What is rhinitis?
Rhinitis is a swelling and inflammation inside of the nose, causing a runny nose, congestion, and sneezing. Rhinitis can be allergic or nonallergic.
Allergic rhinitis, also called “allergies” or “hay fever,” is an exaggerated response by the immune system to an otherwise harmless trigger, called an allergen. Sneezing while cleaning a dusty room or when outdoors in the spring are common examples of an allergic reaction.
Nonallergic rhinitis, however, doesn’t involve the immune system. Fragrances, cigarette smoke, and windy or cold weather are just a few causes of nonallergic rhinitis.
Depending on the cause, rhinitis can be a short-term issue, a seasonal allergy, or it may be something that impacts you for much longer.
Most common symptoms
The most common misconception I hear is that allergies only affect children, and that you can’t develop it as an adult. In fact, many people don’t develop allergies until their twenties or older. And they often delay getting a diagnosis because of this myth. —Dr. Amrita Khokhar
The classic symptoms of both allergic and nonallergic rhinitis include a runny nose, nasal congestion, and sneezing. Sometimes, mucus runs down the back of the throat and causes coughing, known as “post-nasal drip.”
People who have allergies might also suffer from itchy, watery, and red eyes. Occasionally, itching can also affect the mouth and ears.
Some people with allergic rhinitis develop a condition called oral allergy syndrome that causes itching in the mouth when eating certain fresh fruits or vegetables. The type of fruit or vegetable depends on what pollen you’re allergic to.
When symptoms last for a long time, people can also develop chronic headaches and fatigue. Trouble sleeping—and even snoring—is a problem for some people with allergies, especially year-round ones.
People who also have asthma may notice that their breathing gets worse when they have allergic rhinitis. They may experience shortness of breath, wheezing, or coughing.
- Runny nose: Also known as “rhinorrhea.” It tends to be clear and watery—not thick or colored.
- Nasal congestion: Most noticeable several hours after the allergic reaction starts.
- Postnasal drip: Tends to be the most noticeable when lying down and can lead you to want to clear your throat a lot.
- Itchy, watery eyes: Happens with allergies, but not in non-allergic rhinitis.
Other symptoms you may have
- Poor sleep
- Itchy mouth or ears
- Itching after eating fresh fruits or vegetables, like apples, peaches, cherries, celery, carrots, but there are many others.
The main risk factors for developing allergic rhinitis include having a parent with allergies. Or if you have eczema or asthma. In general, children are more likely to be diagnosed with allergies than adults, but allergies can develop at any time in life. And you can outgrow them, too.
Nonallergic rhinitis has many causes, and it’s not completely clear why some people are prone to developing the condition. Certain types of nonallergic rhinitis include:
- Occupational rhinitis: Occurs in people who have exposures at work to things like wood dust, chemicals, or other airborne particles.
- Drug induced rhinitis: A side effect of certain medications, or as a rebound effect from using nasal decongestant sprays. Rebound congestion is when you need more and more doses of medication to get the same relief. The congestion can also get much worse after you stop using a decongestant altogether.
- Pregnancy rhinitis: Occurs in pregnant women as a response to hormonal changes.
- Gustatory rhinitis: A response to eating certain foods, especially hot and/or spicy food. Symptoms can also occur when drinking alcohol.
- Vasomotor rhinitis: This type of rhinitis can have different causes depending on the person: weather changes, fragrances, cigarette smoke are some common examples.
Rhinitis can often be treated with over-the-counter medications. However, if you are not responding to medications or if you are not sure what your triggers are, you may want to see a doctor to help you figure it out.
If you suspect you have allergic rhinitis, an allergist can perform allergy testing to pinpoint your triggers. They can then suggest medications or other treatments that might be the most effective for your specific allergies.
A fear that people have is that they’ll have to give up a family pet, or they won’t be able to exercise outdoors during pollen seasons, or similar struggles. There is more to treatment than just what’s available over the counter. In many cases, we can find a plan that works for your circumstances. —Dr. Khokhar
Rhinitis in children
Allergic rhinitis can begin in children as young as just a few years old. Some signs and symptoms experienced by children include:
- Allergic shiners: Dark bluish-purple circles under the eyes.
- Allergic salute: A crease across the top of the nose from constant rubbing.
- Increased number of ear infections: From chronic inflammation in the ear tubes due to allergies.
- Changes in mouth shape or teeth development: Due to chronic mouth-breathing.
Allergic rhinitis occurs when the immune system treats a normally harmless substance as an invader. When an allergen is inhaled, allergy cells in the lining of the airway set off a series of signals that eventually lead to the release of a chemical called histamine. Histamine is responsible for symptoms like sneezing and itching. Other chemicals released by the body lead to nasal congestion and stuffiness. Every time you come into contact with the allergen, your body responds with this cascade of events.
Nonallergic rhinitis does not involve the immune system. It’s not completely clear why it occurs. There are many different triggers for nonallergic rhinitis and they can affect people differently.
A recently developed treatment option for allergic rhinitis is something called sublingual immunotherapy. This is like an oral version of allergy shots that you can take at home instead of coming into the office. Currently, sublingual immunotherapy is only approved for a few allergens, but keep an eye out for further developments. —Dr. Khokhar
The first step in treating allergic rhinitis is getting an accurate diagnosis. Allergies can be treated using a combination of the following:
- Environmental control measures: Make changes to your home environment to help reduce your exposure to different types of allergens. For example, removing carpeting can reduce dust exposure.
- Medications: Both over-the-counter and prescription treatments can be effective when used alone or in combination with one another. Discuss with your doctor the best options and combinations.
- Allergy shots: Also called immunotherapy, allergy shots help teach your body to become less allergic to your triggers over time.
- Other therapies: Nasal saline rinses (Neti Pot) is a non-medicated rinse that can help flush out allergens and mucus in the nose.
Nonallergic rhinitis is treated with medications to relieve the symptoms and doing your best to avoid the triggers. Treatments like environmental control measures and allergy shots do not work because allergens are not the culprit.
- Antihistamines: These can be taken as needed or daily, and include cetirizine (Zyrtec), fexofenadine (Allegra), and loratadine (Claritin). They help with sneezing and itching, but do not relieve nasal congestion. These are non-sedating, meaning that they should not make you sleepy after you take them. Sleepiness is a common side effect of older antihistamines like diphenhydramine (Benadryl).
- Nasal sprays: Steroid sprays such as fluticasone propionate (Flonase), triamcinolone acetonide (Nasacort), or budesonide (Rhinocort) control allergy symptoms, including congestion, when used daily basis. They are considered the best option to start with for chronic rhinitis. Antihistamines nasal sprays like azelastine (Astelin) can also be effective.
- Eye drops: Ketotifen (Zaditor) is a common over-the-counter allergy eye drop for when eyes are itchy and watery. Prescription-strength eye drops are also available, including olopatadine (Pataday, Patanol).
- Allergy shots: While not a medication in the traditional sense, allergy shots are injections that contain extracts of the allergens that you were found to be positive to on allergy testing. Over a long period of time, allergy shots teach your immune system to become less reactive.
Allergy shots require regular doctor visits and are a long-term commitment. Most people will need to get a shot once a week for several months as the strength of the shot is gradually increased. You will then be able to taper off to once a month shots—a phase that can last from 3 to 5 years. But the benefits of allergy shots are significant. In many cases, they can dramatically improve symptoms, allowing you to taper off of your medications.
It may respond to nasal steroid sprays or nasal antihistamines. Nonallergic rhinitis can often be more difficult to treat than allergic rhinitis. Oral antihistamines are not effective.
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