Nonallergic Rhinitis

Chronic nonallergic rhinitis affects a large segment of the patients we see for evaluation of possible allergic disease. Nonallergic rhinitis produces many symptoms that are very similar to the symptoms of nasal allergy. Occasionally a patient can even have a combination of both allergic and nonallergic rhinitis. Unlike allergic rhinitis, nonallergic rhinitis does not run in families, is often nonseasonal, and allergy skin tests are usually negative. Patients are commonly more susceptible to sinus infections.

Typical symptoms include watery nasal drainage and congestion, itchy eyes and nose, watery eyes, and frequent bouts of sneezing. Sinus pressure or aching is common along with post-nasal drainage.  At first there may appear to be a seasonal pattern but on closer investigation there is usually no correlation with a known pollinating season, animal dander or outdoor activity. The more common triggers include weather changes, cigarette smoke, dusts, alcohol (beer or wine) and odors (malls, new fabrics, perfumes, detergents, etc.).

Some patients simultaneously have chest complaints similar to mild asthma such as feelings of chest tightness or wheeze. These symptoms are often worsened with infection. They may benefit from treatment for asthma.

Unfortunately, nonallergic rhinitis cannot be cured; therefore management is symptomatic rather than curative and requires continuous therapy for control of symptoms. The best treatment obviously is the avoidance of those irritants or triggers. These can be extremely individual and it may take some investigation on your part to discover what triggers should be avoided. Air cleansing devices and air-conditioners are helpful to remove or filter dusts or smoke as well as lessen the impact of outdoor weather changes. Smokers are almost always improved after they kick the habit.

Medications can also be helpful, especially saline nose sprays (e.g. Ocean Mist). These flush irritants away from the nasal membranes as well as add moisture to the nose. Antihistamines and/or decongestants can also be helpful. Prescription nose sprays such as topical steroids or topical antihistamines can be very helpful if used daily. Occasionally a short course of oral cortisone is necessary to open up a congested nose and allow quicker penetration of the prescription nose spray. Avoid using sprays such as Afrin or Neosynephrine for longer than two to three days.

Date: 1/21/2005

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