Rhinitis is a very common condition in all ages. This article describes its symptoms, causes, treatment, and answer to common questions.
Rhinitis is an inflammation of the nasal membrane, that is, the tissue that lines your nose and your nasal sinuses. Inflammation of the nasal membrane causes symptoms such as sneezing and a runny nose. Allergic rhinitis or hay fever is the most common form of rhinitis. The term nonallergic rhinitis encompasses all other kinds of rhinitis, including vasomotor rhinitis, hormonal rhinitis, rhinitis medicamentosa, infectious rhinitis, and nonallergic rhinitis with eosinophilia syndrome.
Hay fever is not a life-threatening condition. However, it often coexists with other disorders such as nasal polyps, sinusitis, asthma, atopic dermatitis, allergic conjunctivitis, and otitis media. It can also cause asthma exacerbations. Around the world, the prevalence of rhinitis has increased. Approximately 30% of adults and 40% of children suffer from rhinitis. I am a medical doctor, and in this article, I will tell you everything you need to know about it.
What is this condition?
The definition of rhinitis is swelling in the lining of the nasal passages (mucous membrane) for whatever reason. The reason gives its last name to the condition or in other words, defines its type. However, all of them, that end in swelling of the inner portions of the nose, will produce similar symptoms.
What are the types of rhinitis?
The types can be either allergic or nonallergic. Allergic rhinitis can be further divided into two subcategories:
- Seasonal Allergic Rhinitis: This form of nasal allergy happens only at a specific time of the year. Outdoor allergens like pollen and ragweed are the most common triggers of this form of allergy.
- Perennial Allergic Rhinitis: This form of rhinitis has allergy symptoms all year round. It may feel like a permanent cold that doesn’t go away. It is usually a reaction to indoor allergens like dust mites, pet dander, and mold.
There are many different kinds of non-allergic rhinitis, here is a list explaining the most common types:
- Infectious rhinitis: This form of rhinitis is the product of some viral infection like a cold or the flu. When a virus attacks, the area the lining of the nose and sinuses become inflamed like in an allergy. Inflammation increases mucus production, which leads to nasal congestion and a runny nose.
- Vasomotor Rhinitis: In patients with vasomotor rhinitis, the nerves that innervate the nose’s blood vessels are too sensitive and produce dilation with specific environmental triggers. Vasodilation leads to excessive blood flow, congestion, and mucus production. Common environmental triggers include smoke, strong perfumes, spicy foods, and a drop in temperature.
- Atrophic rhinitis: In this form of nonallergic rhinitis, the tissue that covers the nasal turbines becomes thinner and harder. The nasal passages become wider and drier. This causes bad-smelling crusts to form inside the nose, a loss of the sense of smell. It also becomes easier for bacteria to grow in this environment. Atrophic rhinitis can occur as a consequence of aging, infection, or nose surgery.
Is rhinitis the same as sinusitis?
Rhinitis is the inflammation of the nasal mucosa, while sinusitis is the inflammation of the linings of the paranasal sinuses. Paranasal sinuses are small air pockets located behind the forehead, nose, and cheekbones. Because the nasal mucosa and the paranasal sinuses are connected, both conditions tend to come together. Rhinitis increases mucus production. Excessive mucus blocks the opening of the paranasal sinuses. Retained mucus, when infected, causes sinusitis. Sinusitis rarely occurs without it. Therefore, rhinosinusitis is now the preferred term for this condition.
Rhinosinusitis has many rhinitis symptoms, such as a runny nose, stuffy nose, nasal congestion, and sneezing. But sinusitis also has some symptoms of its own like pain over the cheek and forehead, postnasal drip, tenderness to pressure in the forehead and cheekbones, persistent coughing, and sore throat.
Acute sinusitis is brought on by viral infections. Acute sinusitis symptoms last for one to two weeks. Chronic sinusitis lasts for more than 3 months and is usually caused by a bacterial infection. Persistent allergies and nasal structural problems are often present in patients with chronic sinusitis.
Characteristics of acute bacterial sinusitis include:
- Persistence of symptoms for more than 10 days
- Worsening of symptoms after ten 10 days after an initial improvement
- Purulent nasal discharge
- Swelling around the eyelids
- Facial rash
Can it turn into sinusitis?
Of course, sinus obstruction due to the mucus caused by rhinitis is the leading cause of sinusitis. Sinus infections without a previous history of rhinitis or hay fever are extremely rare. Besides allergic rhinitis, there are other important risk factors involved in the development of bacterial sinusitis:
- Structural nose abnormalities like a deviated nasal septum, nasal polyp or nasal bone spur
- Tobacco smoking
- Weak immune system
- History of allergies
- Cystic fibrosis
- Airplane travel
Can rhinitis last for years?
Chronic rhinitis persists for over four weeks, and it can last a few months and even a few years. It is different from the acute type, which only lasts for a few weeks (usually one or two). Most cases of chronic rhinitis come in the form of allergic rhinitis. Hay fever is triggered by allergens such as pollen, dust, or pet dander. Many allergic rhinitis patients also suffer from another allergic disease, such as asthma. Nonallergic rhinitis represents approximately one-fourth of cases of chronic rhinitis.
