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Allergic and Non-Allergic Rhinitis

Allergic Rhinitis

If you sneeze and have a running or stuffy nose during the spring, summer or fall allergy seasons, you may have seasonal allergic rhinitis or hay fever. Hay fever is the most common type of allergy problem. It mainly affects the eyes and nose. Hay fever symptoms include sneezing, itching, runny or stuffy nose and red, watery eyes.

Rhinitis can be a problem all year or only some of the year. It can be a problem when inside or when outside. Allergy symptoms are caused when someone has a problem when around a certain substance. These substances are called allergens. They can be inside, such as cats or dust. They can be outside such as tree and grass pollen and molds in the summer and fall. Hay fever is mainly an allergy caused by outdoor allergens.

Non-Allergic Rhinitis

This type of rhinitis is not as well understood. Although not triggered by allergy, the symptoms are often the same as seen in allergic rhinitis. Although the symptoms are similar, allergy skin test results are negative. Nasal polyps may also be seen with this type of rhinitis.

Vasomotor Rhinitis

Common symptoms of vasomotor rhinitis are often nasal congestion and postnasal drip. A person with this type of rhinitis may have symptoms when exposed to temperature and humidity changes. Symptoms may also occur with exposure to smoke, odors and emotional upsets. Allergy skin test results are negative.

Infectious Rhinitis

This can occur as a cold, which may clear rapidly or continue with symptoms longer than a week. Some people may also develop an acute or chronic bacterial sinus infection. Symptoms include an increased amount of colored (yellow-green) and thickened nasal discharge and nasal congestion.

Rhinitis Medicamentosa

This type of rhinitis is seen with long-term use of decongestant nasal sprays or recreational use of cocaine. Symptoms may include nasal congestion and postnasal drip. Decongestant nasal sprays are intended for short-term use only. Over-use can cause rebound nasal congestion. It is very important for a person with rebound congestion to work closely with a doctor to gradually decrease the nasal spray.

Mechanical Obstruction

This is more often seen with a deviated septum or enlarged adenoids. Symptoms often include nasal obstruction, that may be one sided.

Hormonal

This type of rhinitis is often seen with changes in the hormones. This often occurs during pregnancy, puberty, menses or hypothyroidism.

How is rhinitis diagnosed?

Often a person may have more than one types of rhinitis. In making the diagnosis, an evaluation by your doctor may include:

  • Medical History: The doctor will ask questions about your health and your symptoms
  • Physical exam
  • Nasal smears
  • Nasal secretions are examined under a microscope
  • Allergy testing: Skin testing by a board-certified allergist is often recommended for someone with recurrent symptoms. A positive skin test often is seen with allergies. In most cases, an allergic person will react to more than one substance. Your doctor will compare your prick skin test results with your history of symptoms
  • Sinus X-ray or CT scan: Changes in the sinus X-ray or CT scan may indicate sinusitis (inflammation of the sinuses) with or without infection or nasal polyps

How can you manage symptoms?

The goal of treatment is to reduce symptoms. This often includes:

  • Identifying, controlling and/or treating things that make your symptoms worse
  • Using and understanding medications

What makes your symptoms worse?

The best way to prevent allergic rhinitis is to avoid the things to which you are allergic. Because allergic rhinitis is caused by outdoor allergies, this can be hard to do. If you have outdoor allergies there are some things you can do to help:

  • Keep your doors and windows shut during the pollen season
  • Use an air conditioner to cool your home instead of coolers or fans that bring in outside air
  • Consider pollen counts when planning outdoor activities. It may help to limit your outdoor activities when pollen and mold counts are at their highest

Pollen and Mold

Pollen and mold counts can vary throughout the day. Peak times are:

  • Grass: afternoon and early evening
  • Ragweed: early midday
  • Mold: some types peak during warm, dry, windy afternoons; other types occur at high levels during periods of dampness and rain

House Dust Mites

 If you are allergic to house dust mites and live in a humid area:

  • Cover your mattress and box spring in zippered, dust proof encasings
  • Wash your pillows, sheets and blankets weekly in hot water. Dust mites will survive in lukewarm water

Animals

Dander, urine and saliva from feathered or furry animals are a major year-round allergen. Cats, dogs, birds, hamsters, gerbils and horses are common pets.

