Rhinitis, non-allergic

Page last reviewed: 13/07/2011

Rhinitis is a condition where the inside of your nose becomes inflamed (swollen), causing cold-like symptoms such as sneezing and a blocked or runny nose.

One of the most common causes of rhinitis is an allergic reaction to a substance such as pollen. However, if the condition is not caused by an allergic reaction, it is known as non-allergic rhinitis. 

These pages focus on non-allergic rhinitis.

Types of non-allergic rhinitis

There are several different types of non-allergic rhinitis:

  • Viral or infectious rhinitis is caused by an infection, such as the common cold.
  • Vasomotor rhinitis is where the blood vessels in your nose are over-sensitive. Certain environmental triggers, such as cold weather or smoke, can cause them to expand, causing congestion.
  • Atrophic rhinitis is where the membranes inside your nose thin and harden, causing your nasal passages to widen and dry out. Foul-smelling crusts form inside your nose and you may lose your sense of smell. Atrophic rhinitis can occur as a complication of nose surgery or as a result of infection.
  • Rhinitis medicamentosa is caused by overuse of nasal decongestants.

Non-allergic rhinitis can also occur as a result of hormone imbalances caused by pregnancy, puberty or the use of hormone replacement therapy (HRT) or hormonal contraception.

Outlook

Non-allergic rhinitis is not harmful, but the symptoms can be irritating and can affect your quality of life.

Treatment depends on how bad your symptoms are and the cause of your rhinitis. In some cases, avoiding certain triggers and self-care measures, such as rinsing your nasal passages, may relieve symptoms. In other cases, medication or surgery may be needed.

Page last reviewed: 13/07/2011

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

  • sneezing
  • runny nose
  • blocked nose
  • nasal pressure and pain

Atrophic rhinitis

Atrophic rhinitis is when the membranes in your nose thin (atrophy) and harden. It causes additional symptoms such as:

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

Page last reviewed: 13/07/2011

The blood vessels inside your nose help control the flow of mucus by expanding and narrowing. Non-allergic rhinitis occurs when blood vessels in your nose expand, filling the nasal lining with blood and fluid. The swelling of your nasal lining causes congestion and stimulates the mucus glands in your nose, resulting in the typical symptoms of sneezing and a runny nose. There are several possible causes.

Viral rhinitis

In viral rhinitis, a virus attacks the lining of your nose and throat and causes it to become inflamed (swollen), which triggers the production of mucus.

Vasomotor rhinitis

For unknown reasons, people with vasomotor rhinitis have very sensitive nasal blood vessels and environmental triggers can make the blood vessels expand, leading to congestion and an excess of mucus. Common triggers include:

  • chemical irritants, such as smoke, perfumes 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 that are covered by a layer of tissue. These layers of tissue are known as turbinate tissue. Atrophic rhinitis sometimes occurs when the turbinate tissue becomes damaged.

Turbinate tissue can be damaged by infection, although this is very rare in Ireland. The bacteria usually responsible for atrophic rhinitis, known as Klebsiella ozenae, are mainly found in India, China and Egypt.

In Ireland, turbinate tissue is more commonly damaged or removed during surgery. Sometimes it is necessary to surgically remove turbinate tissue if it is obstructing your airflow.

Turbinate tissue plays an important role in the effective functioning of your nose by:

  • keeping the inside of your nose moist
  • protecting the body from being infected with bacteria
  • containing many important nerve endings that are used to transmit information, such as smells, to your brain

If your nose loses a certain amount of turbinate tissue, it becomes dry, crusty and prone to infection.

People with atrophic rhinitis can also experience shortness of breath, because the turbinate tissues are no longer able to regulate air pressure effectively and the lungs have to work harder to receive air. Many people also lose their sense of smell (anosmia).

The amount of turbinate tissue that can be lost before atrophic rhinitis develops will differ from person to person. Some people lose a large amount of turbinate tissue and never develop the condition, while others develop the condition after just a small loss of tissue.

Rhinitis medicamentosa

Rhinitis medicamentosa is caused by the overuse of nasal decongestant sprays. The condition can also occur as a complication of cocaine abuse.

Nasal decongestants work by reducing the swelling of the blood vessels in your nose. However, if decongestant sprays are used for more than five to seven days at a time, they can cause your nasal linings to swell up again, even when 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 (known as 'rebound congestion').

Some people find they get locked into a cycle of overuse and dependence on nasal decongestants, much like a drug addiction.

Hormonal imbalance

Hormonal changes caused by pregnancy, puberty and taking hormone replacement therapy (HRT) or the contraceptive pill can trigger non-allergic rhinitis.

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.

