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Vasomotor Rhinitis / Nonallergic Rhinitis

Do you have a chronic runny or stuffy nose on and off all year? If so, you, along with millions of others, may have nonallergic rhinitis.

If you have nonallergic rhinitis, the lining of your nose swells due to expanding blood vessels — causing a congested and drippy nose. The symptoms of nonallergic rhinitis are similar to those of hay fever (allergic rhinitis), but no allergy is involved. Nonallergic rhinitis affects approximately 17 million people in the U.S. — both children and adults.

Another term for nonallergic rhinitis is vasomotor rhinitis. Vasomotor rhinitis refers to an exaggerated response to irritation of the nasal lining.

Although nonallergic rhinitis is more annoying than harmful, it can affect your quality of life. A variety of factors may trigger symptoms of nonallergic rhinitis, including infections, environmental irritants, medications, hormonal changes, temperature changes, stress or activity. A diagnosis of nonallergic rhinitis is made after an allergy cause is ruled out. This often requires allergy skin or blood tests.

Nonallergic rhinitis is caused by blood vessels in your nose expanding (dilating), filling the nasal lining with blood and fluid. Sometimes nonallergic rhinitis is caused by inflammation of the lining of the nose. There are several possible causes of this abnormal dilation of the blood vessels or inflammation in the nose. But, whatever the underlying cause, the result is the same — swollen nasal membranes and congestion of an already-narrow area.

Many things can cause nonallergic rhinitis — some resulting in short-lived symptoms, and others causing chronic problems.
  • Infections. A common cause of nonallergic rhinitis is a viral infection — a cold or the flu, for example.This type of nonallergic rhinitis tends to resolve itself over a few weeks but can cause lingering mucus in the throat (postnasal drip). Sometimes, infectious rhinitis can become chronic, causing ongoing discolored nasal discharge, facial pain and pressure.
  • Environmental irritants. Dust, smog, secondhand smoke or strong odors, such as perfumes, can trigger nonallergic rhinitis. Chemical fumes, such as those you might be exposed to in certain occupations, also may be to blame.
  • Weather changes. Temperature or humidity changes can trigger the membranes inside your nose to swell and cause a runny or stuffy nose.
  • Stress or activity. Emotional or physical stress can trigger nonallergic rhinitis.
  • Hormone changes. Changes in hormones due to pregnancy, menstruation, oral contraceptive use or a hormonal condition such as hypothyroidism can cause nonallergic rhinitis.
  • Foods and beverages. Nonallergic rhinitis may occur when you eat, especially after eating hot or spicy foods. Drinking alcoholic beverages, such as beer and wine, also may cause the membranes inside your nose to swell, leading to nasal congestion.
  • Certain medications. Some medications can cause nonallergic rhinitis. These include nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, and blood pressure (hypertension) medications, such as beta blockers. Nonallergic rhinitis can also be caused by sedatives, antidepressants and drugs for erectile dysfunction.
  • Prolonged use of decongestant nasal drops or sprays. Extended use of over-the-counter decongestant nasal drops or sprays (Afrin, Dristan, others) can cause the membranes inside your nose to become red and inflamed. Using these products consecutively for five to seven days can actually cause more severe and prolonged nasal congestion when the decongestant wears off (often called rebound congestion).
Risk Factor:
Factors that may increase your risk of nonallergic rhinitis include:
  • Exposure to irritants. If you're exposed to smog, exhaust fumes or tobacco smoke — to name a few — you may be at increased risk of developing nonallergic rhinitis. Inhaled irritants on the job — such as latex, wood dust, chemical fumes, detergents or cleansers — can increase your risk of nonallergic rhinitis.
  • Overuse of decongestant nasal drops or sprays. Don't use decongestant nasal drops or sprays for more than two or three days at a time. Prolonged use of these medications can cause nasal inflammation and rebound congestion once the drugs are stopped.
  • Being female. Due to hormonal changes, nasal congestion often gets worse during menstruation and pregnancy. This occurs even in women who normally don't have problems.
When to seek medical advice:
If you have signs and symptoms of nonallergic rhinitis and haven't found relief from over-the-counter medications or self-care tactics, see your doctor for help with a more effective treatment plan. Also see your doctor if your problems are severe or if you have side effects from over-the-counter medications.

