Rhinitis is a very common condition and has many different causes. Basically, rhinitis may be defined as inflammation of the inner lining of the nose. More specifically speaking, it may be defined by the presence of one or more of the following symptoms:
- Rhinorrhea (runny nose)
- Nasal itching
- Nasal congestion
A significant association exists between rhinitis (allergic), asthma, and chronic sinusitis (inflammation of the sinuses for >12 weeks) in some individuals. Some evidence suggests that 1 to 3 of every 5 patients has multiple conditions.
Post-nasal drip is mucus accumulation in the back of the nose and throat leading to, or giving the sensation of, mucus dripping downward from the back of the nose.
One of the most common characteristics of chronic rhinitis is post-nasal drip. Post-nasal drip may lead to chronic sore throat, chronic cough, or throat clearing.
Post-nasal drip can be caused by excessive or thick secretions, or impairment in the normal clearance of mucus from the nose and throat.
What causes rhinitis?
Rhinitis has many possible causes. Rhinitis can be either acute orchronic, and is categorized into three areas: allergic rhinitis, non-allergic rhinitis, and mixed rhinitis, which is a combination of the previous two.
Allergic rhinitis is the most common cause of rhinitis. It is caused by environmental allergies and is characterized by an itchy/runny nose, sneezing, and nasal congestion. Other allergic symptoms include:
- itchy ears and throat,
- Eustachian tube problems (the tube connecting the inner ear to the back of the throat),
- red/watery eyes,
- fatigue/loss of concentration/lack of energy from loss of sleep, and
- headaches or facial tenderness (not typical).
People with allergic rhinitis also have a higher incidence of asthma and eczema, which are also mainly allergic in origin.
Seasonal allergic rhinitis (hay fever) is usually caused by pollen in the air, and sensitive patients have symptoms during peak times during the year.
Perennial allergic rhinitis, a type of chronic rhinitis is a year-round problem, and is often caused by indoor allergens (particles that cause allergies), such as dust and animal dander in addition to pollens that may exist at the time.
Symptoms tend to occur regardless of the time of the year.
Is rhinitis always related to allergies?
No, rhinitis may have many causes other than allergies. Some of these other types of rhinitis are listed below.
Non-allergic rhinitis occurs in those patients in whom an allergic or other causes of rhinitis cannot be identified. Forms of non-allergic rhinitis include:
- idiopathic rhinitis
- vasomotor rhinitis,
- gustatory rhinitis,
- rhinitis of pregnancy,
- atrophic rhinitis, and
- non-allergic rhinitis with nasal eosinophilia syndrome (NARES).
These conditions may not have the other allergic manifestations such as, itchy and runny eyes and are also more persistent and less seasonal.
Idiopathic rhinitis often does not have a specific cause identified, but commonly includes upper respiratory infections.
Vasomotor rhinitis is thought to occur because of abnormal regulation of nasal blood flow and may be induced by temperature fluctuations in the environment such as, cold or dry air, or irritants such as:
- air pollution,
- tobacco smoke,
- car exhaust, or
- strong odors such as, detergents or fragrances.
- Gustatory rhinitis may present predominantly as runny nose (rhinorrhea) related to consumption of hot or spicy food.
- Rhinitis of pregnancy or, generally speaking, hormonal alterations as seen with pregnancy, menopause, and some thyroid changes have been linked to rhinitis.
- Atrophic rhinitis following extensive sinus surgery or from a rare nasal bacterial infection.
- Non-allergic rhinitis with nasal eosinophilia syndrome (NARES) is characterized by a clear nasal discharge.
- The nasal discharge is found to have eosinophils (allergic cell type), although the patient may not have any other evidence of allergy by skin testing or history or symptoms.
- Occupational rhinitis may arise from exposure to irritants at a person’s workplace with improvement of symptoms after the person leaves the workplace.
Other causes of rhinitis may be related to:
- certain medications (oral contraceptives, some blood pressure medications, some anxiety medications, some
- erectile dysfunction medications, and some anti-inflammatory medications), or
- some nasal structural abnormalities (deviated septum, perforated septum, tumors, nasal polyps, or foreign bodies).
