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Allergic and Non-Allergic Rhinitis

Allergic and Non-Allergic Rhinitis

Do you suffer from a runny or stuffy nose much of the time? You may not have given it much thought because it typically is not a serious condition. It can, however, be quite annoying. This condition is known as rhinitis. Approximately 40 million people in the U.S. suffer to one degree or another from rhinitis. Although hay fever, or seasonal allergic rhinitis, is the condition that most people are familiar with, there are different types of rhinitis. This fact sheet reviews these conditions and current treatments.

Classifications of Rhinitis

Atopic Rhinitis
There are three types of atopic (associated with allergic-like symptoms) rhinitis.

Seasonal Allergic Rhinitis (also known as hay fever) This is triggered by allergy to pollens, including trees in spring, grasses in summer and weeds in fall. Symptoms include sneezing, itching, tickling in the nose, runny or stuffy nose and watery or itchy eyes. Seasonal rhinitis is diagnosed primarily by your medical history. Skin testing is not always indicated, especially if your symptoms are mild.

Perennial Rhinitis (year-round) with Allergic Triggers These triggers include indoor allergens such as mold, house dust mite, cockroach and animal dander. Symptoms are the same as seasonal allergic rhinitis but are experienced throughout the year. The health care provider makes the diagnosis for perennial rhinitis by your medical history and positive skin tests to relevant allergens.

Perennial Rhinitis with Non-Allergic Triggers This type of rhinitis is not well understood. Although not triggered by allergy, it's an allergic-like condition with increased eosinophils (a special type of white blood cell associated with allergy) in the lining and secretions of the nose. Symptoms are the same as perennial rhinitis with allergic triggers. Diagnosis is determined from negative skin tests and a nasal smear test positive for eosinophils. Nasal polyps can be a complication of this condition.

Idiopathic Non-Allergic Rhinitis
This is also known as vasomotor rhinitis. A person with this type reacts to temperature and humidity changes, smoke, odors and emotional upsets. Symptoms are primarily nasal congestion and postnasal drip.

Diagnosis comes after negative skin tests and nasal smear negative for eosinophils.

Infectious Rhinitis
This can occur as an acute viral respiratory infection (cold) which may clear rapidly or continue with symptoms up to six weeks. Some people develop the complication of an acute or chronic bacterial sinus infection, usually associated with blocked sinus drainage.

Symptoms of infectious rhinitis are an increased amount of colored (yellow-green) and thickened nasal discharge and nasal congestion. The diagnosis of an acute or chronic sinus infection is confirmed by an abnormal sinus X-ray or CT scan.

Other types of rhinitis
Rhinitis Medicamentosa This type is associated with long-term use of decongestant nasal sprays or recreational use of cocaine. Symptoms typically are nasal congestion and postnasal drip. A person who has taken a decongestant nasal spray for months or years is using this treatment inappropriately. These medications are intended for short-term use only. Over-use can cause rebound congestion, which leads to increased nasal obstruction. It is very important for a person with rebound congestion to work closely with a physician to gradually withdraw the nasal spray.

Mechanical Obstruction This is most often associated with a deviated septum or enlarged adenoids. If you have chronic nasal obstruction that is one-sided, a medical evaluation is recommended.

Hormonal This is generally associated with pregnancy or untreated hypothyroidism.



Often a person may have more than one type of rhinitis. In making the diagnosis, an evaluation by your doctor may include:

History specific symptoms and when they occur, family history and work history. Physical exam Nasal smears microscopic exam of nasal secretions, especially eosinophils. Allergy testing skin testing by a board-certified allergist is generally indicated for someone with recurrent symptoms. A positive skin test indicates the presence of IgE antibody, which can react with specific substances to produce an allergic reaction. In most cases, an allergic person will react to more than one substance. Sinus X-ray About 40 percent of persons with perennial rhinitis will have changes on the sinus X-ray. This can indicate the presence of sinusitis (inflammation of the sinuses) with or without infection or nasal polyps.

What are possible complications?

Complications of seasonal allergic rhinitis are rare. The condition may be associated with bronchial asthma, but evidence that rhinitis specifically predisposes you to asthma is not convincing. Two epidemiologic studies in the United States. found that asthma followed allergic rhinitis in 1 to 10 percent of the cases, which suggests that the subsequent development of asthma in rhinitis sufferers may be only slightly more common than in the overall population. In childhood, bronchial asthma may precede the onset of allergic rhinitis. Persons with rhinitis are prone to recurrent respiratory, sinus and ear infections.



How is rhinitis diagnosed?

