What is chronic rhinitis?

Rhinitis¹ means “inflammation of the nose.” The nose produces a fluid called mucus, which is normally thin and clear. Mucus helps keep foreign contaminants like dust, allergens, and infectious particles out of the sinuses and lungs. It usually drains down the back of the throat (called postnasal drip, when in larger quantities).

When the nose is irritated, however, it may produce a larger amount of thick, pale yellow mucus. The mucus may then flow to the front of the nose, rather than down the back of the throat, causing a runny nose.

There are multiple types of chronic rhinitis².

• Seasonal allergic rhinitis: Also known as hay fever, is caused by airborne allergens (substances that can cause immune responses). This condition causes cold-like symptoms, including a runny nose, sneezing, and itchy eyes.

Hay fever symptoms are caused by an allergic response to allergens such as pollen from trees and grasses. Symptoms present immediately upon exposure to allergens and go away after the cause of the allergic reaction has been removed.

• Perennial allergic rhinitis: Also caused by allergens. These allergens, however, are present all year long. Perennial allergens can be found both indoors and outdoors, and include dust mites, mold, animal dander, and cockroach debris.
• Infectious rhinitis: Also known as the common cold or an upper respiratory infection, is the most common type of rhinitis. This type of infection is caused by a virus—the common cold, for example, is usually caused by infection with a rhinovirus.
• Chronic nonallergic rhinitis³: Unlike allergic rhinitis, chronic rhinitis is not caused by an immune response to allergens. Irritants like smoke, chemicals, pollution, or other particles in the air can trigger nonallergic rhinitis.

Though the cause of this condition is often not very well understood, hormonal changes, nasal defects (like a deviated septum or nasal polyps), or the overuse of nasal sprays have been determined to cause nonallergic rhinitis.

Some patients have also experienced inflammation caused by antidepressants and oral contraceptives (birth control pills). The symptoms of this type of rhinitis are similar to those of allergic rhinitis.

What is nonallergic rhinitis?

As stated above, nonallergic rhinitis⁴, unlike hay fever, does not always have an immediately apparent cause. Nonallergic rhinitis is often diagnosed after it has been determined that an allergy is not causing your symptoms.

The symptoms of this type of rhinitis are similar to those of allergies, including chronic sneezing, congestion or runny nose, and occasionally (though less commonly than in hay fever) itchy or watery eyes.

People who are affected by this condition often have the urge to blow their nose without any mucus coming out; this is because they feel that they are congested with mucus, but in actuality have nasal passages that are so swollen that breathing may be partially or totally blocked.

While nonallergic rhinitis can affect both children and adults, the condition is the most common after age 20⁵. It can be triggered by irritants, or particles in the air that irritate and can cause inflammation in the nose, throat, sinuses, and lungs.

What types of irritants trigger rhinitis varies from person to person, and can include pollution and chemicals in the air. Additionally, certain medications, foods, and chronic health conditions can trigger nonallergic rhinitis.

The symptoms of both allergic and nonallergic rhinitis reactions can be lessened by avoiding triggers such as allergens and irritants, respectively. In order to prevent nonallergic rhinitis symptoms, it is important to avoid identified triggers like harsh chemicals, smoke, and pollution.

Rhinitis symptoms

Allergic rhinitis, or hay fever, is seasonal—symptoms occur when allergens are present⁶. People with different types of allergies are most likely to present symptoms when their particular allergens are highest (for example, when certain trees are pollinating).

Nonallergic rhinitis, however, can occur at all times of the year. Like hay fever, your symptoms present when your rhinitis triggers are present; however, since these triggers are not allergens like pollen, you can come into contact with them at any time.

These symptoms may come and go, depending on the presence or absence of triggers in your indoor and outdoor environments. You may have constant or persistent symptoms, or may only experience symptoms for a short period of time.

Some of the common symptoms of nonallergic rhinitis include:

• Sneezing
• Congestion (a stuffy nose)
• Runny nose
• Postnasal drip (persistent flow of mucus down the throat)

You may also experience an itchy throat, eyes, or nose. However, these symptoms are most commonly present in allergic rhinitis.

