What is non-allergic rhinitis? How effective is the treatment?

Rhinitis is a fairly common disease and includes many types. It can be broadly classified into allergic rhinitis and non-allergic rhinitis. Non-allergic rhinitis includes many subtypes depending on the specific cause. Although allergic rhinitis is well understood, the pathogenesis of nonallergic rhinitis is poorly understood.

Treatment of rhinitis in general and non-allergic rhinitis in particular is not only based on the specific type of rhinitis but also on the main symptoms of the patient. Treatment can be quite challenging in severe cases of rhinitis.

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• 1. What is non-allergic rhinitis?
• 2. Mechanism of non-allergic rhinitis
• 3. What are the types of non-allergic rhinitis?
• 4. Causes of non-allergic rhinitis
• 5. Symptoms of non-allergic rhinitis
• 6. Complications of non-allergic rhinitis
• 7. When do you need to see a doctor?
• 8. How is non-allergic rhinitis diagnosed?
• 9. What are the ways to treat non-allergic rhinitis?
• 10. How can I prevent non-allergic rhinitis?
• Conclude

1. What is non-allergic rhinitis?

Rhinitis is an inflammation of the lining lining the inside of the nasal passages. When rhinitis occurs unrelated to allergens, they are called nonallergic rhinitis.

The symptoms of nonallergic rhinitis are similar to those of allergic rhinitis but in these cases there was no evidence of an allergic reaction.

>> Read more articles about Allergic Rhinitis

Nonallergic rhinitis can occur in both adults and children. But it appears more commonly after the age of 20. Diagnose non-allergic rhinitis after excluding allergic causes. It may then be necessary to perform an allergy skin test or a serum test.

Non-allergic rhinitis is a type of rhinitis that is not caused by an allergic mechanism – Source: Medicalnewstoday

2. Mechanism of non-allergic rhinitis

Unlike allergic rhinitis, the pathogenesis of nonallergic rhinitis is still unknown. Non-allergic rhinitis includes many different types depending on the specific cause.

In which, idiopathic rhinitis, also known as vasomotor rhinitis, is the most common type of non-allergic rhinitis. This type of rhinitis is thought to be related to an imbalance of the autonomic nervous system. This imbalance can lead to overactive nasal mucus glands and congestion.

Another type of non-allergic rhinitis is occupational rhinitis. They may occur due to an allergic mechanism or in response to a stimulus.

3. What are the types of non-allergic rhinitis?

Nonallergic rhinitis includes many different types. Each has different causes and mechanisms, including:

• Rhinitis due to infection. It could be a viral or bacterial infection.
• Occupational rhinitis. Environmental agents cause rhinitis or worsen existing rhinitis.
• Rhinitis caused by drugs. There are many drugs that can trigger rhinitis such as: Non-steroidal anti-inflammatory drugs, Aspirin, antihypertensive drugs, oral contraceptives, etc. Among them, Medicamentosa rhinitis is caused by overuse of nasal decongestant sprays. topical nasal decongestant) for more than 5 to 10 days.
• Hormonal rhinitis. Hormonal changes can cause rhinitis. For example, in the following cases: Pregnancy, menstruation, hypothyroidism, etc.
• Idiopathic rhinitis. Also called vasomotor rhinitis. This type of rhinitis is not related to allergies or infections and has no specific cause.
• NARES. Nonallergic rhinitis with eosinophilia.
• Rhinitis of taste. The patient has a runny nose after eating hot spicy food.
• Atrophic rhinitis. It can occur due to infection with bacteria Klebsiella ozaenae or after trauma, surgery of the nose and sinuses.

Overuse of decongestant sprays can lead to non-allergic rhinitis.

4. Causes of non-allergic rhinitis

There are many known causes of non-allergic rhinitis. Each cause is related to a specific type of rhinitis. They can cause temporary or persistent symptoms.

