sprays – these reduce the amount of mucus your nose produces, which helps to relieve a runny nose
  • decongestant nasal sprays – these relieve congestion by reducing swelling of the blood vessels inside your nose

Many of these sprays can be bought over the counter in pharmacies without a prescription. Therefore, it's important to check the leaflet that comes with them before you use them because they are not suitable for everyone. If you are at all uncertain whether you should be using one of these medications, check with your GP or pharmacist.

You should also make sure you check the manufacturer's instructions to see how to correctly use these sprays.

If you use a decongestant spray, make sure you don't use it for longer than five to seven days at a time. This is because overusing decongestants can make congestion worse.



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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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