What Causes Chronic Rhinitis?

Medical professionals usually categorize chronic rhinitis into two main groups depending on the underlying cause:

• Allergic rhinitis: Also known as hay fever, this can occur because of an allergic response to specific allergens, such as pollen, dust, or pet dander. During an allergic response, your body’s immune system overreacts to the presence of one of these allergens in the air.
• Nonallergic rhinitis: This includes any form of rhinitis that doesn’t involve your body’s immune system. Environmental factors, such as air pollution, smoke (whether from tobacco, cannabis, or a fire), or strong odors can trigger it. In some cases, doctors may not identify a specific cause.

Chronic nonallergic rhinitis isn’t as common as allergic rhinitis. Chronic nonallergic rhinitis represents about 25% of all rhinitis cases.

If you’re not sure what’s causing your symptoms, a doctor can perform an allergy test called an allergen-specific immunoglobulin E (IgE) antibody test. This may help determine if an allergy is causing your symptoms.

Allergic and nonallergic chronic rhinitis have many different causes. If your symptoms don’t go away, you may want to see a doctor for a diagnosis and treatment.

Causes of allergic rhinitis

In allergic rhinitis, allergens in the air bind with a substance called immunoglobulin E (IgE) in the nose. Your body releases a chemical called histamine to help defend against the allergen. This histamine release results in allergic rhinitis symptoms.

Common allergens that can lead to chronic rhinitis may include:

• ragweed
• pollen
• mold
• dust mites
• pet dander
• cockroach residue

Pollen can be especially challenging at certain times of the year. Tree and flower pollen allergies more commonly occur in the spring. Allergies to grasses and weeds tend to occur in the summer and fall.

Causes of nonallergic rhinitis

Unlike allergic rhinitis, nonallergic rhinitis doesn’t involve the immune system. Nonallergic rhinitis is thought to occur when the blood vessels inside the nose expand. This leads to swelling and congestion. It’s not known exactly why the blood vessels in the nose dilate, but the reaction may be triggered by:

• irritants or air pollution in the environment, such as:
  • perfumes
  • detergents
  • strong odors
  • smog
  • tobacco smoke
• fluctuations in the weather, such as cold or dry air
• upper respiratory infections like a cold or the flu (though these typically cause acute rhinitis)
• hot or spicy foods or drinks (gustatory rhinitis)
• certain medications, including:
  • aspirin
  • ibuprofen
  • beta-blockers
  • antidepressants
  • oral contraceptives
• overuse of nasal decongestant sprays (rhinitis medicamentosa)
• hormonal changes associated with pregnancy, menstruation, or thyroid conditions
• stress
• extensive sinus surgery
• structural problems that affect the nasal passages, including a deviated septum, enlarged turbinates, and enlarged adenoids
• other medical conditions, including GERD, asthma, or chronic sinusitis

For some people, doctors can’t identify the specific cause of nonallergic rhinitis.

The main symptom of chronic rhinitis is nasal congestion or a stuffy nose.

You may feel that you need to blow your nose all the time but find that little mucus comes out. This happens because the congestion isn’t caused by mucus buildup but because the nasal passages are swollen.

Both allergic and nonallergic rhinitis share many of the same symptoms, but there are a few key differences.

Treatments involve a combination of medications and lifestyle changes. In rare cases, a doctor may recommend surgery to relieve symptoms of chronic rhinitis.

Medications

Medications known as antihistamines can help treat the underlying cause of allergic rhinitis.

Other over-the-counter (OTC) and prescription medications may help reduce inflammation in the nasal passages. These include:

• OTC or prescription corticosteroid nasal sprays: Doctors may also recommend using corticosteroid nasal sprays to reduce inflammation.
• Prescription anticholinergic nasal sprays: Doctors may prescribe these topical treatments for nonallergic rhinitis.
• OTC or prescription antihistamines: These medications work for allergies and include oral medications and nasal sprays. These medications work best if they’re started before pollen enters the air.
• OTC saline nasal sprays: These sprays may help reduce discomfort without side effects.
• Allergic immunotherapy: This may include allergy shots or sublingual immunotherapy for allergies.
• Botulinum toxin: While less common, some doctors may recommend injections of botulinum toxin for short-term relief in people with nonallergic rhinitis.
• Mast cell stabilizers: Doctors may prescribe these medications for preventive use before you encounter an allergy trigger.

Doctors may prescribe OTC decongestants for short-term use. Don’t use these decongestants for longer than 3 days, or they can cause a rebound effect, making your symptoms worse.