Possible causes of non-allergic rhinitis include:

• Infection. It is a common cause of non-allergic rhinitis. It could be a viral or bacterial infection. For example, the flu.
• Stimulants from the environment or work. These substances can include smog, cigarette smoke, perfumes, etc. Chemicals in certain occupations can also be to blame.
• Change Weather. Changes in temperature or humidity can irritate the lining of the nose, leading to a stuffy or runny nose.
• Medicine. Certain medications can cause non-allergic rhinitis. These medications include: NSAIDs, Aspirin, blood pressure medications, tranquilizers, antidepressants, birth control pills, or medications used to treat erectile dysfunction. Overuse of decongestant nasal sprays such as oxymetazoline, phenylephrine can cause a type of non-allergic rhinitis called Medicamentosa rhinitis.
• Hormonal changes. Hormonal changes due to pregnancy, menstruation, hypothyroidism, etc. can also cause non-allergic rhinitis.
• Food and drink. Non-allergic rhinitis can occur when you eat, especially hot, spicy foods. Drinking alcoholic beverages can also cause swelling of the nasal mucosa, leading to nasal congestion.
• Stress or vigorous exercise. Stress can also cause idiopathic rhinitis, which is a type of non-allergic rhinitis.
• After trauma or surgery of the nose and sinuses. Atrophic rhinitis is a rare complication after rhinoplasty.

5. Symptoms of non-allergic rhinitis

The symptoms of nonallergic rhinitis can overlap and be difficult to distinguish from allergic rhinitis. However, they may vary slightly depending on the specific type. Symptoms may be short-lived or persistent. Common symptoms include:

• Stuffy nose .
• Runny nose.
• Postnasal drip or a feeling of mucus in the throat.
• And some other side symptoms such as: Cough, sore throat, etc.
• Non-allergic rhinitis usually does not cause itchy nose, itchy or watery eyes, or itchy throat. These symptoms are common in allergic rhinitis.

Symptoms of non-allergic rhinitis can be difficult to distinguish from allergic rhinitis.

6. Complications of non-allergic rhinitis

Persistent nonallergic rhinitis can cause the following:

• Nasal polyps :  These are soft, non-cancerous growths. They develop on the lining of the nose or sinuses due to chronic inflammation. Small polyps may not cause problems. But large polyps can block airflow through the nose, causing persistent nasal congestion.
• Sinusitis : Persistent nasal congestion due to non-allergic rhinitis may increase the likelihood of developing sinusitis 
• Inflammation of the middle ear . Nasal congestion and increased discharge can increase the risk of otitis media.
• Interruption of daily activities. Nonallergic rhinitis can disrupt daily functioning. You may be less productive. It also takes time to rest or see a doctor.

7. When do you need to see a doctor?

You should see a doctor in the following cases:

• Symptoms are severe, cause discomfort, or interfere with daily activities.
• Symptoms and manifestations of the disease do not improve despite taking medicine and self-care at home.
• You experience unpleasant side effects after using medicine for rhinitis.  

8. How is non-allergic rhinitis diagnosed?

Diagnosing nonallergic rhinitis can be difficult because nasal congestion and rhinorrhea can also occur in allergic rhinitis or chronic rhinosinusitis. Your doctor may use the following to help diagnose the type of rhinitis you have:

Allergy test

Allergy tests are performed to distinguish non-allergic rhinitis from allergic rhinitis. These include allergy skin testing and serum-specific IgE antibody testing. Antihistamines for 2 days and corticosteroids should be discontinued 3 to 6 days before this test is performed. If both of these tests are negative, the rhinitis is less likely to be allergic rhinitis.

Skin prick tests are used to identify allergies to common agents.

Nose stimulation test

The nasal irritation test is mainly done to diagnose occupational rhinitis. Used to determine a cause-and-effect relationship between exposure and symptoms. The test is conducted by spraying the allergen in a certain dose into one or two nostrils and monitoring the patient's response. Patients should breathe deeply before spraying to avoid depositing this substance deep in the lower airways.

Other tests of the nose

Functional testing may be used to assess the severity of rhinitis. By measuring the degree of nasal obstruction such as measurement of peak expiratory flow from the nose, nasal barometric pressure, nasal sound waves.

