Nonallergic rhinitis (NAR) is an inflammation of the mucous membrane lining the inside of the nose. The blood vessels in the nose dilate causing nasal congestion and a clear, watery nasal discharge. This condition is primarily seen in adults and is not due to an allergy. It is separate and distinct from allergic rhinitis (AR) such as hay fever.
Every year millions of Americans suffer from nonallergic rhinitis. People with NAR have symptoms throughout the year in contrast to seasonal allergic rhinitis. The symptoms may last for a short period of time and recur or be more persistent. They range from mild to debilitating. Of note, itchy nose, eyes or throat are not usually associated with NAR.
The symptoms might include:
- Nasal congestion
- Clear, watery runny nose
- Post nasal drip
- Cough
- Sneezing
Other symptoms associated with NAR can be clogged ears due to Eustachian tube dysfunction, ear infections, sinusitis or loss of smell called anosmia.
After taking a good medical history and physical examination, the diagnosis is established when you rule out infection and the workup for allergy is negative. NAR does not involve the immune system. Allergy skin testing is negative, as well as laboratory tests for allergy in patients with nonallergic rhinitis. NAR is suggested when irritants such as perfumes, smoke or chemicals exacerbates a person’s symptoms.
Warren is a 52 y/o man who complains of nasal congestion, a clear, “watery” nasal discharge and a tickle in the back of his throat. Second hand smoke worsens the congestion and drainage which at times, “won’t stop running.” He has no complaints of sneezing or itchiness and his symptoms occur throughout the year. He takes medications for hypertension and his bothersome headaches.
His problem took a turn for the worse about five months ago. His family doctor referred him to an allergist who ordered allergy skin testing and laboratory tests including an IgE immunoassay. He was informed that the test results were negative and told his problem was not due to allergies. He has nonallergic rhinitis.
The allergist referred him back to his family physician. Warren was advised to stop taking aspirin for his headaches and to discontinue the beta-blocker medication that was prescribed five months ago for his hypertension. He was prescribed a different medication for his high blood pressure and told about triggers of NAR. Such triggers might include chemicals at work or in the air, certain medications, some foods and changes in the weather. He was treated with steroid nasal sprays on an as needed basis.
Triggers of Nonallergic Rhinitis
There are many irritants that can trigger symptoms of NAR. Regardless of the trigger, they all can cause nasal congestion and other symptoms as noted above.
Medications
- Aspirin, ibuprofen
- Antihypertensive medications-beta blockers
- Oral contraceptives
- Overuse of nasal sprays
Hormonal Factors
- Hypothyroidism
- Pregnancy
Infectious Rhinitis
- Viral or bacterial infections
- Chronic rhinosinusitis
Occupational or Environmental Irritants
- Exposure to chemical fumes at work
- Second hand smoke
- Perfumes
- Dust, Smog
Weather Changes
- Exposure to cold, dry or humid air can trigger nasal congestion
Food and Beverage Triggers
- Hot or spicy foods
- Alcoholic beverages
People diagnosed with sarcoidosis, a deviated septum, nasal polyps or those under stress can experience NAR. Gustatory rhinitis is a type of nonallergic rhinitis that occurs when you eat certain foods or drink alcoholic beverages.
NAR has many different triggers that can ruin the quality of your life. It can cause discomfort, fatigue, headaches and difficulty breathing. It can make you become more stressful and cause you to miss days at school or work. NAR can interfere with sleep and at times, aggravate asthma.
The key point in evaluating people with rhinitis is to distinguish NAR from allergic rhinitis. The best treatment is to avoid whatever is triggering NAR. Staying hydrated, humidification at home or in the workplace and nasal saline washes has proven to be beneficial in certain cases. Intranasal steroids are the initial medical choice of treatment for NAR, although response to treatment can vary.
References
- Brian Schroer, Lily C. Pien; Nonallergic rhinitis: Common problem, chronic symptoms; Cleveland Clinic Journal of Medicine; April 2012;
- Brody McConnell: Occupational Rhinitis: A Hard Day’s Work for Noses; Pharmacy Times, May, 10, 2016
- Cyrus H Nozad et al; Non-allergic rhinitis: a case report and review; Clin Mol Allergy. 2010
- Settipane RA, Charnock DR; Epidemiology of rhinitis; Clin Allergy Immunol. 2007
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.