Lifestyle changes

The best way to prevent and treat chronic rhinitis is to avoid the environmental allergen or trigger causing it. While it’s not always possible to completely avoid an allergen or trigger, you can minimize your exposure with the following tips:

• Keep windows closed when pollen counts are high.
• Wear a mask when mowing the lawn, doing garden work, or cleaning the house.
• Use an air purifier with a HEPA filter.
• Change your heating and air conditioning filters often.
• Use a vacuum with a HEPA filter.
• Get a dust-mite-proof pillow and use a vacuum with a HEPA filter.
• Wash your bedding weekly in hot water.
• Bathe and groom pets frequently.
• Take showers after being outside.
• Avoid secondhand smoke.

Surgery

Chronic rhinitis caused by structural problems with the nose and sinuses, like a deviated septum or persistent nasal polyps, may require surgical correction. Doctors typically recommend surgery as a last resort if several other treatment options don’t work.

You typically need to see an ear, nose, and throat (ENT) doctor, or otolaryngologist, to determine if surgery is needed. A surgeon can correct structural problems of the nose or sinuses with surgery.

Nasal irrigation is a home remedy that may be useful for both allergic and nonallergic rhinitis.

Nasal irrigation, also called nasal lavage, involves using a saltwater solution to rinse the nasal passages. Nasal sprays are available pre-packaged in most drugstores, or you can try using a device called a neti pot.

If you choose to use a neti pot for nasal irrigation, be certain that you use distilled, sterile, previously boiled and cooled, or filtered water to prevent dangerous infections.

To learn more about how to safely use a neti pot, follow these steps.

You can also try using a humidifier to keep the nasal passages lubricated and healthy. The Environmental Protection Agency (EPA) recommends cleaning your humidifiers every 2 to 3 days to prevent the growth of mold and bacteria.

Make sure you’re also drinking enough water and other caffeine-free liquids to encourage mucus drainage from the nose and reduce inflammation.

Capsaicin, which is derived from chili peppers is also sometimes touted as a treatment option for nonallergic rhinitis. However, only a few small lower quality studies have shown evidence that it’s effective at improving nasal symptoms. Larger, controlled trials are needed to confirm its effectiveness.

Capsaicin is available as an OTC nasal spray, but you should consult with a doctor before you try it.

If not treated, the chronic inflammation in the nose can lead to:

• Nasal polyps: Nasal polyps are noncancerous growths in the lining of the nose caused by chronic inflammation. Large polyps can block airflow through the nose and make it hard to breathe.
• Sinusitis: Sinusitis is inflammation of the membrane that lines the sinuses.
• Frequent middle ear infections: Infections in the ear may result from fluid and congestion in the nose.
• Missed work or disruption in daily activities: The symptoms of chronic rhinitis can be frustrating and make your day-to-day activities less enjoyable.

If you’re experiencing persistent nasal congestion that won’t go away after using OTC decongestants or antihistamines, you may want to consult a doctor.

You should also call a doctor if you have a fever or severe pain in your face or sinuses. This could mean you have a sinus infection or another serious condition that requires treatment.

At your appointment, be prepared to tell the doctor how long you’ve had these symptoms and what treatments you’ve already tried.

The following includes common questions about chronic rhinitis.

Can chronic rhinitis last for years?

Chronic rhinitis can occur due to seasonal allergies whenever the pollen you’re allergic to is in the area, whether for days, weeks, months, or years, depending on the allergen. In some cases, people can experience rhinitis with no known cause.

What is the difference between rhinitis and sinusitis?

Rhinitis is inflammation that occurs in the inner lining of the nose. Sinusitis happens when the sinus passages — the small air pockets between the eyes and behind the forehead, nose, and cheekbones — become inflamed. Both can occur with a viral infection, but rhinitis can also occur with allergies including hay fever.

What foods cause rhinitis?

Gustatory rhinitis can occur when eating certain types of foods. This may include spicy foods, hot foods like soup, and alcohol. It can cause your nose to run.

While typically not serious, chronic rhinitis can affect your day-to-day life. The best way to treat chronic rhinitis is to avoid its triggers.

If this isn’t possible, certain medications may help with your symptoms, including OTC and prescription nasal sprays and decongestants.

Try not to overuse nasal decongestants, as this can actually worsen your symptoms. Antihistamines can relieve symptoms due to allergic rhinitis but won’t work for nonallergic rhinitis.

Talk with a doctor if you’ve had nasal congestion that has persisted for more than 4 weeks, and OTC medications aren’t working.