Infections, mostly viral, are a common cause of rhinitis. Viral rhinitisis usually not chronic and may resolve by itself.
Sometimes rhinitis may be related to other generalized medical conditions such as:
- acid reflux disease (GERD),
- Wegener’s granulomatosis,
- cystic fibrosis, and
- other less common conditions.
Who gets persistent rhinitis?
Persistent rhinitis is common. It can affect anyone of any age although it affects adults more commonly than children. It is becoming increasingly common in older people.
Many people with persistent rhinitis say they have a persistent cold. However, colds are due to viral infections and normally only last a week or so. Persistent rhinitis is not due to an infection.
Allergic rhinitis (be it hay fever or persistent rhinitis) tends to run in families. You are also more likely to develop allergic rhinitis if you already have asthma or eczema.
Equally, if you have allergic rhinitis, you are more likely to develop eczema or asthma. The conditions asthma, eczema and allergic rhinitis are known together as atopic conditions or atopy. A tendency to atopy can run in families.
Are any tests needed?
Usually not. Most cases are due to allergy and the symptoms are usually typical. Your doctor can usually diagnose allergic persistent rhinitis by talking to you about your symptoms and your medical history. They may also examine your nose.
If allergic persistent rhinitis is suspected, your doctor or nurse will usually suggest treatment for your symptoms (see below).
If the symptoms respond to treatment, this can help to confirm the diagnosis. Sometimes if the cause of persistent rhinitis is unclear, or when the diagnosis is in doubt, your doctor may suggest blood tests or skin prick allergy testing.
These tests help to look for the exact cause of your symptoms. See separate leaflet called Skin Prick Allergy Test for more detail. Confirming the exact cause of any allergy may help if you want to try to avoid it (see below).
Other tests, such as a detailed examination of your nose, are sometimes needed to look for other possible causes of your symptoms They may also be needed if complications are suspected (for example, to check for a nose polyp).
These can include X-rays and scans.
What are the commonly used treatments?
The following treatment options are for allergic rhinitis – the most common cause of persistent rhinitis. Non-allergic rhinitis can be more difficult to treat and depends on the cause.
Steroid nasal sprays may be helpful. Treatments for non-allergic rhinitis are not discussed further here.
The commonly used treatment options for allergic rhinitis are avoiding the cause of the allergy, antihistamine nose sprays, antihistamine tablets and steroid nose sprays.
Note: if your rhinitis symptoms are not controlled on the medication that you are taking after 2-4 weeks, you should discuss this with your doctor. You may need to try a different treatment or add in another treatment.
How long is treatment needed for?
Persistent rhinitis is an ongoing (chronic) condition that usually needs regular treatment to prevent symptoms.
However, over time the condition may ease and even go completely in some cases. It may be worth stopping treatment every six months or so to see if symptoms come back without the treatment.
The treatment can be started again if symptoms return.
Of course, if you have persistent rhinitis caused by an allergy, if you remove the source of the allergy, your symptoms should reduce and stop. You may no longer need treatment.
Are there any complications of persistent rhinitis?
Sinusitis is the most common complication of persistent rhinitis. The sinuses are small, air-filled spaces inside the cheekbones and forehead.
They make some mucus which drains into the nose through small channels. Allergens can irritate the lining of your sinuses in the same way that they irritate the lining of your nose.
If you have a blocked or congested nose or lots of nasal discharge, it can stop your sinuses from draining properly into your nose.
This means that the mucus in the sinuses becomes blocked and can be more easily infected. See separate leaflets called Acute Sinusitis and Chronic Sinusitis for more details.
Nasal polyps are sometimes a complication of rhinitis. A nasal polyp is a swelling that can grow from the lining of your nose.
When it is fully grown it looks rather like a grape. One polyp can form or there may be a number of polyps together. Sometimes polyps can form in the sinuses as well. They are usually flesh-coloured, pale grey or pink.
If a polyp is big or if there are large numbers of polyps, a number of problems can develop. Your sense of smell may be affected or your nose may feel blocked, causing difficulty breathing.
Sometimes polyps can block the drainage of your sinuses and lead to sinusitis as described above.
Large polyps may need to be surgically removed but smaller polyps can often be treated with steroid nasal drops (see above) which help to shrink them.