Non-allergic rhinitis

If you have rhinitis, the inside of your nose will become inflamed, causing symptoms such as a build-up of mucus in the nasal cavities and a blocked or runny nose.

Introduction

If you have rhinitis, the inside of your nose will become inflamed, causing symptoms such as a build-up of mucus in the nasal cavities and a blocked or runny nose.

You may also feel pressure or pain in your nose. Read more about the symptoms of non-allergic rhinitis.

Rhinitis is often caused by an allergic reaction to a substance such as pollen. This is known as allergic rhinitis.

Non-allergic rhinitis is where the nasal lining becomes swollen and inflamed due to causes other than allergy. These pages focus on non-allergic rhinitis.

What causes non-allergic rhinitis?

In non-allergic rhinitis, the inflammation and swelling is usually the result of swollen blood vessels and an accumulation of fluid in the tissues of the nose.

This leads to nasal congestion and stimulates the mucus glands in your nose, resulting in typical symptoms, such as nasal obstruction, catarrh (a build-up of mucus in the nasal cavities) and a runny nose.

There are several possible causes of non-allergic rhinitis which can relate to ‘external’ or ‘internal’ factors. External factors include viral infections that attack the lining of the nose and throat, and environmental factors, such as changes in humidity.

Internal factors include hormone imbalances, such as those that occur during [pregnancy] or puberty, and the use of hormone replacement therapy (HRT) or hormonal contraception, such as the contraceptive pill. Stress can also be a possible internal trigger.

Read more about the causes of non-allergic rhinitis.

Treating non-allergic rhinitis

Although non-allergic rhinitis is not harmful, it can be irritating and affect your quality of life. Treatment will depend on how severe the condition is and what is causing it.

In some cases, avoiding certain triggers and self-care measures, such as rinsing your nasal passages, may help to relieve your symptoms. This can be done either by using a home made solution or a solution from a pharmacy.

In other cases, medication may be needed, such as a nasal spray that contains corticosteroids. These will help to relieve the congestion, but need to be used over a number of weeks to be fully effective.

Always check with your doctor or pharmacist before taking any medication for your symptoms.

Read more about treating non-allergic rhinitis.

Complications of non-allergic rhinitis

Complications of non-allergic rhinitis include:

  • nasal polyps – abnormal, but benign (non-cancerous) sacs of fluid that grow inside the nasal passages and sinuses; large nasal polyps can cause an almost total nasal blockage
  • sinusitis – a bacterial or viral infection caused by nasal inflammation and swelling that prevents the sinuses from draining

Symptoms

If you have non-allergic rhinitis, your symptoms may be constant or may come and go through the year. Symptoms include:

  • a runny nose
  • a blocked nose
  • sneezing (although this is less severe than in allergic rhinitis)
  • mild nasal pressure and pain

Atrophic rhinitis

Atrophic rhinitis is where membranes lining the inside of your nose become thin and hard (atrophy). This causes a number of additional symptoms including:

  • nasal crusting
  • a foul-smelling odour produced by the crust
  • nosebleeds if you try to remove the crusts
  • loss of the sense of smell

Causes

Non-allergic rhinitis occurs when the nasal lining becomes swollen and inflamed, usually due to both swollen blood vessels and an accumulation of fluid in the tissues of the nose.

Blood vessels inside your nose help to control the flow of mucus by expanding and narrowing.

Swelling of the nasal lining causes congestion and stimulates the mucus glands in the nose, resulting in the typical symptoms of nasal obstruction, catarrh (a build up of fluid in the nasal cavities) and a runny nose.

There are several possible causes of non-allergic rhinitis described below.

Viral rhinitis

In cases of viral rhinitis, a virus attacks the lining of the nose and throat, resulting in it becoming inflamed and triggering the production of mucus.

Vasomotor rhinitis

For reasons that are unknown, people with vasomotor rhinitis have very sensitive nasal blood vessels. Environmental triggers can make the blood vessels expand, leading to congestion and a build-up of mucus. Common triggers include:

  • chemical irritants, such as smoke, perfume or paint fumes
  • changes in the weather, such as a drop in temperature
  • alcohol
  • spicy food
  • stress

Atrophic rhinitis

Inside your nose, there are three ridges of bone covered by a layer of tissue. These layers of tissue are called turbinates. Atrophic rhinitis can occur if the turbinates become damaged.