Sometimes, your nonallergic rhinitis symptoms may be a cause for concern. You should see your healthcare provider or an allergy specialist if:

• You have severe or unbearable symptoms
• Your symptoms are not relieved or improved by over-the-counter or prescription medications
• You exhibit uncomfortable or worrying side effects from over-the-counter or prescription rhinitis medications

Complications from rhinitis

Chronic nonallergic rhinitis may sometimes lead to infections or other complications. Some, like sinusitis, are common and treatable. Complications like ear infections, however, can be uncomfortable and difficult for children.

Complications caused by nonallergic rhinitis may include:

• Sinusitis (sinus infection): An infection of the soft tissue lining the sinuses (hollow, connected, fluid-filled cavities located in the skull). Sinusitis can be caused by viral, bacterial, or fungal infections. Chronic congestion caused by nonallergic rhinitis may increase your chances of developing acute (short-term) or chronic (long-term) sinusitis.
• Middle ear infections⁷ (otitis media): An infection of the middle ear, the air-filled space found behind the eardrum. Otitis media is more common in children than in adults. Symptoms include ear pain, fluid drainage from the ear, and trouble hearing. Increased fluid and nasal congestion due to rhinitis may lead to middle ear infections.
• Nasal polyps: Soft, benign (noncancerous) growths on the lining of the nose or sinuses as a result of chronic inflammation. Small polyps are usually not a cause for alarm and don’t often cause problems. Larger polyps, however, can sometimes block airflow through the nose, making it difficult to breathe.

Allergic rhinitis or a cold?

Because allergic rhinitis⁸, or hay fever, can present with many of the same symptoms as the common cold, it can be different to tell the two conditions apart.

Unlike allergies, which are caused by an immune response and the release of histamines, colds are caused by viral infections (most frequently, the rhinovirus). Both allergies and viruses are more likely to spread at certain times of the year.

However, allergies occur at the same time each year and last as long as the allergen is present (usually 2–3 weeks per allergen), while a cold lasts as long as it takes for your body to fight off and recover from the infection (usually about 1 week).

It is important that you see a healthcare provider or allergy specialist in order to determine whether your symptoms are caused by nonallergic rhinitis. If you know that you or your child have this condition but suspect the presence of complications as a result of rhinitis, you should see your healthcare provider immediately.

Rhinitis causes

The different types of rhinitis can be caused by various substances, as well as environmental and physical factors.

Nonallergic rhinitis causes

Unfortunately, the exact cause of nonallergic rhinitis is unknown⁹. Several causes have been proposed, however. It is possible that people with nonallergic rhinitis have hyperresponsive nerve endings in their noses (similar to the way the lungs react when someone has asthma).

While the cause of this type of rhinitis has not been identified, what experts do know is how the body reacts to triggering irritants. Nonallergic rhinitis occurs when blood vessels in the nose expand and fill the nasal lining with blood and fluid, causing swelling, congestion, or excessive mucus.

Triggers of nonallergic rhinitis triggers can result in both short- and long-term symptoms. These triggers can include:

• Environmental irritants: Irritating substances like first- or secondhand smoke, dust mites, pollution or smog, or strong odors (like perfume) can trigger rhinitis symptoms. Chemical irritants (such as strong cleaners, or chemicals you may be exposed to in certain professions) can also cause rhinitis.
• Infections: As previously stated, viral infections like the common cold and the flu can frequently cause nonallergic rhinitis.
• Changes in weather: Changes in temperature or humidity in your environment can trigger your nasal membranes to swell, causing congestion or a runny nose.
• Medications: Certain medications may trigger nonallergic rhinitis in some people.

These medications include aspirin, ibuprofen (Advil, Motrin), and hypertension (high blood pressure) medications like beta blockers¹⁰, which include propranolol (Inderal), acebutolol (Sectral), and atenolol (Tenormin).

Nonallergic rhinitis may also be caused by sedatives, antidepressants, oral contraceptives (birth control pills), or erectile dysfunction medications. A particular type of nonallergic rhinitis called rhinitis medicamentosa can also be caused by the overuse of decongestant nasal sprays (like Afrin, which contains oxymetazoline).