Nasal cytology may also be done to help diagnose the type of rhinitis. Eosinophilic counts are commonly elevated in allergic rhinitis, parasitic infections, and nonallergic rhinitis with eosinophilic syndrome (NARES).

The ciliary mucus function test can help diagnose nasal ciliary dysfunction.

Suspicious lesions of the nasal mucosa should be biopsied to rule out cancer or granulomatous diseases.

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Nasoscopic sinusoscopy was performed to rule out structural abnormalities. For example, nasal polyps or deviated septum, etc. can make symptoms worse.

A CT scan is indicated to rule out conditions such as chronic sinusitis and tumors.

Straight X-rays are now thought to be no longer useful.

Nasal endoscopy detects nasal polyps

9. What are the ways to treat non-allergic rhinitis?

Treatment of rhinitis will vary depending on the specific individual. Your doctor will target the symptom that is most troubling you. Treatment can be quite challenging in severe cases of rhinitis. The illness can be long-lasting and you will need to adapt your treatment regimens as well. You should see your doctor to choose the best treatment for you.

Treatments for non-allergic rhinitis may include:

Avoid irritants such as cigarette smoke. Can be applied to all types of rhinitis.

Nasal spray corticosteroids may be effective in reducing nasal congestion in patients with idiopathic rhinitis and non-allergic rhinitis syndrome with eosinophilia (NARES).

Decongestant sprays may also be used. However, use of this drug should be limited to 7 days to avoid side effects. People with rhinitis medicametosa need to stop using the decongestant spray slowly and often need a corticosteroid nasal spray. In severe cases, short-term use of oral corticosteroids may be necessary.

Topical anticholinergics can relieve runny nose and are useful in taste rhinitis. These anticholinergics are first-line agents in the treatment of rhinorrhea in elderly patients. Efficacy assessment is usually done after 6 weeks of dosing.

Nasal spray antihistamines have been shown to relieve nasal congestion and discharge in patients with idiopathic rhinitis. It is also effective in patients with a combination of both allergic and non-allergic rhinitis.

Oral antihistamines alone are not usually indicated in this setting because of their limited effectiveness .

Avoid irritants such as cigarette smoke.

Treatment of occupational rhinitis

Occupational rhinitis is of particular interest because of its close association with occupational asthma . The most important treatment is complete avoidance of known rhinitis triggers. If completely avoiding these triggers isn't possible and you're at low risk for asthma, you can reduce your exposure and use more medications. You need to keep a close eye on your symptoms for the first signs of occupational asthma.

When is surgery chosen?

Surgery is performed when there is an accompanying structural abnormality.

Septal correction is performed in cases where there is a deviated nasal septum causing uncomfortable symptoms of nasal congestion

A partial lower volvulus may be performed in cases of medicamentosa-type rhinitis that is resistant to drug therapy. It is also performed with other drug-resistant bronchiectasis.

Endoscopic sinus surgery is performed when rhinitis is accompanied by diseases such as chronic rhinosinusitis or nasal polyps.

Vidian neurectomy in the treatment of idiopathic rhinitis has been replaced by drug therapy. Avoid complications caused by surgery.

10. How can I prevent non-allergic rhinitis?

If you already have non-allergic rhinitis, you can take the following steps to reduce your symptoms and prevent flare-ups:

• Avoid stimulants. If you can identify the things that cause or worsen your symptoms, avoiding them can make a big difference.
• Don't overuse decongestant sprays. Using these medicines for many days may worsen your symptoms.
• Use an effective treatment regimen. If treatment doesn't work, go back to your doctor. Your doctor can change your treatment to better prevent or relieve your symptoms.
• A new study shows that children who eat fish with oils or certain unsaturated fatty acids are less likely to develop allergic and non-allergic rhinitis. This study found a reduced risk of disease in children who ate herring, mackerel or salmon at least once a week.

Avoid overusing decongestant sprays

Conclude

Rhinitis is a common disease worldwide. It can be classified into allergic and non-allergic rhinitis . Accurate diagnosis of the type of rhinitis is essential for the course of treatment. Treatment of rhinitis often targets symptoms to improve the patient's quality of life.