Non-Allergic Rhinitis

What are the different types of rhinitis?

Rhinitis is the term for inflamed nasal membranes. A fair number of people think that allergies are the only cause of rhinitis.  There are various conditions that can cause symptoms similar to allergic rhinitis.  Most non-allergic causes of rhinitis cause runny nose, nasal congestion and sneezing.  One symptom unique to allergic rhinitis would be itching which is absent in other forms of rhinitis.  Listed below are other causes of rhinitis

1)      Nonallergic rhinitis without eosinophilia.  Also called vasomotor rhinitis or idiopathic rhinitis. Patients who have this form of rhinitis have symptoms of runny nose, post-nasal drainage or nasal congestion all year round unrelated to any allergen exposure.  Symptoms are often worsened by changes in the environment (such as weather, temperature, humidity, barometric pressure), exposure to airborne irritants (odors, fumes, perfumes), dietary factors (spicy foods, alcohol) emotional factors and sexual arousal.   Known triggers of non-allergic rhinitis include the following:

  1. Changes in environment
    • Change in temperature
    • Change in humidity
    • Change in barometric pressure
    • Change in weather
  2. Exposure to airborne irritants
    • Odors
    • Fumes
    • Perfumes
    • Cleaning agents
  3. Dietary Factors
    • Spicy Foods
    • Alcohol
    • Hot foods
  4. Emotional factors
  5. Sexual arousal

2)      Nonallergic rhinitis with eosinophilia.  Also called NARES or eosinophilic nonallergic rhinitis.  Patients with this form of rhinitis have symptoms that resemble allergic rhinitis. They have all year round symptoms with congestion, itching, and sneezing, runny nose and occasionally with itchy and watery eyes.  These patients appear to have all the symptoms of allergies but allergy skin tests or allergy blood tests are all negative.  Patients with NARES often can have asthma or nasal polyps.

3) Infectious Rhinitis

  • Viral Rhinitis.  This is your “common cold.” It usually starts with profuse runny nose, followed by nasal stuffiness and some sneezing, which clear rapidly but may linger for about a week.   Can occur as a cold, which may clear rapidly or continue with symptoms longer than a week. Some people may also develop an acute or chronic bacterial sinus infection. Symptoms include an increased amount of colored (yellow-green) and thickened nasal discharge and nasal congestion.
  • Bacterial rhinosinusitis can occur as a secondary infection from the common cold.  Suspect this when you “cold” symptoms last more than 7 days, and the clear water discharge changes to thick, yellow-green discharge with nasal and sinus congestion.  Other symptoms include fever, cough, sinus headache and increased post-nasal drip.

4)      Hormonal rhinitis.  The predominant symptom seen in hormonal rhinitis is perennial nasal congestion.  Hormonal conditions that can cause this include thyroid (hyperthyroid or hypothyroid), pregnancy or birth control tablets.

5)      Drug-induced rhinitis.  Patients with this condition usually have chronic nasal congestion, and usually starts in relation to the introduction of a medication, orally or topically.  Drugs known to cause nasal congestion include blood pressure medications (beta-blockers, methyldopa), and non-steroidal anti-inflammatory drugs.

6)      Rhinitis Medicamentosa is a form of drug-induced rhinitis.  This occurs when topical decongestant nasal sprays are used more than the recommended 3 days. This results in “rebound nasal congestion” or in layman’s term when the nose gets “addicted to the nasal spray.”  Oxymetazoline and phenylephrine are over the counter nasal decongestant sprays known to cause rhinitis medicamentosa.

7)    Gustatory rhinitis is a form of non-allergic rhinitis wherein the person experiences profuse runny nose anytime he/she eats.  There is no nasal congestion, sneezing or itching, and the person feels completely fine.  This is believed to be caused by an aberrant reflex wherein the reflex to stimulate saliva production inadvertently sends a message to make the nose run, too.