NON-ALLERGIC OR VASOMOTOR RHINITIS
Non-allergic or vasomotor rhinitis is a form of rhinitis which has some symptoms similar to allergic rhinitis;
however it is not triggered by
allergens and does not respond to the classic oral antihistamines that often improve allergic rhinitis symptoms.
Post nasal drip
If you have non-allergic rhinitis, the lining of your nose swells due to expanding blood vessels, causing a
congested and drippy nose. Non-allergic rhinitis affects approximately 17 million people in the U.S., both
children and adults.
Although non-allergic rhinitis is more annoying than harmful, it can significantly affect your quality of life. A
variety of factors may trigger symptoms of non-allergic rhinitis, including infections, environmental irritants,
medications, hormonal changes, temperature changes, stress or activity. A diagnosis of non-allergic rhinitis is
made if symptoms are present and allergy tests are negative. The diagnosis in many people is more
complicated because at least 50% of people who have allergic rhinitis also report having some non-allergic or
vasomotor triggers, such as humidity changes, temperature changes and strong odors. So many people with
nasal congestion and runny nose may have both allergic and non-allergic rhinitis.
Non-allergic rhinitis doesn't usually cause itchy nose, eyes, palate or throat. These symptoms are usually
associated with allergies and allergic rhinitis.
Non-allergic rhinitis is caused by blood vessels in your nose expanding (dilating), filling the nasal lining with
blood and fluid. Sometimes non-allergic rhinitis is caused by inflammation of the lining of the nose. There are
several possible causes of this abnormal dilation of the blood vessels or inflammation in the nose. Whatever the
underlying cause, the result is the same, swollen nasal membranes and nasal congestion. Many things can cause non-allergic rhinitis — some resulting in short-lived symptoms, and others causing chronic problems.
Environmental irritants. Dust, smog, secondhand smoke or strong odors, such as perfumes, can trigger non
-allergic rhinitis. Chemical fumes, such as those you might be exposed to in certain occupations, also may be to
Weather changes. Temperature or humidity changes can trigger the membranes inside your nose to swell and
cause a runny or stuffy nose.
Stress or activity. Emotional or physical stress can trigger non-allergic rhinitis.
Infections. A common cause of non-allergic rhinitis is a viral infection — a cold or the flu, for example. This type
of non-allergic rhinitis tends to resolve itself over a few weeks but can cause lingering mucus in the throat
(postnasal drip). Sometimes, infectious rhinitis can become chronic, causing ongoing discolored nasal discharge,
facial pain and pressure.
Hormone changes. Changes in hormones due to pregnancy, menstruation, oral contraceptive use or a hormonal
condition such as hypothyroidism can cause non-allergic rhinitis.
Foods and beverages. Non-allergic rhinitis may occur when you eat, especially after eating hot or spicy foods.
Drinking alcoholic beverages, such as beer and wine, also may cause the membranes inside your nose to swell,
leading to nasal congestion.
Certain medications. Some medications can cause non-allergic rhinitis. These include non-steroidal anti
-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, and blood pressure (hypertension) medications,
such as beta blockers. Non-allergic rhinitis can also be caused by sedatives, antidepressants and drugs for
Prolonged use of decongestant nasal drops or sprays. Extended use of over-the-counter decongestant nasal
drops or sprays (Afrin, Dristan, others) can cause the membranes inside your nose to become red and inflamed.
Using these products consecutively for five to seven days can actually cause more severe and prolonged nasal
congestion when the decongestant wears off (often called rebound congestion).
Factors that may increase your risk of non-allergic rhinitis include:
- Exposure to irritants. If you're exposed to smog, exhaust fumes or tobacco smoke — to name a few — you may be at
increased risk of developing non-allergic rhinitis. Inhaled irritants on the job — such as latex, wood dust, chemical fumes, detergents or cleansers — can increase your risk of non-allergic rhinitis.
- Overuse of decongestant nasal drops or sprays. Don't use decongestant nasal drops or sprays for more than two or three
days at a time. Prolonged use of these medications can cause nasal inflammation and rebound congestion once the drugs are stopped.
- Being female. Due to hormonal changes, nasal congestion often gets worse during menstruation and pregnancy. This occurs
even in women who normally don't have problems.
WHEN TO SEEK MEDICAL ADVICE
If you have signs and symptoms of non-allergic rhinitis and haven't found relief from over-the-counter medications
or self-care tactics, see your doctor for help with a more effective treatment plan. Also see your doctor if your
problems are severe or if you have side effects from over-the-counter medications.
TESTS AND DIAGNOSIS
Non-allergic rhinitis is diagnosed based on your signs and symptoms and when they occur. If it's clear that your
nasal congestion isn't triggered by allergies, your doctor may determine that you have non-allergic rhinitis.
