An Overview of Rhinitis or Nasal Allergy

Saima Andrabi   by Saima Andrabi, MS, Clinical Biochemistry    Last updated on September 13, 2019,

rhinitis or nasal allergy

 

What is Rhinitis?

Rhinitis or nose allergy is an inflammation and swelling in the mucous membrane of the nose. It is characterized by a runny and stuffy nose and is usually caused by the common cold or a seasonal allergy. The word rhinitis means “inflammation of the nose.” The nose produces fluid called mucus. Normally this fluid is thin and clear and helps to keep dust, debris and allergens out of the lungs. Mucus also traps dust and pollen particles in addition to bacteria and viruses. Mucus usually drains down the back of our throat but we are not aware of this most of the time because it is in small amount and is thin. However when the nose becomes irritated, it may produce more mucus, which becomes thick and pale yellow. This thick mucus starts flowing from the front as well as back region of the nose. Therefore, the substances in the mucus may irritate the back of the throat and cause coughing.

Rhinitis basically refers to the inflammation of the mucosa of the nasal cavity (i.e., the lining of the nasal cavity). Rhinitis is different from rhinosinusitis. In most of the cases, non-inflammatory conditions are grouped with rhinitis, but this is wrong, since the mechanisms are entirely different. In fact, all non inflammatory nasal conditions should be considered to be in the category of rhinopathy.

Types of Rhinitis

There are usually three types of rhinitis:

  • Allergic rhinitis
  • Non-allergic rhinitis
  • Infectious rhinitis

Allergic Rhinitis

Allergic rhinitis is an inflammation in the nasal cavity caused by an allergic response to specific allergens. Allergens are otherwise harmless substances that result in an allergic reaction. Allergic rhinitis is also called as hay fever. It has been found that almost 8 percent of adults in the United States experience allergic rhinitis of some kind. There are different types of allergens which cause allergic rhinitis. Some of the most common allergens are:

  • Outdoor allergens like pollens and smoke
  • Indoor allergens like dust mites, pet hair or dander etc
  • Some other irritants like cigarette smoke, perfumes, chemicals and exhaust fumes

There are many symptoms of allergic rhinitis like:

  • Coughing
  • Sneezing
  • Itching in the nose
  • Congestion
  • Watery discharge from the nose

Allergic rhinitis cause severe allergy in the eyes resulting in itchy and watery eyes. In such patients, the sensation of itchy, watery eyes is an important issue. The mechanism behind an allergic rhinitis is an immunoglobulin E (IgE) mediated hypersensitivity reaction against inhaled allergens.

Non-Allergic Rhinitis

Non-allergic rhinitis is a type of rhinitis which is not caused by allergens. However, some factors like smoke, chemicals and other irritating environmental conditions may provoke non-allergic rhinitis. Besides, some hormonal changes, physical defects of the nose (like a deviated septum), certain medications, and the excessive use of nose sprays may also cause it. The actual cause of this type of rhinitis is not well known yet. But it is commonly found in patients with non-allergic asthma. The symptoms of a non-allergic rhinitis are often similar to allergic rhinitis but there is no evidence of an allergic reaction in the body. Non-allergic rhinitis usually involves chronic sneezing or a congested, drippy nose with no obvious cause.

Non-allergic rhinitis can affect both children and adults, however it is more common in people who are above the age of 20. There are many triggers of non-allergic rhinitis such as certain odors or irritants in the air, changes in the weather, certain medications, some types of foods, and certain chronic health conditions. Non-allergic rhinitis can be diagnosed only if there is any allergic cause. This requires skin and blood tests which may be recommended by your doctor based on your actual condition.

Symptoms of Non-Allergic Rhinitis

Some of the main signs and symptoms of non-allergic rhinitis include:

  • Stuffiness in the nose
  • Running nose
  • Sneezing
  • Mucus (phlegm) in the throat (postnasal drip)
  • Cough
  • Low grade fever

Causes of Non-Allergic Rhinitis


The exact cause of non-allergic rhinitis is not known yet but experts suggest that non-allergic rhinitis occurs when blood vessels in our nose expand and fill the nasal lining with blood and fluid. There are several other possible causes of non-allergic rhinitis like hyper responsiveness in the nerve endings of the nose that interact in a similar way as lungs do react in asthma. Whatever the cause, the results are swollen nasal membranes followed by congestion and excessive mucus production.

