Rhinitis

Allergic rhinitis, also known as hay fever, occurs when your body’s immune system over-responds to specific, non-infectious particles such as plant pollens, molds, dust mites, animal proteins, chemicals, foods, medicines, insect venom, and other triggers. During an allergic attack, a special antibody (fighting protein), called IgE, attaches to cells that release histamine and other chemicals in the lungs, skin, and the mucous linings of the body. These chemicals open the blood vessels and produce skin redness and swollen membranes. When this happens in the nose, sneezing, itching, runny nose, and congestion occur.

Seasonal allergic rhinitis depends on specific plants that are pollenating at that time. In the United States, springtime allergic rhinitis is typically due to pollinating trees. Early summer allergic rhinitis is often due to grass pollination, and allergic rhinitis in the fall is usually due to weeds pollinating. Hypersensitivity to ragweed is very common in autumn. Also in the fall, you may experience allergic symptoms from mold spores on falling leaves.

Perennial allergic rhinitis can be felt year-round and can result from sensitivity to animal proteins, mold, houseplants, and dust mites in carpeting and upholstery. When seeking a medical evaluation for suspected allergic rhinitis, it is important to be aware of the pattern of symptoms (seasonal triggers, indoor vs. outdoor, specific triggers, animal exposure, etc.).

Non-allergic rhinitis and vasomotor rhinitis (a type of non-allergic rhinitis) do not depend on the presence of IgE antibodies, and is not due to an allergic reaction. You can have non-allergic rhinitis even if you test positive for allergies. Some of the causes of non-allergic rhinitis include:

• Certain infections
• Certain medications (various over-the-counter and prescription preparations)
• Eating and drinking (sometimes specific foods, sometimes all food/drink consumption)
• Weather or temperature changes
• Aging
• Hormonal changes or pregnancy
• Consumption of alcohol, especially red wine
• Inflammation or irritation in the nose unrelated to allergy
• Nasal symptoms of other medical conditions

Are There Related Factors and Conditions?

Depending on the type of rhinitis, certain conditions may be associated, such as:

• Asthma
• Acute sinusitis
• Inflammation of the eye (conjunctivitis)
• Atopic dermatitis or eczema
• Poor ventilation of the ears (or eustachian tube dysfunction)
• Laryngitis (inflammation causing hoarseness of voice)
• Eosinophilic esophagitis
• Sleep disturbance

Treating rhinitis depends on the specific cause or diagnosis. If there is a specific trigger that can be avoided, this may be a successful treatment. For example, in people with cat allergy, avoidance of cat exposure and direct contact with cats may help to control symptoms.

Often, medications are used to control symptoms. Depending on the specific cause of the rhinitis symptoms, some of the medications that may be used include:

• Intranasal saline spray or rinse
• Antihistamines (oral or intranasal)
• Corticosteroids (usually applied as an intranasal spray)
• Ipratropium bromide intranasal spray

For allergic rhinitis, allergen immunotherapy may be an option. This is most commonly provided via allergy shots or tablets or liquid drops taken under the tongue. Again, a qualified ENT specialist or allergist should assess your situation to determine whether allergen immunotherapy is an option.

For severe runny nose or nasal obstruction/congestion that does not respond to medications, your ENT specialist may consider additional office procedures or surgery appropriate to your situation.

1. What is the most likely cause of my rhinitis symptoms?
2. Is allergy testing a consideration in my case?
3. Will avoiding certain triggers help to improve my symptoms?
4. Which medications are best suited to treat my condition?
5. Are any additional evaluations necessary? Lab tests? Consultations with other specialists?