What is chronic rhinitis?
Rhinitis is inflammation of the mucous membrane that lines the nose. It is called chronic when it lasts more than about 4–12 weeks or recurs regularly. The swollen lining blocks airflow, produces excess mucus and becomes hypersensitive to triggers. Chronic rhinitis is not a single disease: it includes allergic rhinitis, non-allergic rhinitis (vasomotor and others), infectious rhinitis and rhinitis caused by medicines, hormones or structural problems. See stuffy nose and postnasal drip.
Symptoms
- Nasal congestion or blockage, often worse at night or when lying down. See blocked nose at night.
- Runny nose with clear, watery discharge.
- Sneezing, sometimes in long bursts.
- Itchy nose, throat, palate or eyes, typical of allergy.
- Postnasal drip, throat clearing and a chronic cough.
- Reduced sense of smell and taste. See loss of smell.
- Facial pressure, headache and ear fullness.
- Fatigue and poor sleep, because of blocked nasal breathing and snoring.
- Mouth breathing, dry mouth and sore throat on waking. See mouth breathing.
Allergic chronic rhinitis
In allergic rhinitis, the immune system reacts to harmless substances (allergens), releasing histamine and other chemicals. Seasonal triggers include tree, grass and weed pollen; perennial triggers include house-dust mites, pet dander, cockroaches and indoor moulds. Symptoms are typically itchy and watery, often with itchy eyes, and may be linked to eczema or asthma. Skin-prick tests or blood tests (specific IgE) can confirm the allergens. See sore throat from allergies.
Non-allergic chronic rhinitis
- Vasomotor rhinitis: sensitive nasal nerves react to temperature or humidity changes, strong smells, smoke, spicy food or alcohol. See vasomotor rhinitis.
- Rhinitis medicamentosa: rebound congestion from using decongestant sprays for more than 3–5 days.
- Hormonal rhinitis: during pregnancy, puberty and with thyroid disease.
- Drug-induced rhinitis: some blood pressure drugs, NSAIDs, antidepressants and erectile dysfunction medicines.
- Gustatory rhinitis: a runny nose triggered by eating, especially hot or spicy food.
- Atrophic rhinitis: dry, crusted nose in older adults or after surgery.
- NARES (non-allergic rhinitis with eosinophilia syndrome) and occupational rhinitis from chemicals or dusts. See non-allergic rhinitis.
Conditions that mimic or accompany rhinitis
- Chronic sinusitis, with facial pressure and thick discharge. See sinus infection symptoms.
- Nasal polyps, which cause persistent blockage and loss of smell. See nasal polyps.
- Deviated septum and enlarged turbinates.
- Enlarged adenoids in children.
- Cerebrospinal fluid leak (rare), a clear watery drip from one side after head injury.
- Foreign body, especially in children with one-sided smelly discharge.
- Asthma and eczema often accompany allergic rhinitis.
Self-care and avoiding triggers
- Saline nasal rinses once or twice a day to flush allergens and mucus. See neti pot sinus rinse.
- Avoid known allergens: keep windows closed in pollen season, use dust-mite covers, wash bedding at 60 °C, keep pets out of the bedroom.
- Avoid irritants: tobacco smoke, perfumes, strong cleaning products and polluted air.
- Use a humidifier if the air is dry, and clean it regularly.
- Shower and wash your hair after high-pollen days.
- Limit alcohol and spicy foods if they trigger symptoms.
- Sleep with your head slightly raised.
- Keep a symptom diary to spot patterns.
Medicines
- Intranasal corticosteroid sprays (fluticasone, mometasone, budesonide): the most effective for allergic and many non-allergic types; use daily, aim away from the septum and allow 1–2 weeks to reach full effect.
- Antihistamine tablets (cetirizine, loratadine, fexofenadine) for sneezing, itching and watery nose; less effective for blockage.
- Antihistamine nasal sprays (azelastine), which work within minutes and also help non-allergic rhinitis.
- Ipratropium nasal spray for a very watery runny nose.
- Combination sprays (steroid plus azelastine) for stubborn symptoms.
- Leukotriene blockers (montelukast) in selected cases; discuss risks with your doctor.
- Decongestant sprays only up to 3 days; longer use causes rebound congestion. Oral decongestants raise blood pressure.
- Allergen immunotherapy (injections or tablets) for severe allergic disease; it can alter the long-term course.
Procedures for persistent blockage
When medicines fail and enlarged turbinates or a deviated septum remain, ENT surgeons can reduce turbinate size (radiofrequency, coblation or partial resection) or straighten the septum (septoplasty). For severe watery rhinitis with no response, posterior nasal nerve ablation is an option in some centres. Surgery treats blockage, not allergy, so medical treatment usually continues.
Chronic rhinitis in children
Children with persistent nasal symptoms may snore, breathe through the mouth, have dark circles under the eyes, rub their nose and sleep poorly, which can affect concentration and mood. Allergy and enlarged adenoids are the usual causes. Treatment includes saline, allergen control and a paediatrician-guided nasal steroid or antihistamine. Persistent one-sided discharge needs examination for a foreign body.
When to see a doctor
- Symptoms lasting more than 4 weeks without improvement.
- Blockage on one side only, nosebleeds or a smell from one side.
- Loss of smell or facial pain that persists.
- Wheeze, chest tightness or cough, possible asthma.
- Repeated sinus infections or ear problems.
- Overuse of decongestant sprays.
- Swelling around the eye, severe headache or fever: urgent.
Three common situations
A student with a blocked nose, itchy eyes and sneezing all year: likely perennial allergy to dust mites; allergen control and a nasal steroid.
An adult with a clear runny nose in cold air and after spicy food: consider vasomotor rhinitis; ipratropium or azelastine may help.
A person using a decongestant spray every night for months: rebound rhinitis; stop gradually and start a steroid spray.
Key points to remember
Chronic rhinitis is common and treatable. Work out whether it is allergic or not, avoid triggers, rinse with saline and use a daily steroid spray correctly. See an ENT for persistent or one-sided symptoms. Our team can help you find the cause.
This guide is for general information and does not replace an examination by your own doctor or ENT specialist.
Questions about chronic rhinitis
These answers are general information and do not replace an examination or individual medical advice.
What is chronic rhinitis?
Long-lasting inflammation of the nasal lining causing blockage, runny nose, sneezing and postnasal drip.
What is the difference between allergic and non-allergic rhinitis?
Allergic is triggered by allergens and often itchy; non-allergic is triggered by irritants, weather, hormones or medicines.
What is the best treatment?
Saline rinses, trigger avoidance and a daily steroid nasal spray; antihistamine sprays are an alternative.
Are decongestant sprays safe?
Only for up to 3 days; longer use causes rebound congestion.
Can chronic rhinitis go away?
It can improve with treatment, but it often needs long-term management.
When should I see an ENT?
If symptoms last over 4 weeks, are one-sided, or come with bleeding, loss of smell or facial pain.
Sources
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.