Turbinates can be damaged by infection, although this is rare in the UK. Bacteria usually responsible for atrophic rhinitis, known as Klebsiella ozenae, are mainly found in India, China and Egypt.

In the UK, turbinates are more commonly damaged or removed during surgery. Sometimes it is necessary to surgically remove turbinates if they are obstructing your airflow.

Turbinates play an important role in the functioning of your nose by:

  • keeping the inside of your nose moist
  • protecting the body from being infected with bacteria
  • regulating the air pressure of oxygen you breathe in
  • containing important nerve endings that are used to transmit information, such as smells, to your brain

If a certain amount of turbinates are damaged or removed, the remaining tissue will become dry, crusty and prone to infection.

If you have atrophic rhinitis, you may also experience shortness of breath, because the turbinates are no longer able to regulate air pressure effectively and your lungs have to work harder to receive air. Many people also lose their sense of smell (anosmia).

The amount of turbinates that can be lost before atrophic rhinitis develops will differ from person to person. Some people lose a large amount of turbinates and never develop the condition, whereas others develop the condition after losing a small number of turbinates.

Rhinitis medicamentosa

Rhinitis medicamentosa is caused by the overuse of nasal decongestant sprays. It can also occur as a complication of [cocaine misuse].

Nasal decongestants work by reducing the swelling of the blood vessels in your nose. However, if decongestant sprays are used for longer than five to seven days at a time, they can cause the lining of your nose to swell up again, even after the cold or allergy that originally caused the problem has passed.

If you use more decongestants in an attempt to reduce the swelling, it is likely to make the problem worse. This is sometimes known as 'rebound congestion'.

It is possible to get locked into a cycle of overuse and dependence on nasal decongestants, in a similar way to becoming addicted to drugs.

Hormonal imbalance

Non-allergic rhinitis can also be caused by hormonal changes due to pregnancy, puberty or taking hormone replacement therapy (HRT) or the contraceptive pill. An underactive thyroid gland (hypothyroidism) is another possible cause.

It is thought that hormones play a role in the enlargement of the nasal blood vessels that can lead to rhinitis.

Diagnosis

Diagnosing non-allergic rhinitis correctly will depend on the nature of your symptoms.

Viral rhinitis

A diagnosis of viral (infectious) rhinitis will usually be based on the presence of other typical cold or flu symptoms, such as muscular aches and pains.

Vasomotor rhinitis

Diagnosing vasomotor rhinitis can be difficult because it shares many of the same symptoms as allergic rhinitis.

There are no specific tests for vasomotor rhinitis so a diagnosis will usually be made after excluding other possible allergic causes of rhinitis, such as pollen. There are three main tests used to check for allergies, they are the:

  • skin prick test
  • blood test
  • patch test

If test results show you do not have an allergic reaction, vasomotor rhinitis may be diagnosed.

Read more about allergy tests.

Atrophic rhinitis

Atrophic rhinitis is usually diagnosed after checking for characteristic symptoms, such as nasal crusting, widening of the nasal passages, a foul odour and a loss of smell.

A computerised tomography (CT) scan may be used by specialists if complications of rhinitis, such as nasal polyps or sinusitis, are suspected.

CT scans are regularly used before nasal surgery to obtain a detailed picture of the anatomy of your nasal cavities.

Rhinitis medicamentosa

If you have rhinitis medicamentosa, your doctor should be able to diagnose the condition by asking you about your previous use of nasal decongestant sprays.

It is important you are honest about possible overuse of the sprays so you can receive the appropriate treatment.

Treatment

Treatment for non-allergic rhinitis depends on the specific type.

Viral rhinitis

Rhinitis caused by an infection usually clears up within 14 days so treatment is often not required.

Decongestants may help to relieve symptoms of congestion, but it is important to follow the manufacturer's instructions. Overusing decongestants could make your congestion worse and lead to rhinitis medicamentosa (see below).

