Rhinitis – Is It Due to Allergies or Something Else?
Rhinitis is a term that means inflammation of the mucus membranes of inside the nose. It is a very common condition. Rhinitis can either be acute or chronic. Acute rhinitis is inflammation of the mucus membranes of the inner nose that lasts up to 4 weeks in duration. It is not uncommon for acute rhinitis to last a few days as in the case of the common cold. Chronic rhinitis, on the other hand, is inflammation that lasts more than 4 weeks in duration. The symptoms of rhinitis may include runny nose, nasal congestion, post-nasal drip, and/or sneezing. Rhinitis can be classified into allergic rhinitis and nonallergic rhinitis. For the paragraph below, nonallergic rhinitis is further divided into rhinitis caused by infections and by other nonallergic stimuli.
The inflammation of rhinitis may be caused by any of the following:
- Allergies – Allergic rhinitis due to dust mites, molds, pollens (e.g., trees, grasses, weeds), pets, cockroaches, etc.
- Infections – Viral, bacterial, or parasitic
- Other Nonallergic Stimuli
- Foods – Gustatory rhinitis due to spicy foods, alcohol, or other foods
- Hormonal imbalance – Thyroid disease, pregnancy, menstruation, etc.
- Medications – Rhinitis medicamentosa due to oxymetazoline and phenylephrine nasal sprays; other medication-induced rhinitis due to nonsteroidal anti-inflammatory drugs (e.g., ibuprofen, naproxen, meloxicam), beta blockers (e.g. metoprolol, propranolol, carvedilol), alpha blockers (e.g., doxazosin, terazosin, tamsulosin), diuretics, antidepressants (e.g., chlorpromazine, risperidone, amitriptyline), aspirin, oral contraceptives, calcium channel blockers (e.g., amlodipine, nifedipine, verapamil), erectile dysfunction medications (i.e., phosphodiesterase 5 inhibitors such as sildenafil, vardenafil, and tadalafil)
- Emotional issues – Stress
- Asthma – There is a higher association of rhinitis with asthma
- Exercise – May act as a trigger of rhinitis
- Airborne Irritants – Air pollution, strong scents, cigarette smoke, smog, etc.
- Pregnancy – Probably as a result of hormonal changes
- Gastroesophageal Reflux Disease (GERD)
- Decreased Blood Flow – Atrophic rhinitis in mostly elderly individuals
- Environmental Changes – Change in barometric pressure, temperature, and/or humidity
- Structural Defects – Deviated septum, enlarged nasal turbinates, tumors, enlarged adenoids, nasal polys, etc.
- Inflammatory/Immunologic Disorders – Sarcoidosis, granulomatous infections, Wegener granulomatosis, Churg-Strauss, amyloidosis, midline granuloma, relapsing polychondritis, etc.
- Cerebrospinal Fluid Leak – Cerebrospinal fluid rhinorrhea is caused by the leaking of brain fluid out of the nose. Some of the causes may include head trauma, tumor, congenital birth defect, and increased intracranial pressure.
- Nonallergic Rhinitis with Eosinophilia (NARES) – A syndrome that has symptoms consistent with allergic rhinitis but without evidence of atopy as allergy skin testing is negative. In addition, nasal cytology demonstrates more than 20% eosinophils. Anosmia (i.e., lack of the ability to smell) is a prominent feature which is usually not seen with allergic rhinitis.
- Obstructive Sleep Apnea – Allergic rhinitis increases the risk of developing obstructive sleep apnea.
Some complications of rhinitis may include sinusitis, middle ear infections, nasal polyps, and/or an interruption of daily activities at home, school, and work due to being less productive since rhinitis is known to decrease the quality of life. After the “common cold,” rhinitis is the second most common cause of missed school or work days.
Prevention of the offending triggers of rhinitis will help to mitigate one’s symptoms. Although it is not always possible to avoid the triggers of rhinitis, one can do their best to try to evade them. It is important not to use over-the-counter nasal decongestants as they just cause a temporary improvement in nasal symptoms. Continued use of nasal decongestants [e.g., Afrin (oxymetazoline)] may cause “rebound” nasal congestion. This “rebound” nasal congestion occurs when an individual suddenly discontinues the use of nasal spray. The nasal congestion that occurs as a result of stopping the medication tends to feel worse than the initial nasal congestion before the nasal decongestion was used. The instructions on oxymetazoline nasal spray clearly states that it should not be used for more than 3 days. This paradoxical condition is called rhinitis medicamentosa. In addition to avoiding triggers and avoiding nasal decongestants, vaccines for viruses (e.g., influenza, measles, rubella) and bacteria (e.g., diphtheria, Bordetella pertussis, Streptococcus pneumoniae, Haemophilus influenzae) may help reduce the likelihood of infectious agents that will cause rhinitis.
The diagnosis of rhinitis is best made by a board certified allergist such as the ones at Black & Kletz Allergy. A comprehensive history and physical examination are important to diagnosing rhinitis. Allergy testing via skin tests and/or blood tests are also typically performed. A CT scan of the sinuses may be necessary to diagnose chronic sinusitis in some individuals who do not improve with standard treatments.
The treatment of rhinitis largely depends on the cause of the rhinitis. It is important for the allergist to determine the cause as treatment is usually tailored to the cause. Some treatment modalities for rhinitis may include saline irrigation, nasal corticosteroids, oral antihistamines, nasal antihistamines, oral decongestants, nasal anticholinergics, and leukotriene antagonists. Allergy shots (i.e., allergy immunotherapy, allergy desensitization, allergy hyposensitization) are a very effective therapy for the treatment of allergic rhinitis and asthma. Allergy shots have been used for more than 100 years in the U.S. and are effective in 80-85% of individuals who take them. They are usually taken for 3-5 years.
The board certified allergists at Black & Kletz Allergy have expertise in diagnosing and treating rhinitis, as well as all other types of allergic conditions and asthma. We treat both adult and pediatric patients and have been doing so in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 50 years. Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All 3 of our offices have on-site parking. For further convenience, our Washington, DC and McLean, VA offices are Metro accessible. Our McLean office location offers a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line. For an appointment, please call our office or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. If you suffer from rhinitis, we are here to help alleviate or hopefully end your bothersome symptoms so that you can enjoy a better quality of life. Black & Kletz Allergy is dedicated to providing the highest quality allergy care in a relaxed, caring, and professional environment.