If you are allergic to an animal:

  • Do not keep any furry or feathered pets in your home
  • If you must keep the pet, try to keep it outdoors. If the pet comes indoors, make sure it stays out of your bedroom at all times. After exposure to the pet, wash your hands and change your clothes

Irritants

Many substances can irritate the nose, throat or airways. Common irritants include smoke such as tobacco and smoke from wood burning stoves and fireplaces, aerosol sprays, strong odors, dust and air pollution. Reducing exposure to irritants can be very helpful.

  • It is important that no one smokes in the home or car
  • Always look for non-smoking sections in public areas
  • void aerosol spray, perfumes, strong cleaning products and other odor sources in the home

What medications treat rhinitis?


Anti-inflammatory

Anti-inflammatory medicines control inflammation in the body. This inflammation causes redness and swelling (congestion).

Nasal Steroid Sprays

Nasal steroid sprays work well to reduce nasal symptoms of sneezing, itching, runny and stuffy nose. Nasal steroids may also improve eye symptoms. A steroid nasal spray may work after several hours or take several days to work. Nasal steroids work best if you take them daily.

Common nasal steroid sprays:

  • Beconase®, Beconase AQ®, Vancenase®, Vancenase AQ® (beclomethasone)
  • Rhinocort® (flunisolide)
  • Nasarel® (flunisolide)
  • Flonase® (fluticasone)
  • Nasonex® (mometasone)
  • Nasacort®, Nasacort AQ® (triamicinolone)

Montelukast

Montelukast is a new class of anti-allergy medication that blocks certain allergy mediators and reduces swelling, sneezing, and runny nose.

Cromolyn and Nedocromil

Cromolyn and nedocromil are anti-inflammatory medicines that are not steroids. They may help prevent nasal and eye symptoms.

Nasal Wash

A nasal wash with salt water may help clean out your nose. When done routinely, this can also lessen post-nasal drip. If you do a nasal wash, do this before using other nasal medicine.

Antihistamines

Antihistamines can help decrease allergy symptoms. They may be used daily during allergy season or when allergy symptoms occur. There are many different antihistamines. If one doesn't work, another can be tried. Some can make you sleepy and some do not.

Common antihistamines that do not make you sleepy:

  • Claritin® (loradtadine)
  • Clarinex® (desloratadine)
  • Allegra® (fexafenadine)
  • Zyrtec® (cetirizine) (causes drowsiness in some people)
  • Some over the counter antihistamines can make you feel sleepy. They may also affect thinking and your reflexes. If you take one of these, use caution when driving or using any kind of machine.
  • Astelin® (azelastine) is an antihistamine nasal spray. It usually does not make you sleepy.

Decongestants

Decongestants help when your nose is stuffy (congestion). They are available as pills, liquids or nasal sprays. Many are available over the counter. A common over the counter decongestant is Sudafed (pseudoephedrine). Use caution when taking a decongestant nasal spray. Using one longer than 4 days can have a rebound effect. This causes you to have more nasal congestion.

Atrovent®

Atrovent® (ipatroprium bromide) is a nasal spray. Atrovent may be helpful for decreasing symptoms of a runny nose. This nasal spray may be helpful for vasomotor rhinitis.

Allergy Shots

Allergy shots (also known as immunotherapy) may be helpful for specific allergies that aren't controlled with medicine.

Rhinitis can be managed so you can have an active, fun life. Talk with you doctor if you think you have rhinitis. Your doctor is your partner in you healthcare.

Contact Information

Allergy and Inflammation
Department of Medicine
Beth Israel Deaconess Medical Center
One Brookline Place, Suite 623
Brookline, MA 02445
617-278-8100
617-278-8101