What drugs can cause rhinitis?
Many different factors can trigger nonallergic rhinitis. Among them, we find certain drugs. These drugs include aspirin, ibuprofen, antihypertensive medications, beta-blockers, sedatives, antidepressants, and oral contraceptives. The overuse of an over the counter nasal spray causes a form of a drug-induced condition known as rhinitis medicamentosa.
When possible, the offending drug should be discontinued or avoided. In cases where the drug cannot be stopped, like in severe hypertension or depression, experts recommend using an intranasal corticosteroid spray to alleviate symptoms. Adding an intranasal antihistamine on top of the intranasal corticosteroid might be necessary in some cases.
Other causes of nonallergic rhinitis include the following:
- Weather changes: Humid weathers, in particular, trigger the membranes inside the nose, producing inflammation.
- Food and Beverages: Especially hot or spicy foods like Indian food. Alcoholic beverages can also trigger it in some people.
- Environmental and occupational irritants: Smoke, dust, tobacco smoke, chemical fumes, and strong odors.
- Hormonal changes: The hormonal changes that come with pregnancy, menstruation, and oral contraceptive use may cause nonallergic rhinitis.
- Vasomotor rhinitis: Is caused by the dilation or expansion of the blood vessels inside the nose. Dilation of vessels causes congestion, inflammation, and nasal obstruction.
- Idiopathic rhinitis: Is the preferred term for causes of nonallergic rhinitis in which no specific cause is found.
Complications of nonallergic rhinitis include the following:
- Sinus Infection
- Middle ear infection
- Nasal polyps
But, without a doubt, the most important complication is the disruption of daily life. Rhinitis can be disruptive and decrease your productivity and impair your capacity to live a healthy life.
What does rhinitis look like?
Common rhinitis symptoms include:
- Constant sneezing
- Runny nose
- Red Eyes
- Postnasal drip
- Nasal congestion
- Decreased sense of smell
- Dark circles around the eyes
- Abnormal grow (hypertrophied) of nasal turbinates that may cause some difficulty breathing
- Sleep apnea
Besides asking you about your nasal symptoms, your doctor might inquire about things like your family history, if you have other allergic diseases such as asthma, age of onset, severity, frequency of symptoms, and previous treatment regimes.
What foods can cause rhinitis?
Rhinitis flare-ups after eating, tend to involve spicy food, but this isn’t the only cause. Persons with full allergies develop rhinitis after eating the food they are allergic to. So in allergic rhinitis, the food that triggers the episode varies in each individual. Some people are allergic to oranges, others to nuts and others to bananas. The key for these patients is determining which food they are allergic to and avoid it.
Food allergies don’t typically cause a runny nose. They tend to cause nasal congestion, itchy sensation in the mouth, and itchy skin. Allergy symptoms usually appear within the first two hours of eating the food. Other symptoms may include:
- Throat tightening
Cases of severe allergy require immediate medical attention and are considered life-threatening medical emergencies.
Some people develop rhinitis with food without having any food allergy. It is a form of rhinitis called gustatory rhinitis, is a form of nonallergic rhinitis. Gustatory rhinitis causes a runny nose after eating spicy or hot foods. It does not have any of the features of allergic rhinitis. This happens because, in some people, spicy food stimulates the trigeminal nerve, which stimulates the blood vessels in the nose to dilate. Gustatory rhinitis is more frequent in older adults and tends to have an excessive watery discharge. People with this condition have two options:
- Avoid eating spicy food
- Using a decongestant nasal spray before eating, topical intranasal atropine is excellent in gustatory rhinitis.
How is allergic rhinitis diagnosed?
Most of the time, the diagnosis of hay fever is a clinical one. The diagnosis is mostly based on the patient’s symptoms. History of another allergic disease like atopic eczema or asthma supports the diagnosis and a family history of hay fever or asthma. Also, your doctor may inquire about your environmental exposures, occupational exposure, and effects on your quality of life. The idea is to identify your triggers. For example, in seasonal allergic rhinitis symptoms have a certain periodicity.
Testing for reactivity to specific allergens helps confirm the diagnosis of allergic rhinitis and to identify specific allergic triggers. Commonly used methods to identify allergens include allergy skin tests and in vitro diagnostic tests.
Skin testing can be done in a doctor’s office. The test takes 20 to 40 minutes. A scratch test can check for immediate allergic reactions to 50 different substances at once. The nurse will clean the test site with alcohol, mark each test site, and apply a drop of the allergen in each mark. The test uses lancets to prick the extracts into the skin surface. After 15 minutes, the nurse will search for any sign of an allergic reaction.
Another useful test consists of measuring your blood’s IgE levels. IgE is the antibody that mediates allergic reactions. Patients with hay fever are more likely to have elevated IgE levels than the general population. However, up to 50% of allergic rhinitis patients have normal IgE levels, and up to 20% of normal have elevated IgE levels.
Imaging studies are useful in identifying structural abnormalities like nasal turbine hypertrophy.
How is the nonallergic condition diagnosed?