Page last reviewed: 13/07/2011

Viral rhinitis

The diagnosis of viral (infectious) rhinitis is normally based on the presence of other typical cold or flu symptoms, such as muscle 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 the condition. Instead, diagnosis is usually made after excluding all the other possible allergic causes of rhinitis, such as pollen. If tests show you are not experiencing an allergic reaction, a diagnosis of vasomotor rhinitis can be made.

There are three main tests used to check for allergies:

  • skin prick test
  • blood test
  • patch test

For more information on allergy tests, see the Health A-Z topic on Allergies - diagnosis.

Atrophic rhinitis

Atrophic rhinitis is usually diagnosed after checking for the 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 to get a detailed picture of your nasal cavities and confirm the diagnosis.

For more information on this procedure, see the Health A-Z topic on CT scan.

Rhinitis medicamentosa

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

It is important that you are honest about any possible overuse of the sprays, so you can receive the appropriate treatment for your condition.

Page last reviewed: 13/07/2011

Viral rhinitis

Medical treatment for viral (infectious) rhinitis is often not required because the infection that causes it normally passes within 14 days.

Decongestants may help 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.

Do not use nasal decongestants if you are taking a type of antidepressant called a monoamine oxidase inhibitor. However, they do not effect other antidepressant medication.

Vasomotor rhinitis

Once the diagnosis of vasomotor rhinitis has been made, it is important to recognise any potential environmental triggers and, if possible, avoid them.

Symptoms can usually be relieved through the use of a nasal spray containing corticosteroids. Corticosteroids relieve congestion by reducing inflammation (swelling).

If your condition does not respond to treatment, several alternative methods can be tried:

  • Antihistamine nasal sprays, although typically used to treat allergic conditions, can also help reduce the inflammation caused by vasomotor rhinitis.
  • Anticholinergic nasal sprays enlarge the airways, making breathing easier. They also reduce the amount of mucus your body produces, which relieves a runny nose.
  • Sodium cromoglicate reduces inflammation and the production of mucus. It is normally taken through an inhaler.

Always check with your pharmacist or GP before starting to take any medication for your symptoms.

Atrophic rhinitis

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

Antibiotics can also be used to treat any infection and reduce or remove the offensive odour. In addition, several surgical treatments can be used to treat atrophic rhinitis:

  • Young's operation involves surgically closing the affected nasal cavity to allow it to heal without becoming infected. After a period of time, normally around nine months, the cavity is reopened.
  • Nasal narrowing operation narrows the affected nasal cavity using grafted bone or cartilage, or sometimes artificial materials such as Teflon or silicon. Narrowing the cavity leads to a reduction of the levels of crusting and can improve airflow in the nose.

Rhinitis medicamentosa

The best way to treat rhinitis medicamentosa is to stop using nasal decongestant sprays. However, many people find this difficult, particularly if they 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. Do not drive or operate heavy machinery when taking these sorts of antihistamines.
  • You can naturally 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.

In more severe cases of rhinitis medicamentosa, a short course of corticosteroid tablets may be prescribed by your GP.

Preventing rhinitis

In many cases, there is no way to avoid the underlying cause of non-allergic rhinitis.

However, you can take steps to reduce your symptoms, such as:

  • avoiding your triggers
  • not overusing nasal decongestants (taking these medications for more than a few days at a time can make your symptoms worse)
  • rinsing your nasal passages regularly with salt water, to keep your nose free of irritants

Page last reviewed: 13/07/2011

Nasal polyps

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

A nasal polyp is shaped like a teardrop when it is growing and looks like a grape on a stem when fully grown. Nasal polyps may be yellowish, grey or pink in colour and vary in size. They can either grow on their own or in clusters, and usually affect both nostrils.

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

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

Smaller polyps can be shrunk using corticosteroid nasal sprays so that they do not cause any obstructions in your nose. Large polyps may need to be surgically removed.

See the Health A-Z topics on Nasal polyps for further information on the causes and possible treatments.

Sinusitis

A common complication of rhinitis is sinusitis. This is inflammation or infection of the sinuses.

Usually, if your sinuses become filled with mucus, the fluid drains away. However, if the fluid cannot drain away, for example as the result of a blockage, it can become infected with bacteria.

Sinusitis is a common problem for people with rhinitis, because an excess of mucus or nasal polyps can stop the sinuses from draining properly.

Common symptoms of sinusitis 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 becomes blocked with mucus, any pain and tenderness in the affected area may become worse
  • high temperature over 38C (100.4F)

The 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 that you have around the infected area.

Children under 16 years of age should not take aspirin. Ibuprofen is not recommended for asthmatics or people who have (or have had) stomach conditions, such as ulcers. Speak to your GP if you are unsure.

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

See the Health A-Z topic on Sinusitis for information on the causes and possible treatments.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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