Non-Allergic Rhinitis

Non-allergic rhinitis has symptoms very similar to allergic rhinitis (“hay-fever”). The difference is that it is not caused by allergic triggers! About half of all people with chronic nose symptoms have non-allergic rhinitis and are usually very surprised to find out that they don’t have “allergies.” Some patients actually have a combination of allergies AND non-allergic rhinitis!

Non-allergic rhinitis patients typically have more complaints of congestion, sinus pressure and thick post-nasal drainage and less of the classic sneezing, itching and clear, watery drainage seen with true allergies. Although all ages can be affected by non-allergic rhinitis, it becomes much more common as we get older.

  1. Vasomotor rhinitis is triggered by irritants such as strong odors, perfumes, changes in temperature and humidity, smoke, fumes and bright sunlight.
  2. Rhinitis medicamentosa is related to overuse of over-the-counter decongestant sprays, such as Afrin. People who over-use these sprays essentially become “addicted” to the medication, needing more and more medication to control their symptoms. Only stopping the medication will resolve the problem.
  3. Gustatory rhinitis can be related to food or alcohol intake, but is not due to an allergic cause. Patients experience a profuse runny nose, particularly after eating hot or spicy foods.
  4. Rhinitis related to acid reflux disease is particularly common in young children. Symptoms tend to occur after heavy meals or in the morning after the person has been lying flat all night.
  5. Medication-induced rhinitis can occur in some patients using high blood pressure medication, birth control pills and non-steroidal anti-inflammatory drugs (such as aspirin and ibuprofen).
  6. Hormonal rhinitis can occur during pregnancy and in patients with low thyroid function. Pregnant women usually have symptoms of severe nasal congestion during their second month of pregnancy, and this can persist until the baby is born. Symptoms typically disappear shortly after delivery.

Avoiding the non-allergic triggers listed above is the best way to treat non-allergic rhinitis, but it is not always possible. Typically, non-allergic patients do not respond well to anti-histamine pills.

Some helpful medications include both steroid and antihistamine nose sprays. Patients with a constant runny nose and post-nasal drip usually benefit from the drying effect of an anti-cholinergic nasal spray, particularly in vasomotor and gustatory rhinitis.

Rhinitis during pregnancy can respond to saline nose sprays. Rhinitis medicamentosa requires stopping the over-the-counter topical decongestant and usually replacing it with a prescription nasal spray.

Allergy shots (“immunotherapy”) only work for allergic triggers and are not helpful in non-allergic rhinitis.

A diagnosis is usually based on the history of symptoms, medication use, other known medical problems plus a physical examination. Allergy testing will be negative in patients with non-allergic rhinitis and this testing is usually required to make sure that true allergies are not present.