Testing for nonallergic rhinitis is very similar to testing for allergic rhinitis. The difference is that in the former, all tests will be negative. In nonallergic rhinitis, symptoms are not the consequence of an allergic reaction. Sometimes rhinitis has both an allergic and non-allergic component.
If your physician suspects the problem is due to a structural abnormality like a deviated septum, he may indicate imaging tests like:
- Nasal Endoscopy: This test consists of looking into your nasal tissue with the help of a fiber-optic instrument called an endoscope. The doctor passes the instrument through your nostril all the way to the nasal passage. The procedure is performed under local anesthesia.
- CT scan: A CT scan can produce detailed images of your sinuses.
How can you prevent allergic reactions?
Atopic diseases like rhinitis or asthma cannot be prevented because they are genetic in nature. People who suffer from atopic eczema during early childhood are likely to develop other atopic conditions like asthma, food allergies, and hay fever later in life. Prevention strategies for the atopic disease have been unsuccessful in the past. These strategies consisted of things like applying body emollients once a day during the first six months of life, dust avoidance, and dust covers for mattresses. Unfortunately, none of these strategies proved to decrease the risk of developing atopy in susceptible individuals.
Although you cannot avoid having it, you can prevent flare-ups by avoiding allergens. Prevention tips include de following:
- Washing your hands with soap and water often
- Avoid rubbing or touching your nose
- Use dust mite-proof covers for your pillows and mattresses
- Keep windows closed during high pollen seasons
- Washing your hands after petting animals
- Wearing sunglasses outside during high mold and pollen seasons
- Showering before bed to wash out allergens from your hair and skin
- Keep humidity levels in the house between 40% and 45%
- Avoid having rugs carpets, or any other items that collect dust
- Do not smoke nor be around smokers
- Wash bedding in hot water at least once every two weeks
Who is likely to have nonallergic rhinitis?
Everyone can have nonallergic it. However, some risk factors increase the risk of suffering from this condition. Some of these risk factors include:
- Being older than 20: While allergic rhinitis tends to start during adolescence, nonallergic rhinitis tends to start off well into adulthood.
- Exposure to irritants: Continuous exposure to irritants such as tobacco smoke, chemical fumes, and strong odors increases the risk of developing nonallergic rhinitis.
- Female sex: Due to hormonal changes during pregnancy, menstruation, and the use of oral contraceptives.
- Prolonged use of decongestant nasal drops or sprays: Prolonged use of topical nasal decongestants can lead to rebound congestion. Rebound congestion is usually more severe than the initial congestion.
- Certain health conditions: Conditions such as lupus, cystic fibrosis, and asthma increase the risk of suffering from nonallergic rhinitis.
- Stress: Emotional and physical stress have proven to be important triggers of nonallergic rhinitis in some patients.
- The use of certain drugs: ACE inhibitors and NSAIDs
What are the treatments for allergic rhinitis?
Hay fever treatment has three significant categories of treatment: environmental control and allergen avoidance, pharmacological therapy, and immunotherapy.
The most important step in controlling allergic rhinitis is determining what your triggers are to avoid them. Global environmental control without identifying specific triggers can be counterproductive.
Patients with moderate acute symptoms benefit from oral antihistamines, oral decongestants, or both. Second-generation antihistamines like cetirizine, fexofenadine, loratadine, and desloratadine, are preferred over first-generation drugs. Decongestant drugs like pseudoephedrine stimulate vasoconstriction of the vessels inside the nose, decreasing congestion. Anxiety and insomnia are common side effects of pseudoephedrine.
Furthermore, patients with more severe allergy symptoms or those with chronic allergic rhinitis might require more aggressive treatment with a nasal glucocorticoid or an oral leukotriene receptor antagonist like montelukast. Nasal steroid sprays have proven to control allergic rhinitis’s four primary symptoms: sneezing, itching, runny nose, and nasal congestion. Adverse effects of nasal corticosteroids include nose bleeding and nasal irritation. Side effects can be easily resolved with temporary discontinuation.
What is immunotherapy for allergic rhinitis?
Immunotherapy for allergic rhinitis consists of allergy shots. Success rates of immunotherapy reach 90% for some allergens. However, this is a long process, and results occur 6 to 12 months after starting treatment. Allergy shots are for patients with severe disease and poor response to treatment. Immunotherapy should be combined with pharmacologic therapy and environmental control. Immunotherapy is not without risk, and sometimes severe allergic reactions occur.
Moreover, treatment begins with a buildup phase in which the patient receives injections with increasing doses of allergen two or three times a week. In most cases, the target dose is reached 3 to 6 months after beginning treatment. After the patient reaches the target dose, the maintenance phase begins with shots every 2 to 4 weeks. The maintenance phase lasts for 3 to five years.
Some people have lasting remission of symptoms after immunotherapy and others relapse after finishing the maintenance phase. There is no way to predict who will experience complete remission and who will relapse.
Are you having symptoms of it?
This tool is a rhinitis symptoms checker. It would help a given person to identify the symptoms, signs, and risk factors of this common condition. Therefore, it is essential for the prevention of complications and for seeking treatment. Besides, it is free and will only take a few minutes.