What causes rhinitis?

The causes of persistent rhinitis can be divided into allergic and non-allergic.

Allergic rhinitis

The most common allergies causing rhinitis are pollen (hay fever), house dust mite and pets, most commonly cats.

Hay fever is seasonal and occurs during a particular period each year.

Symptoms of allergy in the nose are due to the immune system reacting to the allergen (the individual cause of the allergy). Cells in the lining of the nose release histamine and other chemicals when they come into contact with the allergen. This causes inflammation in the nose with swelling, excess mucus production and irritation.

Allergic rhinitis can be associated with asthma and eczema and can run in families.

Non-allergic rhinitis

Rhinitis commonly occurs without an allergic cause and there is often no identifiable cause for the condition. Many factors can influence the nasal lining however including:

• Changes in temperature or humidity
• Hormonal changes e.g. during pregnancy
• Food and drink, e.g. alcohol
• Emotion such as stress and anxiety
• Medication: some medications can have side effects on the nose e.g. blood pressure medication and the contraceptive pill
• Use of decongestants. Rhinitis medicamentosa is the name given to rhinitis that can occur due to the overuse of nasal decongestant sprays. These sprays are used to relieve a blocked nose and they reduce swelling inside the nose by causing blood vessels in the nose to constrict. However, with prolonged use, they cause rebound nasal congestion which is more severe than the original swelling. The temptation is to use yet more decongestant and a vicious circle can be set up. A similar problem can occur in people who abuse cocaine

In some people, no cause for their persistent rhinitis is found and it is called idiopathic or vasomotor rhinitis.

Are any tests needed?

You may require allergy tests if allergic rhinitis is suspected. These can be in the form of skin prick tests or blood tests.

Treatment

The commonly used treatment options for allergic rhinitis include:

• Avoiding the cause of the allergy
• Antihistamine tablets
• Steroid nose sprays
• Steroid nose drops and tablets (for limited periods)
• Nasal Douching (this involves spraying salt water into the nose)

In some cases, other forms of medication are required. Severe allergic rhinitis can sometimes be treated with immunotherapy. This consists of a course of tablets or injections which modify your immune system in order to prevent the allergic reaction from occurring.

The main form of treatment for non-allergic rhinitis is a steroid nasal spray. This sprays to reduce secretion from the nose and nasal douching are also used.

Surgery

This can be indicated when medical treatment has failed or if the rhinitis is associated with sinusitis (see the section on sinusitis) or large adenoids (see the section on adenoids). Nasal surgery for rhinitis involves reducing the size of the nasal turbinates. These are extensions of the side wall of the nose which become swollen in rhinitis.