Non-allergic rhinitis
The nose blocks and runs all year round, and the allergy tests come back clean. This happens often, and the person either uses a decongestant spray for years…
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Medicines commonly prescribed for Non-allergic rhinitis
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: NASAL PRODUCT, 27.5 micrograms/sprayActive substance: fluticasone furoateManufacturer: Cipla EuropePrescription requiredDosage form: NASAL PRODUCT, 27.5 MICROGRAMS/SPRAYActive substance: fluticasone furoateManufacturer: Laboratorios Cinfa S.A.Prescription requiredDosage form: NASAL PRODUCT, 27.5 micrograms/sprayActive substance: fluticasone furoateManufacturer: Teva B.V.Prescription required
The nose blocks and runs all year round, and the allergy tests come back clean. This happens often, and the person either uses a decongestant spray for years or decides that "the allergy simply wasn't found". In fact this is a condition in its own right: the lining of the nose responds far too briskly to ordinary irritants — cold air, smells, spicy food — while there is no allergy at all. It is worth sorting out, and not only for comfort: a nose like this spoils sleep and concentration, and sometimes something quite different hides behind similar complaints.
What is going on inside the nose
The lining of the nose is rich in blood vessels and its job is to warm and moisten the air being breathed in. The width of the airway is adjusted continuously: the vessels fill with blood and narrow the passage, then empty again. Nerves that work without our involvement are in charge of this.
In non-allergic rhinitis that adjustment has gone wrong. An irritant that would do nothing at all to somebody else sets off an excessive response here: the vessels swell, the glands pour out mucus, the nose blocks. The immune system takes no part in it — which is why no antibodies to allergens are found, and why ordinary allergy tablets usually do not help.
This kind of rhinitis generally starts in adult life and has no clear season: flare-ups are tied not to pollen but to events — stepping out into the cold, walking into a smoky room, eating a bowl of hot soup.
How it shows itself
The list of complaints is short and fairly recognisable:
- a blocked nose, often alternating from one side to the other;
- clear, watery discharge, sometimes literally dripping;
- sneezing — usually one or two at a time rather than in fits;
- mucus running down the back of the throat, a night-time cough, the habit of clearing the throat every morning;
- a weakened sense of smell, which makes food taste of little.
Sometimes the lining dries out instead: crusts form inside the nose, they smell, and trying to pick them off starts a nosebleed.
What is usually absent in non-allergic rhinitis: strong itching in the nose and palate, red and watering eyes, and fits of ten or fifteen sneezes in a row. Those point to allergy.
What irritates the nose
The list of triggers is different for everybody, and it is worth keeping it in writing for a week or two — the pattern usually surfaces quickly.
- Changes in temperature and humidity: going out into the cold, air conditioning, the dry air of the heating season.
- Smells: tobacco smoke, perfume, cleaning products, paint, solvents, exhaust fumes.
- Workplace exposures: flour, wood dust, chemicals, fumes on the shop floor. The clue is a nose that is clear on holiday and blocked through the working week.
- Spicy and hot food, alcohol. The nose runs during the meal itself and settles half an hour later — a separate and entirely harmless variety.
- Hormonal change: pregnancy, puberty, the contraceptive pill or hormone replacement therapy, an underactive thyroid. Rhinitis of pregnancy usually clears soon after the birth.
- Exercise and age. In some people the nose runs on a run, and in older people there is a "dripping nose": clear fluid, particularly in the cold and at the table.
A separate and very common cause is medicines. Blockage is produced by blood pressure treatments from the ACE inhibitor and beta blocker groups, some medicines for men's health, certain antidepressants, and also aspirin and anti-inflammatory painkillers. If the rhinitis started in the same weeks as a new medicine, that is a matter to discuss with a doctor: the prescription must not be changed on your own.
How it is told apart from allergic rhinitis
This is the key step, and it is often skipped. Non-allergic rhinitis is diagnosed not from the pattern of complaints but from the absence of allergy: allergy is looked for first and not found, and only then does the diagnosis become legitimate.
- Skin prick tests or a blood test for specific antibodies to the allergens that fit the circumstances: pollen, house dust mite, animal dander, mould. This is the investigation that settles the question.
- Total IgE and "food intolerance panels" will not do the job: the first can be normal in obvious allergy, and the second have nothing to do with diagnosis at all.
- Examination by an ear, nose and throat doctor with an endoscope. Needed when one side is blocked, when there are crusts or blood, or when polyps or a deviated septum are suspected.
- A thyroid check if there are other signs of it working slowly.
- A CT scan of the sinuses — not for everyone, but where polyps or chronic sinus inflammation are suspected.
Both can coexist: there is an allergy, but on top of it the nose also reacts to cold and to smells. In that case both halves are treated, otherwise the result will be half a result.
What you can do yourself
Non-allergic rhinitis is not dangerous, and in many cases it is managed without prescriptions.
First, remove what you know to be your trigger: do not smoke and do not sit in smoke, air the rooms, humidify in winter, wear a scarf in frosty weather, use protection at work, cut down on alcohol.