Dust Mites
If you are allergic to house dust mites and live in a humid area:

Cover your mattress and box spring in zippered, dust proof encasings. Wash your pillows, sheets and blankets weekly in hot water. Mites will survive lukewarm water.

Pet Dander
Dander from pets, particularly cats and dogs, is a major year-round allergen. If you are allergic to your pet, the obvious recommendation is removal of the pet from your home. If you choose to keep it, completely exclude the animal from your bedroom, and keep the doors and heating ducts closed. Keep in mind that the more restricted the area in which the pet is allowed, the less allergic exposure you will have.

Irritants
Many irritants (non-allergenic substances) can also trigger rhinitis symptoms. Reducing exposure to irritants is recommended for persons with allergic or non-allergic rhinitis. Cigarette smoke is a strong respiratory irritant and it is important that no one smoke in your home. You may need to avoid aerosol sprays, perfumes, dusty or polluted environments, strong cleaning products and other sources of strong odors.



What is the treatment including environmental control?

Avoidance of triggers is clearly the most important treatment for allergic rhinitis. Although total avoidance is usually not possible (except for family pets), you can take a few steps to significantly reduce your exposure to allergens.

Pollens
Keep your doors and windows closed during your allergy season. The use of central air conditioning dramatically reduces the level of indoor pollen and can also lessen indoor humidity. Lower humidity reduces both mold and dust mite allergen concentrations. Pollen and mold counts can vary throughout the day.

Peak times are:
     grass: afternoon and early evening

ragweed: early midday

mold spores: some types peak during warm, dry, windy afternoons; other types occur at high levels during periods of dampness and rain and peak in the early morning hours

 

It may help to limit your outdoor activities during the times of highest pollen and mold counts.

Molds
Mold can grow in damp areas of your home, such as the kitchen, bathroom or basement. If you are allergic to mold, take measures to lessen mold growth.

These include: Ventilate these areas well. Clean damp areas frequently, using a weak, chlorine bleach solution as needed. Use a humidifier with caution because frequent use increases growth of mold and dust mites within your home. Clean your humidifier routinely as it can become a source for mold and bacteria growth. Consider a dehumidifier if your basement is damp, or if you live in a very humid climate.

 

What medications are used to treat rhinitis?

The goal of medical treatment is to reduce symptoms and use medications with few or no side effects.

Inhaled steroids
are often used to decrease symptoms by decreasing swelling in the nose. Commonly available preparations include:

Beconase AQ®, Vancenase DS AQ®, (beclomethasone) Nasacort® (triamcinolone) Nasarel® (flunisolide) Flonase® (fluticasone) Rhinocort® (budesonide) Nasonex® (mometasone)

Nasalcrom®
(cromolyn sodium) This nonprescription nasal spray reduces milder symptoms of nasal discharge and sneezing. This is also a preventive medication and does not relieve symptoms immediately.

Astelin®
(azelastine) This prescription medication may benefit those with allergic and non-allergic (vasomotor) rhinitis.

Atrovent®
(ipatroprium bromide) This prescription medication occasionally benefits those with non-allergic rhinitis.

Nasal Wash
A salt water nasal wash is helpful in removing mucus from the nose. The salt water nasal wash is often done before using nasal medications. It temporarily reduces symptoms of nasal congestion and postnasal drainage.

Oral Corticosteroids
These prescription tablet/syrup preparations are very effective in treating and preventing symptoms of rhinitis. However, the side effects of oral steroids, especially with long-term use, limit their use. Your doctor may prescribe a short course (three to seven days) for more severe symptoms. It is important to note that the corticosteroids used in respiratory treatment are not the same as the anabolic steroids used by athletes.



What is Immunotherapy?

Immunotherapy ("allergy shots") consists of a series of injections containing the allergens believed to be triggering allergy symptoms. The objective is to reduce your sensitivity to these allergens so that you experience fewer symptoms. Treatment usually begins with injections of a weak solution given once or twice a week, with the strength gradually increasing. When the strongest dosage is reached, the injection is then usually given once a month.

Immunotherapy has proven effective against the following allergens: grass pollen, ragweed pollen, birch pollen, mountain cedar pollen, house dust mite, cat and dog dander and Alternaria mold spores.

Skin testing, or RAST testing, can identify your specific allergens. Immunotherapy is specific against only the allergens used in the treatment. For example, if someone with allergy to both ragweed pollen and grass pollen is treated for ragweed only, this person will continue to experience rhinitis triggered by grass pollen.

Physicians generally recommend immunotherapy for allergic rhinitis in someone with clear-cut allergy to very specific allergens who responds poorly to treatment or whose symptoms persist over several seasons or throughout the year. Doctors at National Jewish recommend that allergy testing and immunotherapy be done by a board-certified allergist.


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