Rhinitis

Causes

• Allergic Rhinitis: This is an immune system response to specific allergens.
  • Seasonal Allergic Rhinitis (Hay Fever): Triggered by outdoor allergens that are present during certain seasons, such as pollen from trees, grasses, and weeds.
  • Perennial Allergic Rhinitis: Triggered by indoor allergens present year-round, such as dust mites, pet dander, mold spores, and cockroach droppings.
• Non-Allergic Rhinitis: This type is not caused by an immune system reaction to allergens. Causes include:
  • Irritants: Exposure to environmental irritants like tobacco smoke, strong odors (perfumes, cleaning products), air pollution, and chemical fumes.
  • Weather changes: Sudden changes in temperature or humidity.
  • Infections: Viral infections (e.g., common cold, flu) are a very common cause of acute rhinitis. Bacterial infections can also occur.
  • Hormonal changes: Fluctuations during pregnancy, puberty, or with thyroid conditions.
  • Certain medications: Such as NSAIDs (e.g., aspirin), beta-blockers, oral contraceptives, and some blood pressure medications.
  • Food: Spicy foods or alcohol can sometimes trigger non-allergic rhinitis symptoms.
  • Structural problems: Deviated septum, nasal polyps, or enlarged turbinates can contribute to chronic congestion.
  • Atrophic Rhinitis: A rare condition where the nasal lining thins and hardens.
  • Vasomotor Rhinitis: Occurs when blood vessels in the nose overreact to non-allergic triggers, leading to congestion and runny nose.

Symptoms

• Runny nose (rhinorrhea): Clear, watery discharge is common in allergic rhinitis and viral infections.
• Nasal congestion (stuffy nose): Difficulty breathing through the nose.
• Sneezing: Often occurs in bouts, especially with allergic rhinitis.
• Itchy nose, throat, eyes, or roof of mouth: Particularly characteristic of allergic rhinitis.
• Postnasal drip: Mucus dripping down the back of the throat, leading to a cough or throat clearing.
• Watery, red, or itchy eyes (allergic conjunctivitis): Common with allergic rhinitis.
• Reduced sense of smell (hyposmia).
• Headache or facial pressure: Can occur with severe congestion or sinus involvement.
• Fatigue: Especially if symptoms interfere with sleep.

Diagnosis

• Medical history and physical exam: The doctor will ask about your symptoms (when they occur, what triggers them), family history of allergies, and examine your nasal passages.
• Allergy testing (for allergic rhinitis):
  • Skin prick test: Small amounts of allergens are pricked onto the skin to see if a reaction occurs.
  • Specific IgE blood test (RAST test): Measures levels of specific allergy antibodies in the blood.
• Nasal endoscopy: A thin, lighted tube is used to examine the nasal passages and sinuses for structural problems, polyps, or inflammation.
• CT scan of the sinuses: May be performed if sinus infection or structural abnormalities are suspected.
• Ruling out other conditions: The doctor may conduct tests to rule out other conditions that cause similar symptoms, such as the common cold, sinusitis, or nasal polyps.

Treatment

• For Allergic Rhinitis:
  • Allergen avoidance: Identifying and minimizing exposure to specific allergens.
  • Nasal corticosteroids: (e.g., fluticasone, budesonide) are often the most effective treatment for reducing nasal inflammation, congestion, sneezing, and runny nose.
  • Antihistamines: Oral antihistamines (e.g., cetirizine, fexofenadine) or antihistamine nasal sprays (e.g., azelastine) relieve itching, sneezing, and runny nose.
  • Decongestants: Oral (e.g., pseudoephedrine) or nasal sprays (e.g., oxymetazoline) can relieve congestion. Nasal decongestant sprays should be used for only a few days to avoid rebound congestion.
  • Cromolyn sodium nasal spray: Helps prevent the release of allergy-causing chemicals.
  • Allergen immunotherapy (allergy shots or sublingual tablets): Long-term treatment that can desensitize the immune system to specific allergens.
  • Nasal saline rinses: Help clear mucus and allergens from the nasal passages.

• For Non-Allergic Rhinitis:
  • Avoidance of irritants: Limiting exposure to smoke, strong odors, and other triggers.
  • Nasal saline rinses: Help clear nasal passages.
  • Nasal corticosteroids: Can be effective for some types of non-allergic rhinitis.
  • Antihistamine nasal sprays: Some (e.g., azelastine) also have anti-inflammatory properties that can help.
  • Ipratropium bromide nasal spray: Reduces watery nasal discharge.
  • Decongestants: For temporary relief of congestion.
  • Treating underlying conditions: Addressing issues like reflux or thyroid problems if they contribute to symptoms.

• For Infectious Rhinitis (e.g., common cold):
  • Rest, fluids, and over-the-counter symptom relievers (decongestants, pain relievers). Antibiotics are not effective for viral infections.

Getting Rhinitis Under Control

Rhinitis is treatable in nearly everyone, yet it commonly persists for years because the most effective medicine is used incorrectly, the wrong one is used first, or the trigger is a medication or an air-conditioning system.

The nasal steroid, used so it actually works

A daily steroid spray such as fluticasone is the most effective treatment for allergic and most non-allergic rhinitis, but it takes one to two weeks of daily use to reach full effect. Aim the nozzle outward toward the ear rather than at the septum, sniff gently, and avoid blowing the nose for a few minutes; that technique prevents the nosebleeds and crusting that make people quit. Antihistamines such as cetirizine, fexofenadine, or loratadine relieve sneezing and itch but do little for congestion, and older sedating ones raise fall and confusion risk after 65. Montelukast carries a warning about mood effects and is reserved for people who also have asthma.

The spray that causes what it treats

Oxymetazoline and similar decongestant sprays used beyond three days produce rebound swelling worse than the original congestion. Stopping it, with a steroid spray to cover the withdrawal, cures that form of rhinitis. Oral decongestants raise blood pressure and worsen prostate symptoms and are avoided in hypertension.

Medications that cause a runny or blocked nose

Erectile dysfunction pills such as sildenafil, alpha-blockers such as tamsulosin, several blood pressure medicines, and NSAIDs including ibuprofen cause congestion in some people, and the fix is a change of drug rather than another spray. Our non-allergic rhinitis guide covers these and the vasomotor form triggered by cold air and spicy food.

What Florida adds

Pollen here runs nearly year-round, mold spores peak in the wet season, and dust mites thrive in humidity, so "seasonal" symptoms often are not; our year-round allergies guide and indoor air quality article cover filters, humidity control, and duct cleaning. Saline rinses help everyone, but the water must be distilled, sterile, or boiled and cooled, never tap water, because of the rare ameba infection Florida tap water can carry. Allergy testing and immunotherapy, by shots or under-the-tongue tablets, are the step when sprays are not enough, and they change the course of allergic rhinitis rather than mask it.

When it is not rhinitis

Blockage on one side only, blood-tinged discharge, loss of smell without congestion, or a clear watery drip from one nostril that increases when leaning forward, especially after a head injury, needs examination rather than another spray. Congestion that worsens snoring or makes CPAP intolerable is part of sleep apnea treatment. Persistent throat clearing and cough are as often silent reflux or postnasal drip as rhinitis. Our ear, nose, and throat team arranges endoscopy when needed. The American Academy of Otolaryngology and MedlinePlus publish patient guidance on allergic and non-allergic rhinitis.

If you have used a nasal spray for months and still cannot breathe through your nose, schedule a visit.