It’s important to contact your healthcare provider if you experience rhinitis symptoms after taking any of these medications in order to determine whether you are actually allergic to them.

• Hormone changes: Hormonal changes caused by pregnancy, menstruation, oral contraceptives, or other hormonal conditions (like hypothyroidism) may trigger nonallergic rhinitis.
• Food and beverages: Sometimes, foods and drinks that are hot or spicy can trigger nonallergic rhinitis. Alcoholic drinks can also lead to swelling in the nasal membranes, causing a runny or stuffy nose.
• Sleeping on your back, obstructive sleep apnea, and acid reflux: All three may trigger nonallergic rhinitis.

Hay fever (allergic rhinitis) causes

Unlike nonallergic rhinitis symptoms, allergic rhinitis symptoms begin when the allergens that trigger your allergies are present. Hay fever can be caused by an allergic reaction to a number of different substances, including those found both indoors and outdoors.

If you have seasonal allergies, your symptoms will likely worsen at different types of year, depending on what allergens trigger your symptoms. The following outdoor factors may trigger seasonal allergies:

• Tree pollen: Most common in early spring
• Grass pollen: Most common in late spring and summer
• Ragweed pollen: Common in the fall
• Fungi spores: Considered both seasonal and perennial (year-round), these can also grow indoors.

You may be allergic to substances found indoors and experience symptoms year-round. Indoor allergies often worsen in the winter, when houses are often closed up and have less air circulation. Some indoor allergens include:

• Dust mites
• Cockroaches
• Pet dander
• Mold or fungi spores

Rhinitis risk factors

Some people are at higher risk of developing rhinitis or complications from rhinitis than others.

Risk factors for rhinitis¹¹ include:

• Age: While allergic rhinitis most frequently occurs before age 20, nonallergic is most common in people older than 20 years old.
• Occupational exposure to irritants: Nonallergic rhinitis can be triggered by exposure to irritants in the air, including construction materials, solvents, fumes from decomposing organic material (like compost), and any other harsh chemicals.
• Overuse of decongestants: Using over-the-counter decongestant nasal sprays repeatedly for a prolonged period of time can cause “rebound congestion,” or more severe congestion after a spray’s effects wear off.
• Biological sex: Nasal congestion often worsens during menstruation and pregnancy.
• Preexisting health conditions: Various chronic health conditions, like hypothyroidism and chronic fatigue syndrome, can trigger or worsen rhinitis.
• Stress: Sometimes, emotional or physical stress can trigger nonallergic rhinitis.

If you suspect yourself of having rhinitis, your healthcare provider or an allergy specialist may opt to conduct testing in order to determine what is causing the condition.

Pregnancy rhinitis

Pregnancy rhinitis¹² has only somewhat recently been defined as a distinct condition. It is defined as nasal congestion that occurs in the last six or more weeks of pregnancy without other signs of respiratory infection or an allergic reaction—in other words, nasal problems that occur during pregnancy with no obvious cause.

Pregnancy rhinitis is thought to be caused by the hormonal changes that occur during pregnancy. The condition affects as much as 20% of pregnant women and generally goes away on its own within two weeks of giving birth. While the most common symptom is nasal congestion, some women also report having nasal secretions.

Pregnancy rhinitis treatment

While there are no prescriptions or specific medical treatments that target pregnancy rhinitis in particular, there are a number of ways in which you can relieve the symptoms of this condition.

Along with following any treatment suggested by a healthcare provider or pregnancy specialist, some at-home practices may provide relief from the symptoms of rhinitis during pregnancy.

Elevating your upper body by 30–45 degrees while sleeping can help open your nasal passages. Sterile saline nasal sprays (such as Ayr) can also be used to irrigate the nose and relieve congestion.

Risk factors for pregnancy rhinitis

The most common risk factor for developing pregnancy rhinitis is a history of smoking. Factors like the age of the mother and the gender of the baby are not linked to the likelihood of developing this condition.