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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.

Content Supplied by NHS Choices

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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