Triggers of Non-Allergic Rhinitis

There are many things which can trigger the non-allergic rhinitis. Some of them include:

Environmental or occupational irritants: These include such as dust, smog, secondhand smoke or strong odors (perfumes) which can trigger non-allergic rhinitis. Besides, exposure to some chemical fumes in work places can also trigger non-allergic rhinitis.

Weather changes: Changes in the temperature or humidity can cause swelling of the nasal membranes and therefore trigger the non-allergic rhinitis followed by a runny or stuffy nose.

Infections: One of the most common causes of non-allergic rhinitis is a viral infection like a cold or flu.

Foods and beverages: Eating spicy foods and drinking alcoholic beverages may also cause the inflammation of nasal membranes and therefore result in non-allergic rhinitis.

Certain medications: Some medications can also trigger non-allergic rhinitis. These include aspirin, ibuprofen (Advil, Motrin IB,), and high blood pressure (hypertension) medications, like beta blockers.

Hormone changes: Some hormonal changes due to pregnancy, menstruation, oral contraceptive use or other hormonal conditions such as hypothyroidism may also trigger non-allergic rhinitis.

In addition to the above mentioned triggers, non-allergic rhinitis can also be triggered in some people by sedatives, antidepressants, oral contraceptives or drugs used to treat erectile dysfunction in males.

Risk Factors of Non-Allergic Rhinitis

Some factors that may increase the risk of non-allergic rhinitis include:

  • Exposure to irritants like smog, fumes, tobacco and cigarette smoke etc
  • Above 20 years of age
  • Long time use of decongestant nasal drops or sprays
  • Hormonal changes in females during menstruation and pregnancy
  • Exposure to some air-borne irritants at workplaces (occupational rhinitis)
  • Health conditions like hypothyroidism and chronic fatigue syndrome
  • Any kind of emotional or physical stress

Complications of Non-allergic Rhinitis

Some of the complications of non-allergic rhinitis include:

  • Nasal polyps: These are soft, noncancerous (benign) growths that develop on the lining of the nose or sinuses due to chronic inflammation. Large sized polyps can block the airflow through the nose, making it difficult to breathe.
  • Sinusitis: Prolonged nasal congestion due to non-allergic rhinitis may increase the chances of developing sinusitis, which is an infection or inflammation of the membrane that surround the sinuses.
  • Middle ear infections: Increased fluid and nasal congestion found in non-allergic rhinitis may lead to middle ear infections.
  • Interrupted daily activities: Non-allergic rhinitis can be disturbing. A person may be less productive at work or school because of symptom flares

Treatment of Non-Allergic Rhinitis

Treatment of non-allergic rhinitis depends on how much it bothers a person. For mild cases, home treatment and avoiding triggers are enough. However, in severe cases following medications can help and provide relief:

Saline nasal sprays: These sprays help in flushing the irritants of the nose and also help in soothing the nasal membranes.

Corticosteroid nasal sprays: These are used when decongestants or antihistamines do not work. Some of the non-prescription corticosteroid nasal sprays include fluticasone (Flonase) or triamcinolone (Nasacort).

Corticosteroid medications: They help in preventing and treating the inflammation associated with some types of non-allergic rhinitis.

Antihistamine nasal sprays: Antihistamine nasal sprays such as azelastine (Astelin, Astepro) and olopatadine hydrochloride (Patanase) may reduce symptoms of non-allergic rhinitis.

Anti-drip anticholinergic nasal sprays: An asthma inhaler prescription drug ipratropium (Atrovent) is now available as a nasal spray and can be helpful in relieving the symptoms of runny and drippy nose.

Decongestants: Pseudoephedrine-containing drugs (Sudafed) and phenylephrine (Afrin, Neo-Synephrine, others) have been found to be useful in narrowing the blood vessels of the nose and therefore reduce nose congestion.

