Rhinitis

Do you suffer from frequent sneezing, congestion and an itchy or runny nose? If so, you may have rhinitis. Rhinitis is one of the most common chronic conditions, affecting 10% to 30% of adults and up to 40% of children in the United States. If this includes you, you don't have to suffer.

By learning more about rhinitis, you will have a better understanding of your symptoms. An allergist/immunologist, often referred to as an allergist, can make an accurate diagnosis and develop a treatment plan that works for you.

Allergic Rhinitis

There are two types of rhinitis: allergic rhinitis and non-allergic rhinitis. Let's talk first about allergic rhinitis.

Allergic rhinitis is caused by allergens in the air, which are usually harmless but can cause problems in certain people.

Allergy symptoms are the result of a chain reaction that starts in the immune system. Your immune system controls how your body defends itself. For instance, if you have an allergy to pollen, your immune system identifies pollen as an invader or allergen. Your immune system overreacts by producing antibodies called Immunoglobulin E (IgE). These antibodies travel to cells that release chemicals, causing an allergic reaction with symptoms such as sneezing, stuffiness, a runny nose, itching and post-nasal drip.

People with rhinitis are prone to itchy, watery eyes (from allergic conjunctivitis), and they may be more sensitive to irritants such as smoke, perfume or cold, dry air. Rhinitis can contribute to other problems such as asthma, sinus or ear conditions or trouble sleeping.

Causes

When allergic rhinitis is caused by outdoor allergens such as tree, grass and weed pollen, it is called seasonal allergic rhinitis, or "hay fever." Rhinitis can also occur year-round because of indoor allergens from pets, mold, dust mites and cockroach droppings. This is called perennial allergic rhinitis. You can have either seasonal or perennial allergic rhinitis, or a combination of both.

Diagnosis and Treatment of Allergic Rhinitis An allergist can help determine which allergens, if any, are causing your symptoms. He or she will take a detailed health history, perform a physical exam and then test you for allergies. Skin tests show the results within 20 minutes. These results, as well as how frequent and bad your symptoms are, will be considered when developing a treatment plan. Steps to manage your symptoms may include avoiding the allergens you are allergic to, medications and/or allergy shots (immunotherapy).

Avoiding allergens. The American Academy of Allergy, Asthma & Immunology brochures on Indoor Allergens and Outdoor Allergens give helpful advice to help you reduce exposure to the allergens to which you are sensitive.

Medications. Some medications for allergic rhinitis are best used daily to control inflammation and prevent symptoms, while others are used only as needed to relieve symptoms. Nasal corticosteroid sprays can control inflammation and reduce all symptoms of allergic rhinitis, including itching, sneezing, runny nose and stuffiness. Antihistamines in the form of pills or nasal sprays block histamine and may relieve itching, sneezing and runny nose. But they may not be as effective in reducing nasal stuffiness. Anti-leukotrienes in the form of pills can reduce all the symptoms of allergic rhinitis. Decongestant pills or nasal sprays can be used as needed if nasal stuffiness is not relieved with other medications. Decongestant sprays should not be used for long periods of time because they can cause your congestion to return. Ipratropium nasal spray can be used specifically for a runny nose.

Allergy shots, also known as immunotherapy, may be considered if your symptoms are constant, if you don't want to take medications or feel that they are not enough, or if you want long-term control of your allergies with less need for medications. This treatment involves receiving injections periodically-as determined by your allergist-over a period of three to five years. The end result is decreased sensitivity to allergens.

Non-Allergic Rhinitis

Some people with rhinitis symptoms do not have allergies. Non-allergic rhinitis usually begins in adults and causes year-round symptoms, especially a runny nose and nasal stuffiness.

Strong odors, pollution, smoke and other irritants may cause symptoms of non-allergic rhinitis. Non-allergic rhinitis symptoms can also develop as side effects of medications, including some blood pressure medicines, oral contraceptives or medications used for erectile dysfunction. The most common form of this type of non-allergic rhinitis is caused by nasal decongestant sprays such as oxymetazoline, when used for long periods of time. This type of medication-induced rhinitis is also called rhinitis medicamentosa.

Treatment of Non-Allergic Rhinitis

If there is inflammation in the nose, the treatment of choice is nasal corticosteroid sprays. Ipratropium nasal spray can relieve a runny nose. Decongestant pills can be used as needed to relieve nasal stuffiness.

Other forms of treatment may be considered if you have problems with the structure of your nose, such as narrow drainage passages, tumors or a shifted nasal septum (the bone and cartilage that separate the right from the left nostril). In these cases, an operation may be needed.

Healthy Tips

• There are two forms of rhinitis: allergic and non-allergic. In order to control symptoms, it is important to have the right diagnosis.
• Allergic rhinitis can be caused by outdoor allergens such as pollen (seasonal allergic rhinitis) or indoor allergens such as dust mites or pets (perennial allergic rhinitis).
• Some people with symptoms of rhinitis don't have allergies. This is called non-allergic rhinitis and can develop as a side effect of certain medications.
• Seeing an allergist can help you understand your condition, manage your symptoms and make you feel better.
• An allergist will recommend a treatment that is right for you, whether it be avoiding the allergen that causes your symptoms, certain medications or allergy shots.