The only way to be sure you aren't having an allergic reaction is through allergy testing, which may involve skin
or blood tests.
- Skin test. To find a potential allergen, your skin is pricked and exposed to small amounts of common allergens. If you're
allergic to a particular allergen, you develop a raised bump (hive) at the test location on your skin. If you're not allergic to
any of the substances, your skin looks normal.
- Blood test. A blood test can measure your immune system's response to common allergens by measuring the amount of
certain antibodies in your bloodstream, known as immunoglobulin E (IgE) antibodies. A blood sample is sent to a medical laboratory, where it can be tested for evidence of sensitivity to specific allergens.
- If your doctor suspects sinusitis or nasal polyps, he or she may order a computerized tomography (CT) scan of the sinuses.
A sinus CT scan is an X-ray technique that produces images of your sinuses that are more detailed than those produced by conventional X-ray exams.
If you have severe and persistent non-allergic rhinitis, you may develop complications such as:
- Nasal polyps. These are soft, non-cancerous (benign) growths that develop on the lining of your nose or sinuses due to
chronic inflammation. Small polyps may not cause problems, but larger ones can block the airflow through your nose,
making it difficult to breathe.
- Chronic sinusitis. Prolonged nasal congestion due to non-allergic rhinitis may increase your chances of developing sinusitis
— an infection or inflammation of the membrane that lines the sinuses. Sinusitis causes pain, tenderness and swelling around
your eyes, cheeks, nose or forehead.
- Middle ear infections. Increased fluid and nasal congestion may lead to middle ear infections.
TREATMENTS AND DRUGS
Treatment of non-allergic rhinitis depends on how much it bothers you. For mild cases, you may need no
treatment. Simply avoid the things that seem to trigger your symptoms. Rinsing your nasal passages (nasal
lavage) with an over-the-counter saline solution (Ayr, Breathe Right, others) can help to keep your nose free of
For more bothersome symptoms, certain medications may provide relief, including:
- Oral decongestants. Available over-the-counter or by prescription, examples include pseudoephedrine-containing drugs (Sudafed, Actifed, others) and phenylephrine. These medications help narrow the blood vessels, reducing congestion in the
- Saline nasal sprays. Use an over-the-counter nasal saline spray or homemade saltwater solution to flush the nose of irritants
and help thin the mucus and soothe the membranes in your nose.
- Antihistamine nasal sprays. Try a prescription antihistamine spray such as azelastine (Astelin). While oral antihistamines don't seem to help non-allergic rhinitis, antihistamine in the form of a nasal spray may reduce symptoms of non-allergic rhinitis.
- Anti-drip anticholinergic nasal sprays. The prescription drug ipratropium (Atrovent) often used as an asthma inhaler medication, is now available as a nasal spray and can be helpful if a runny, drippy nose is your main symptom.
- Corticosteroid nasal sprays. If your symptoms aren't easily controlled by decongestants or antihistamines, your doctor may suggest a prescription corticosteroid nasal spray, such as budesonide (Rhinocort), fluticasone (Flonase), mometasone
(Nasonex) or triamcinolone (Nasacort). Corticosteroid medications help prevent and treat inflammation.
Over-the-counter oral antihistamines, such as diphenhydramine (Benadryl), clemastine (Tavist) and loratadine (Claritin),
typically don't work nearly as well for non-allergic rhinitis as they do for allergic rhinitis.
In rare cases, surgical procedures may be an option to treat complicating problems such as a deviated nasal septum or
persistent nasal polyps.
LIFESTYLE AND HOME REMEDIES
Try these tips to help reduce discomfort and relieve the symptoms of non-allergic rhinitis:
- Blow your nose. Regularly and gently blow your nose if mucus or irritants are present.
- Humidify. Set up a humidifier in your work or sleep location. Or breathe in the steam from a warm shower to help loosen the mucus in your nose and clear your head of stuffiness.
- Stay hydrated. Drink plenty of liquids, such as water, juice or non-caffeinated tea. Avoid caffeinated beverages, which can
cause dehydration and aggravate your symptoms.
- Try nasal wash (nasal lavage). Use an over-the-counter nasal saline spray or homemade saltwater solution to flush the nose of irritants and help thin the mucus in your nose.
- Use a decongestant. Try an over-the-counter oral decongestant, preferably in liquid or pill form. Nonprescription decongestant nasal drops or sprays (Afrin, Dristan, others) may also be helpful, but should not be used for more than three or four days, as they can be irritating and cause rebound stuffiness. Decongestants can cause a stimulant effect and raise blood pressure for
Adapted from the Mayo Clinic