Second, rinse the nose with salt water. It is a simple procedure that noticeably eases blockage, the drip down the throat and the crusting.
- Take half a litre of water, boil it and let it cool until it is warm. Water straight from the tap must not be used.
- Dissolve a slightly rounded-down teaspoon of salt and a pinch of bicarbonate of soda.
- Wash your hands, lean over the sink and pour the solution into one nostril from a bulb syringe, a bottle or your palm, breathing through your mouth; let the fluid run out. Repeat on the other side.
- Do this up to two or three times a day, making a fresh solution each time. Ready-made saline sprays work in the same way.
Third, do not treat yourself for longer than a couple of weeks. If rinsing and removing triggers have not helped, what is needed next is a doctor, not the next bottle from the chemist.
Decongestant sprays: how not to end up in a circle
This deserves saying separately, because this is where things most often go wrong. The drops and sprays that clear a blocked nose within a minute do it by narrowing the blood vessels of the lining. After a few days of constant use the vessels stop holding their own tone, and the moment the medicine wears off the nose blocks more heavily than before. The person uses it more often, the dose creeps up, and in the end they are no longer treating rhinitis but servicing a dependence on the spray.
The rule is simple: such sprays are used as a short course, for no more than a few days in a row. If you have been using one for months, it is better to come off it with a doctor: they will prescribe a steroid spray for the transition and the change will be gentler. A separate warning — tablets for a blocked nose that contain a decongestant raise blood pressure and speed up the pulse, and they are not suitable for people with hypertension or heart disease.
When a runny nose is not just a runny nose
Most reasons for concern are recognised by a single feature: the complaints are one-sided.
- One nostril is blocked and bleeding, the blockage has been building for weeks, and numbness of the cheek, double vision or a bulging eye have appeared — a tumour in the nasal cavity can present this way. It is rare, but it is exactly the thing that must not be missed.
- A child has thick, foul-smelling discharge from one nostril — almost always a foreign body pushed up there. An ear, nose and throat doctor is needed, and the sooner the easier it is to remove.
- Clear fluid drips from one nostril, especially on bending the head forward and especially after a head injury or an operation — this can be a leak of the fluid that surrounds the brain. That needs a doctor, not drops.
- Crusting, repeated nosebleeds and a collapsing bridge of the nose together with feeling generally unwell, weight loss, joint pain or an abnormal urine test call for investigation: this is how some diseases affecting the whole body begin.
- Nasal polyps, asthma and a reaction to painkillers. If aspirin or ibuprofen blocks your nose, brings on wheezing or sets it running, that is a particular intolerance. Those medicines are not for you, every doctor and every surgical team should be told about it, and pain has to be treated with something else.
An ambulance (in Spain, Italy, Portugal, Poland and Ukraine on the single number 112) is needed if, alongside the rhinitis, there is swelling and redness around an eye, the eye sees less well or moves poorly, a severe headache with vomiting, confusion, or a high temperature with a stiff neck. These are signs of inflammation spreading beyond the sinuses.
What a doctor prescribes
When home measures have not been enough, the doctor has treatments that work specifically in this type of rhinitis.
- A steroid nasal spray. The mainstay. It does not act immediately: the first change comes after several days and the full effect after two to four weeks, so it is used as a course rather than "when it blocks". Technique matters: aim the bottle away from the septum, slightly outwards towards the outer wall of the nose, otherwise bloody crusts follow.
- An antihistamine nasal spray. Unlike allergy tablets, the local preparation does work in non-allergic rhinitis and is often used together with the steroid.
- A spray that reduces mucus production. This helps those whose main complaint is water pouring from the nose, including during meals and in the cold.
- A review of medicines. If a prescription for something else is the culprit, the doctor will find a substitute.
- Referral to an ear, nose and throat doctor for polyps, a markedly deviated septum, persistent one-sided complaints or treatment that is not working. Surgery is sometimes discussed, but it solves a mechanical problem and not the over-reactivity of the lining itself.
Ordinary allergy tablets do not help most people with non-allergic rhinitis, and if they are being taken for months with no result, that is a reason to revisit the diagnosis rather than to raise the dose.
Online consultation
A year-round runny nose is a good thing to start with online. The doctor will go through the circumstances with you: when it began, what it coincided with, how it relates to work, weather, food and medicines; will look over your list of preparations; will explain which allergy tests are worth having and which are money thrown away; and will show you how to use a spray properly and how to rinse the nose, because a great many mistakes are made here.
What an online appointment does not replace: endoscopic examination of the nasal cavity, imaging of the sinuses and the allergy tests themselves. And if the complaints are one-sided, or the signs from the previous section have appeared, a face-to-face visit should not be put off.
This material is for information only and does not replace medical advice.
Consult with a doctor about Non-allergic rhinitis
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Non-allergic rhinitis
Discuss your symptoms and possible next steps for Non-allergic rhinitis with a doctor online.
