Nonallergic rhinitis

Diagnosis

To determine if you have nonallergic rhinitis, your healthcare provider will conduct a thorough evaluation, which may include:

• Physical examination: Your healthcare provider will perform a physical examination and inquire about your symptoms.
• Symptom assessment: They will assess common symptoms associated with nonallergic rhinitis, such as:
  • Nasal congestion (stuffy nose).
  • Runny nose or postnasal drip (mucus dripping down the back of your throat).
• Exclusion of other causes: Your provider will perform tests to rule out other potential causes of your symptoms, such as allergies or sinus issues.
• Medication trial: In some cases, your healthcare provider may recommend trying a specific medication to see if your symptoms improve.
• Allergy testing: If allergies are suspected, your healthcare provider may recommend allergy testing to ensure that your symptoms are not allergy-related. These tests may include:
  • Skin test: A skin test involves pricking your skin with tiny amounts of common allergens found in the environment, such as dust mites, mold, pollen, and pet dander. If you are allergic to any of these substances, your skin may develop raised bumps at the pricked sites.
  • Blood test: A blood test can detect allergies by measuring the levels of immunoglobulin E (IgE) antibodies in your blood. Elevated IgE levels can indicate the presence of allergies that trigger allergy symptoms.
• Sinus evaluation: To determine if your symptoms are related to sinus problems, your healthcare provider may recommend:
• Nasal endoscopy: This procedure involves using a thin, flexible tool called an endoscope, equipped with a camera, to examine the inside of your nasal passages. The endoscope is gently inserted through your nostrils to provide a close-up view of your nasal structures.
• Computed tomography (CT) scan: A CT scan utilizes X-rays to create detailed images of your sinuses. These images provide a comprehensive view of your sinus anatomy and can help identify any structural issues or abnormalities.

In some instances, symptoms may be triggered by both allergic and nonallergic factors. A comprehensive assessment, including these tests, will aid your healthcare provider in determining the most appropriate diagnosis and treatment plan for your specific condition.

Treatment

Treatment options for nonallergic rhinitis vary depending on the severity of your symptoms. For mild cases, you may find relief through home remedies and avoiding triggers. However, if your symptoms are more severe, medications can help alleviate them. Consider the following treatment options:

• Saline nasal sprays: Saline nasal sprays, which contain a mixture of salt and water, can provide moisture to the nasal passages. They also help in thinning mucus and soothing the nasal lining. These sprays are available over the counter, but you can also try nasal irrigation at home using a saline or saltwater solution to flush out irritants and mucus effectively.
• Antihistamine nasal sprays: Antihistamines, commonly used to treat allergies, can also be effective in managing nonallergic rhinitis symptoms. Your healthcare provider may prescribe antihistamine nasal sprays like azelastine (Astepro, Astepro Allergy) or olopatadine hydrochloride (Patanase).
• Oral antihistamines: While oral antihistamines such as diphenhydramine (Benadryl), cetirizine (Zyrtec Allergy), fexofenadine (Allegra Allergy), and loratadine (Alavert, Claritin) are often used for allergies, they may not work as effectively for nonallergic rhinitis.
• Ipratropium nasal spray: This prescription nasal spray can help alleviate symptoms of a runny or drippy nose. However, it may have side effects like nosebleeds and nasal dryness.
• Decongestants: Decongestants can narrow blood vessels in the nose, reducing congestion. They are available over the counter or by prescription. However, they can have side effects like increased blood pressure, palpitations, and restlessness. Examples include pseudoephedrine (Sudafed 24 Hour) and phenylephrine.
• Steroids: Steroid medications can be used to prevent and treat inflammation associated with certain types of nonallergic rhinitis. Steroid nasal sprays, available over the counter, include fluticasone (Flonase Allergy Relief) and triamcinolone (Nasacort Allergy 24 Hour). Stronger steroid sprays may require a prescription. Possible side effects include dry nose or throat, nosebleeds, and headaches.

In some cases, your healthcare provider may recommend surgery to address underlying issues that contribute to nonallergic rhinitis. For instance, nasal growths called polyps may need to be removed, or surgery may be necessary to correct a deviated septum, which is when the nasal partition is off-center or crooked.