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Nonallergic rhinitis

Nonallergic rhinitis involves chronic sneezing or having a congested, drippy nose with no apparent cause. The symptoms of nonallergic rhinitis are similar to those of hay fever (allergic rhinitis), but there's no identified allergic reaction involved. Nonallergic rhinitis can affect children and adults, but is more common after age 20.

Although nonallergic rhinitis is more annoying than harmful, it can make you miserable. Triggers of nonallergic rhinitis symptoms vary and can include certain odors or irritants in the air, changes in the weather, some medications, certain foods, and chronic health conditions. A diagnosis of nonallergic rhinitis is made after an allergic cause is ruled out. This may require allergy skin or blood tests.

Symptoms Causes Risk factors Complications Prevention

If you have nonallergic rhinitis, you probably have symptoms that come and go year-round. You may have constant symptoms, symptoms that last for hours or symptoms that last for days. Signs and symptoms of nonallergic rhinitis may include:

  • Stuffy nose
  • Runny nose
  • Sneezing
  • Mucus (phlegm) in the throat (postnasal drip)

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

When to see a doctor

See your doctor if:

  • Your symptoms are severe
  • You have signs and symptoms of nonallergic rhinitis that aren't relieved by over-the-counter medications or self-care
  • You have bothersome side effects from over-the-counter or prescription medications for rhinitis

Nonallergic rhinitis occurs when blood vessels in your nose expand (dilate), filling the nasal lining with blood and fluid. There are several possible causes of this abnormal expansion of the blood vessels or inflammation in the nose. But, whatever the trigger, the result is the same — swollen nasal membranes and congestion.

Many things can trigger the nasal swelling in nonallergic rhinitis — some resulting in short-lived symptoms while others cause chronic problems. Nonallergic rhinitis triggers include:

  • Environmental or occupational 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.
  • Infections. A common cause of nonallergic rhinitis is a viral infection — a cold or the flu, for example. This type of nonallergic rhinitis usually clears up after a few weeks, but can cause lingering mucus in the throat (postnasal drip). Sometimes, this type of rhinitis can become chronic, causing ongoing discolored nasal discharge, facial pain and pressure (sinusitis).
  • Foods and beverages. Nonallergic rhinitis may occur when you eat, especially when eating hot or spicy foods. Drinking alcoholic beverages also may cause the membranes inside your nose to swell, leading to nasal congestion.
  • Certain medications. Some medications can cause nonallergic rhinitis. These include aspirin, ibuprofen (Advil, Motrin IB, others), and high blood pressure (hypertension) medications, such as beta blockers. Nonallergic rhinitis can also be triggered in some people by sedatives, antidepressants, oral contraceptives or drugs used to treat erectile dysfunction. Overuse of decongestant nasal sprays can cause a type of nonallergic rhinitis called rhinitis medicamentosa.
  • Hormone changes. Changes in hormones due to pregnancy, menstruation, oral contraceptive use or other hormonal condition such as hypothyroidism can cause nonallergic rhinitis.
  • Stress. Emotional or physical stress can trigger nonallergic rhinitis in some people.

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.
  • Being older than age 20. Unlike allergic rhinitis, which usually occurs before age 20, often in childhood, nonallergic rhinitis occurs after age 20 in most people.
  • Prolonged use of decongestant nasal drops or sprays. Using over-the-counter decongestant nasal drops or sprays (Afrin, Dristan, others) for more than a few days can actually cause more severe nasal congestion when the decongestant wears off, often called rebound congestion.
  • Being female. Due to hormonal changes, nasal congestion often gets worse during menstruation and pregnancy.
  • Occupational exposure to fumes. In some cases nonallergic rhinitis is triggered by exposure to an airborne irritant in the workplace (occupational rhinitis). Some common triggers include aircraft fuel or jet exhaust, solvents, or other chemicals and fumes from decomposing organic material such as compost.
  • Having certain health problems. A number of chronic health conditions can cause or worsen rhinitis, such as hypothyroidism and chronic fatigue syndrome.

Complications from nonallergic rhinitis include:

  • 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. When sinusitis lasts for longer than 12 consecutive weeks, it's referred to as chronic sinusitis. 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.
  • Interrupted daily activities. Nonallergic rhinitis can be disruptive. You may be less productive at work or school, and you may need to take time off because of symptom flares or doctor visits.

In many cases, there's no way to avoid the underlying conditions that cause nonallergic rhinitis. However, if you already have it, you can take steps to reduce your symptoms and prevent flare-ups:

  • Avoid your triggers. If you can identify things that cause or worsen your symptoms, avoiding them can make a big difference.
  • Don't overuse nasal decongestants. Using these medications for more than a few days at a time can actually worsen your symptoms.
  • Get treatment that works. If treatment isn't working, see your doctor. Your doctor can make changes that do a better job preventing or reducing your symptoms.
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