If you have nonallergic rhinitis, you probably have symptoms that come and go year-round. Signs and symptoms of nonallergic rhinitis may include :
  • Stuffy nose
  • Runny nose
  • Mucus (phlegm) in the throat (postnasal drip)

Nonallergic rhinitis doesn't usually cause itchy nose, eyes or throat — symptoms associated with allergies.

Nonallergic rhinitis is diagnosed based on your signs and symptoms and when they occur. If it's clear that your nasal congestion isn't triggered by allergies, your doctor may determine that you have nonallergic rhinitis.

The only way to be sure you aren't having an allergic reaction is through allergy testing, which may involve skin or blood tests.
  • Skin test. To find a potential allergen, your skin is pricked and exposed to small amounts of common allergens. If you're allergic to a particular allergen, you develop a raised bump (hive) at the test location on your skin. If you're not allergic to any of the substances, your skin looks normal.
  • Blood test. A blood test can measure your immune system's response to common allergens by measuring the amount of certain antibodies in your bloodstream, known as immunoglobulin E (IgE) antibodies. A blood sample is sent to a medical laboratory, where it can be tested for evidence of sensitivity to specific allergens.
If your doctor suspects sinusitis or nasal polyps, he or she may order a computerized tomography (CT) scan of the sinuses. A sinus CT scan is an X-ray technique that produces images of your sinuses that are more detailed than those produced by conventional X-ray exams.

If you have severe and persistent nonallergic rhinitis, you may develop complications such as:
  • Nasal polyps. These are soft, noncancerous (benign) growths that develop on the lining of your nose or sinuses due to chronic inflammation. Small polyps may not cause problems, but larger ones can block the airflow through your nose, making it difficult to breathe.
  • Chronic sinusitis. Prolonged nasal congestion due to nonallergic rhinitis may increase your chances of developing sinusitis — an infection or inflammation of the membrane that lines the sinuses. Sinusitis causes pain, tenderness and swelling around your eyes, cheeks, nose or forehead.
  • Middle ear infections. Increased fluid and nasal congestion may lead to middle ear infections.
Treatment of nonallergic rhinitis depends on how much it bothers you. For mild cases, you may need no treatment. Simply avoid the things that seem to trigger your symptoms. Rinsing your nasal passages (nasal lavage) with an over-the-counter saline solution (Ayr, Breathe Right, others) can help to keep your nose free of irritants.

For more bothersome symptoms, certain medications may provide relief, including:
  • Oral decongestants. Available over-the-counter or by prescription, examples include pseudoephedrine-containing drugs (Sudafed, Actifed, others) and phenylephrine. These medications help narrow the blood vessels, reducing congestion in the nose.
  • Saline nasal sprays. Use an over-the-counter nasal saline spray or homemade saltwater solution to flush the nose of irritants and help thin the mucus and soothe the membranes in your nose.
  • Antihistamine nasal sprays. Try a prescription antihistamine spray such as azelastine (Astelin). While oral antihistamines don't seem to help nonallergic rhinitis, antihistamine in the form of a nasal spray may reduce symptoms of nonallergic rhinitis.
  • Anti-drip anticholinergic nasal sprays. The prescription drug ipratropium (Atrovent) often used as an asthma inhaler medication, is now available as a nasal spray and can be helpful if a runny, drippy nose is your main symptom.
  • Corticosteroid nasal sprays. If your symptoms aren't easily controlled by decongestants or antihistamines, your doctor may suggest a prescription corticosteroid nasal spray, such as budesonide (Rhinocort), fluticasone (Flonase), mometasone (Nasonex) or triamcinolone (Nasacort). Corticosteroid medications help prevent and treat inflammation.
Over-the-counter oral antihistamines, such as diphenhydramine (Benadryl), clemastine (Tavist) and loratadine (Claritin), typically don't work nearly as well for nonallergic rhinitis as they do for allergic rhinitis.

In rare cases, surgical procedures may be an option to treat complicating problems such as a deviated nasal septum or persistent nasal polyps.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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