Non-Allergic Rhinitis: A Rebel without a Cause? Not Really

James Thompson, MD Health Pro

    Have you ever thought being told “You are not allergic.” would be disappointing news? About forty percent of adults allergy tested to environmental triggers turn out not to have any. Many of them highly suspect they are allergic and are mentally prepared to get confirmation when they come to my office. I almost feel sorry that I’m not able to identify at least a few allergy triggers for them to blame their symptoms on.


    Non-allergic rhinitis is a common problem which may be triggered by many different substances (see below). Unfortunately it is a diagnosis of exclusion. Once we have excluded allergy triggers by skin testing or blood tests, non-allergic rhinitis may be considered.

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    Symptoms of Non-Allergic Rhinitis (NAR)

    Symptoms of NAR are very similar to what one experiences when they have allergic rhinitis. Runny nose and nasal congestion are at the top of the list. Sneezing may also occur but itching of the roof of the mouth or throat, and itchy or watery eyes is very uncommon (in contrast to allergic rhinitis).


    Although symptoms of NAR are never life threatening, the quality of life can be greatly impacted in much the same way reported in people who have allergic nasal problems.


    One can experience:


     -A drop in work / school productivity


     -Poor quality of sleep


     -Fatigue and daytime somnolence (feel sleepy)


     -Feeling of being sick all the time


    - Looking and sounding sick all the time (puffy eye lids / nasal                               voice)


    -Having the same complications of allergic rhinitis (sinus and ear infections, cough from postnasal drip and more difficult to control asthma)



    Non-Allergic Triggers include:

    • Chemical fumes, fragrances (perfumes and colognes), odors                         and gases.
    • Second and third hand tobacco smoke (third hand smoke is from    the ash emitted from the burned cigarette which may infiltrate indoor                     environments).
    • Weather changes (changes in humidity and barometric pressure)
    •  Dry air
    •  Outdoor pollution (car and industry exhaust, ozone and many                         other culprits)
    • Hormonal shifts associated with menstrual cycles or hormone                         supplements or hypothyroidism.
    • Hot or spicy foods and beverages (alcoholic beverages are common           triggers)
    • Medications
    • : Many prescribed and over the counter medications may cause nasal symptoms. Certain drugs for treating hypertension, heart disease, headaches and erectile dysfunction have been reported. Irritation from nasal sprays used to treat allergic and non-allergic rhinitis may cause non-allergic rhinitis. Over the counter nasal decongestants may in addition cause rebound (a sudden plugging up of the nose after a period away from it, leading to increased use) and NAR.         
    • Mental factors such as stress and sexual arousal have been                           associated with NAR.


  • What Can You Do About Non-Allergic Rhinitis?

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    The first step in managing NAR is to identify your trigger factors. Once allergy tests have excluded allergic triggers your allergist can focus on the non-allergic triggers unique to your home, work or school environment. This usually means you will be asked a series of questions in order to understand what you are exposed to during the course of the day. You can assist your doctor by spending some time listing potential triggers in your environment. Use the above list as a guideline for what your exposures may include. Eliminating or reducing the triggers can have the greatest impact on resolving the problem.


    Your doctor will use your historical information along with allergy test results and physical exam to make the diagnosis and initiate treatment.



    Treatment for Non-Allergic Rhinitis

    There is no cure for NAR but often it can be managed to markedly reduce symptoms and prevent flare-ups. Oral antihistamines and steroid based nasal sprays are sometimes effective. Some non-steroidal sprays for example Azelastine (Astelin and Astepro) have indications for non-allergic forms of rhinitis. Your doctor will guide you through the decision points on medications.

    Nasal rinsing with saline can be very helpful in treating NAR.


    Final Words

    Many people who have hay fever also have a component of non-allergic rhinitis. For this reason expertise is often required for managing environmental controls and medications. NAR is not as responsive to allergy medications compared to allergic rhinitis, but often the right formula can be figured out over time by teaming up with your allergy care provider.



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Published On: June 27, 2014