What is non-allergic rhinitis?
Non-allergic rhinitis is chronic or recurrent inflammation or irritation of the nose that is not caused by an allergic (IgE-mediated) reaction. It is usually diagnosed when symptoms persist for months, allergy skin or blood tests are negative and other conditions such as infection or polyps have been ruled out. It typically starts in adulthood, is more common in women and rarely causes itchy eyes. See chronic rhinitis for the wider picture.
Types of non-allergic rhinitis
- Vasomotor rhinitis: reaction to temperature, smell, smoke and other irritants. See vasomotor rhinitis.
- Irritant and occupational rhinitis: chemicals, dust, fumes, cleaning products, wood dust, flour and other workplace exposures.
- Gustatory rhinitis: watery runny nose after eating, especially spicy foods.
- Rhinitis medicamentosa: rebound blockage from overuse of topical decongestants (oxymetazoline, xylometazoline) for more than 3–5 days.
- Drug-induced rhinitis: ACE inhibitors, beta-blockers, alpha-blockers, aspirin and NSAIDs in sensitive people, antidepressants, sildenafil and others.
- Hormonal rhinitis: pregnancy, hypothyroidism, contraceptive pill or hormone therapy.
- NARES: non-allergic rhinitis with eosinophilia, with sneezing and itching but negative allergy tests.
- Atrophic rhinitis: thinning and crusting of the nasal lining, often with a smell, in older people or after surgery.
- Senile rhinitis: watery drip in older age.
Symptoms
- Nasal blockage, often alternating sides.
- Clear runny nose or postnasal drip.
- Sneezing and itching are possible but usually milder than in allergy.
- Throat clearing, cough and hoarseness from drip. See post nasal drip sore throat.
- Reduced smell, ear fullness and headache.
- Symptoms present most of the year, with worsening on exposure to triggers.
- No clear seasonal pattern.
How it is diagnosed
- History: onset, triggers, medicines, work exposure, pregnancy, thyroid history and previous treatments, including how often you use decongestant spray.
- Nasal examination, often with a small endoscope to check for polyps, septal deviation, swollen turbinates and discharge.
- Allergy skin-prick test or blood IgE test to exclude allergy.
- Sometimes a nasal smear for eosinophils, and a CT scan if sinus disease is suspected.
- Blood tests such as thyroid function when indicated.
- Assessment of smell if reduced.
Self-care
- Avoid or reduce exposure to triggers: smoke, fumes, perfumes, cleaning products and dust.
- Use saline nasal irrigation daily. See neti pot sinus rinse.
- Stop decongestant sprays gradually if you have been using them for more than a few days, with a steroid spray for support.
- Keep indoor air humid but not damp; ventilate rooms.
- Wear a mask or improve ventilation in dusty or chemical workplaces.
- Limit alcohol and spicy foods if they trigger symptoms.
- Review medicines with your doctor if rhinitis began after starting a new one.
Medical treatment
- Intranasal steroids: reduce blockage and inflammation; helpful in many types.
- Azelastine (antihistamine spray): effective in vasomotor and mixed rhinitis.
- Ipratropium spray: for a very runny nose.
- Combination sprays for persistent cases.
- Capsaicin spray under supervision for resistant vasomotor rhinitis.
- Oral decongestants sparingly, since they raise blood pressure and heart rate.
- Treating the underlying cause: thyroid replacement in hypothyroidism, changing a drug, workplace controls.
- Surgery (turbinate reduction or septoplasty) for structural blockage that does not respond to medicine.
Rhinitis in pregnancy
Up to a third of pregnant women develop nasal congestion, usually in the second and third trimesters, because of hormonal changes and increased blood volume. It typically settles within two weeks of delivery. Saline irrigation, raising the head during sleep and gentle exercise help. Ask your doctor or midwife before using any medicine, and avoid oral decongestants unless advised. Persistent severe symptoms, high blood pressure or swelling need assessment.
When to see a doctor
- Symptoms lasting longer than 4 weeks or recurring regularly.
- Symptoms on one side only, with bleeding or a bad smell.
- Loss of smell or taste.
- Facial pain, thick coloured discharge or fever.
- Repeated infections, snoring or poor sleep.
- Dependence on decongestant sprays.
- Swelling around the eye or severe headache: urgent.
Three common situations
A hairdresser with a blocked nose at work, clearer on holiday: irritant or occupational rhinitis from chemicals; ventilation and a mask help.
A person with a blocked nose six months after starting a new tablet: ask your doctor about a drug-induced cause.
A person using a decongestant spray every night for a year: rebound rhinitis; taper under guidance.
Key points to remember
Non-allergic rhinitis is a diagnosis of exclusion with several types. Find your triggers, treat with saline and the right nasal spray, and review medicines and workplace exposure. Seek an ENT assessment for one-sided or severe symptoms. Our team can examine and test your nose.
This guide is for general information and does not replace an examination by your own doctor or ENT specialist.
Questions about non-allergic rhinitis
These answers are general information and do not replace an examination or individual medical advice.
What causes non-allergic rhinitis?
Irritants, temperature changes, hormones, medicines, spicy food and nerve overreaction, among other causes.
How is it different from allergic rhinitis?
It has no allergic trigger, so allergy tests are negative and itching is milder.
What is the best nasal spray?
Steroid sprays for blockage, and azelastine or ipratropium for runny nose, depending on symptoms.
Can medicines cause rhinitis?
Yes, including decongestant sprays used too long and some blood pressure and other drugs.
Is non-allergic rhinitis serious?
No, but it can affect sleep and quality of life, and other causes must be excluded.
Does it get better?
Often, with trigger control and treatment, though some people need long-term management.
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.