Infectious Rhinitis

It is one of the most common types of rhinitis, commonly known as the common cold or upper respiratory infection (URI). Colds usually occur when a cold virus reside in the mucous membranes of the nose and sinus cavities and then result in infections.

Classification of Rhinitis

Rhinitis is the inflammation and swelling of the mucous membrane of the nose, often characterized by a runny and stuffy nose, commonly due to cold or any kind of seasonal allergy. Rhinitis can be classified into following groups:

Acute Rhinitis

Acute rhinitis is usually characterized by nasal congestion, nasal discharge (watery-to-thick, mostly clear or gray), sore throat, malaise, fatigue and cough. Adults having acute rhinitis may experience three episodes per year while as children can experience four to six episodes (or more) per year.

Rhinitis in Children

Some of the common early symptoms of acute rhinitis include some nasal congestion, thin nasal discharge, with a scratchy or sore throat. After a few days, the nasal congestion typically worsens and the nasal discharge becomes more viscous, but within a week, symptoms disappear spontaneously. Several viruses, including rhinovirus, parainfluenza, influenza, adenovirus and others are responsible for this condition.

Acute rhinitis is mostly self-limiting, and the treatment is usually supportive that may include taking rest, drinking plenty of fluids, and taking OTC medications, like ibuprofen, acetaminophen, decongestants, mucolytic agents and nasal saline sprays). In a very small percentage of cases, acute rhinitis leads to acute bacterial rhinosinusitis.

Chronic Rhinitis

Chronic rhinitis is usually an extension of rhinitis caused by either an inflammation or a viral infection. However, very rarely it may be caused due to some other diseases like syphilis, tuberculosis, rhinoscleroma, rhinosporidiosis, blastomycosis, histoplasmosis, and leprosy. Almost all of these diseases are characterized by the formation of inflamed lesions (granulomas) and the destruction of soft tissue, cartilage, and bone. Both low humidity and airborne irritants have been found to be responsible for causing chronic rhinitis. Chronic rhinitis causes nasal obstruction and, in more severe cases, it causes crusting, frequent bleeding, and thick, foul-smelling, and pus-filled discharge from the nose.

Atrophic Rhinitis

Atrophic rhinitis is a form of chronic rhinitis characterized by thinning (atrophies)  and hardening of the mucous membrane, which causes the nasal passages to widen (dilate) and dry out. This atrophy is often found in older people. Besides, people having granulomatosis with polyangiitis (formerly called Wegener granulomatosis) are also at risk. This disorder can also develop in people who had a significant amount of intranasal structures and mucous membranes removed through a sinus surgery. A prolonged bacterial infection of the nasal lining can also be a factor.

Vasomotor Rhinitis

Vasomotor rhinitis is also a form of chronic rhinitis characterized by nasal stuffiness, sneezing, and a runny nose. In case of people with vasomotor rhinitis, the nose reacts strongly to irritants (like dust and pollen), perfumes, pollution, or spicy foods. The disorder comes and goes on its own and is worsened by dry air. The swollen mucous membrane varies from bright red to purple in color. People with this form of rhinitis have a slight inflammation of the sinuses but there is no pus-filled discharge or crusting.

Treatment options for vasomotor rhinitis are not always satisfactory. However avoiding smoke and irritants and using a humidified central heating system or vaporizer to increase humidity have been found to be beneficial. Nasal corticosteroid and antihistamine sprays may sometimes help. Nasal decongestant sprays should be avoided but oral decongestants can be used for a few days at a time if the symptoms are worst.

What is Rhinitis Medicamentosa

Rhinitis medicamentosa, also known as rebound congestion, is a condition characterized by severe nasal congestion due to the overuse (over 3 or 4 days of continuous use) of decongestant nasal sprays and drops (not from steroidal sprays).

What is Hay Fever? Is it Different From Rhinitis?

Hay fever is the other name of seasonal allergic rhinitis. People with seasonal allergic rhinitis do not need to have a fever or do not have to be exposed to hay to develop this condition. However, it is an allergic reaction to allergens like pollens, grasses and weeds. This type of allergic rhinitis occurs mainly in the spring and fall, when pollens from trees, grasses and weeds are present in the air.