You should not use nasal decongestants if you are taking a type of antidepressant called a monoamine oxidase inhibitor.

Read more about decongestant medication.

Vasomotor rhinitis

If you are diagnosed with vasomotor rhinitis, it is important to recognise any potential environmental triggers and, if possible, avoid them.

Symptoms can usually be relieved by a nasal spray containing corticosteroids. This will relieve congestion by reducing inflammation.

If your rhinitis doesn't respond to treatment, you can try:

  • antihistamine nasal sprays – they help reduce inflammation caused by vasomotor rhinitis
  • anticholinergic nasal sprays – enlarges the airways and make breathing easier; they also reduce the amount of mucus your body produces which helps to relieve a runny nose
  • sodium cromoglycate – reduces inflammation and production of mucus and is usually taken through an inhaler

Always check with your doctor or pharmacist before you take any medication for your symptoms.

Atrophic rhinitis

Nasal irrigation is the most common treatment for atrophic rhinitis. It involves using a syringe to fill the nasal cavities with saline solution (a mixture of salts and water) which helps reduce crusting and dryness.

Antibiotics can also be used to treat infection and reduce or remove the offensive odour.

Rhinitis medicamentosa

The best way to treat rhinitis medicamentosa is to stop using nasal decongestant sprays. However, this can be difficult, particularly if you have been using them for some time.

Several methods can help ease the withdrawal process:

  • stop using the spray in your 'good' (least congested) nostril – after seven days your good nostril should open up, at which point stop using the spray in your other nostril
  • take an antihistamine that causes drowsiness to reduce night-time congestion and help you sleep
  • lubricate and rinse your nose using a saline solution delivered by a small syringe or ‘neti pot’ – to make the solution, mix half a teaspoon of salt in 220ml (8oz) of lukewarm water

If you have severe rhinitis medicamentosa, your doctor may prescribe a short course of corticosteroid tablets.

Complications

Nasal polyps and sinusitis are t**wo possible complications of non-allergic rhinitis.

Nasal polyps

Nasal polyps are fleshy swellings that grow from the lining of your nose or sinuses (the small cavities above and behind your nose). They are caused by inflammation of the membranes of the nose and sometimes as a result of rhinitis.

Nasal polyps are shaped like teardrops when they are growing and they look like a grape on a stem when fully grown. They vary in size and can be a yellow, grey or pink colour. They can grow on their own or in clusters and usually affect both nostrils.

If nasal polyps grow large enough, or in clusters, they can:

  • interfere with your breathing
  • reduce your sense of smell
  • block your sinuses, leading to sinusitis (see below)

Small nasal polyps can be shrunk using corticosteroid nasal sprays so they do not cause an obstruction in your nose. Large polyps may need to be surgically removed.

Read more about nasal polyps.

Sinusitis

Sinusitis is a common complication of rhinitis. It is where sinuses become inflamed or infected.

If sinuses become filled with mucus, the fluid usually drains away. However, if fluid cannot drain away – for example, as the result of a blockage, it may become infected with bacteria.

Sinusitis often occurs as a complication of rhinitis because a build-up of mucus or nasal polyps can prevent sinuses draining properly.

Common symptoms include:

  • pain and tenderness of the infected sinus – you may experience a throbbing pain in your sinuses and toothache, or pain in your jaw when you eat
  • a blocked or runny nose – your nose may produce a greenish or yellowish mucus; if your nose gets blocked with mucus, any pain or tenderness in the affected area may become worse
  • a high temperature (fever) of over 38C (100.4F)

Symptoms of sinusitis can be relieved using over-the-counter painkillers, such as paracetamol, ibuprofen or aspirin. These will relieve a headache, high temperature and any pain or tenderness around the infected area.

Children under 16 years of age should not take aspirin. Ibuprofen is not recommended for people with asthma or those who currently have stomach conditions, such as stomach ulcers, or have had them in the past. Speak to your doctor if you are unsure.

Antibiotics may be recommended if you develop a secondary infection in your sinuses. In cases of long-term sinusitis (chronic sinusitis), surgery may be needed to improve the drainage of your sinuses.

Read more about sinusitis.

Content supplied by NHS Choices