Chronic Rhinitis: Causes, Symptoms, Treatment, and Management

Chronic Rhinitis Causes

There is no single cause of chronic rhinitis. There are two types of chronic rhinitis broadly (allergic and nonallergic), and some people get both.

Allergic rhinitis

Allergic rhinitis is a response of the immune system to an allergen. An allergen is a substance which causes an allergic reaction in a susceptible person. In this reaction, chemicals like histamine are released. Itching, sneezing, swelling and the production of mucus are caused by these chemicals.

Common triggers include:

• House dust mites

• The pollen of trees, grass and weed.

• Mold spores

• Pet dander

• Cockroach particles

For example, if you dust a room that has not been dusted in several weeks and your nose starts to itch and you start sneezing frequently, the airborne dust particles or dust mites may be responsible for your condition. Another common allergen is pollen. Those who suffer from pollen allergies may find their symptoms to be more severe during certain seasons, and those who are allergic to indoor allergens may find their allergy symptoms more difficult throughout the year.

Asthma, eczema, and other allergic diseases can also develop concurrently with allergic rhinitis. If you're experiencing these symptoms, in addition to chronic nasal issues, discuss them on your medical visit.

Nonallergic rhinitis

The symptoms of nonallergic rhinitis are similar to those of allergic rhinitis but are not due to an allergic reaction. Nose in this condition may be sensitive to changes in temperature, air quality, or to strong odors. The exact process is not known and varies. Common triggers include:

• Cigarette smoke

• Car emissions and air pollution

• Fresheners and perfumes which are released into the air.

• Cleaning chemicals

• Cold or dry air

• Sudden changes in humidity

• Spicy foods

• Alcoholic drinks

For example, you may get a runny nose when you're preparing a hot broth, or when you go for a walk on a cold morning. This may indicate nonallergic nasal sensitivity if it occurs more often. Contrary to allergic rhinitis, people usually don't experience itching of the eyes and nose with nonallergic rhinitis. But symptoms overlap and sometimes symptoms are not sufficient to diagnose the cause.

Medicines and rebound congestions.

Medicines might produce nasal effects or exacerbate preexisting nasal congestion.

An example of this is the use of topical nasal decongestant nasal sprays. These medications reduce the size of swollen nose blood vessels and relieve symptoms quickly. But when used longer than recommended, they can cause rebound congestion. As the medicine wears off, the nose gets clogged again. The spray can then be used more frequently for relief and this can perpetuate the cycle.

Some other medications also may cause nasal symptoms. You should let your physician know if your congestion started after you began taking a new medication or when you changed the dose. Avoid self-discontinuing prescribed medication.

Hormonal changes

The nasal lining can be altered due to hormonal changes during pregnancy and at other times in life. Sometimes, congestion or a runny nose occurs even if the person has no history of allergies. Persistent nasal congestion in pregnancy can be due to pregnancy related rhinitis. 

It should be distinguished from allergies, infection, etc. of the nose due to the fact that treatment options may differ.

Diagnosis of Chronic Rhinitis

A doctor will usually begin by asking about your symptoms and examining your nose.

You may be asked whether your symptoms occur throughout the year, during particular seasons, or after exposure to specific substances. Your doctor may also ask about your sleep, other allergies, asthma, and any medicines or nasal sprays you use.

These details can help narrow down the possible causes.

Allergy testing

• An allergy test may be recommended when allergic rhinitis is suspected but the trigger is unclear. Skin-prick testing and blood tests for allergen-specific IgE antibodies are commonly used.

• A positive result does not automatically mean that the allergen is causing your symptoms. Your doctor needs to compare the test result with your medical history.

Examination of the nose.

• Nasal examination may show swelling, mucous or polyps or structural issues.

• Your doctor may recommend nasal endoscopy if your symptoms are very troublesome, unusual, or not controlled by other treatments. 

• This enables a more detailed examination of the inside of the nose.

• If rhinitis is uncomplicated, it is not routinely necessary to obtain a CT scan. 

• It might be recommended for people whose physicians think they have chronic sinusitis or another condition that requires further testing.

A proper diagnosis ensures that the wrong medication is not utilized for months and months without any improvement.

Chronic Rhinitis Treatment Options

Treatment is based on the cause and symptoms that are most bothersome. Medicines effective in treating allergic sneezing may not be as effective in controlling a constant runny nose from nonallergic rhinitis.

1. Steroid nasal sprays

Steroid nasal sprays help to decrease inflammation within the nose. They are often prescribed for chronic allergic rhinitis and may be useful for some people with nonallergic symptoms.

These include fluticasone, budesonide, and mometasone.

These sprays can help with nasal blockage, sneezing and a runny nose. As with any medication, regular use as directed is essential as the full benefit may take several days or more.

The correct technique is also important.

• Before using the spray, gently blow your nose.

• Slightly lean your head forward.

• Hold the nozzle in your nostril just inside.

• Point it outside the middle wall of your nose.

• Breathe in deeply while one is spraying.

Directing the nozzle at the middle partition may cause irritation of the tissue and may lead to nasal bleeding. If bleeding occurs on an ongoing basis, consult your doctor/pharmacist for help.

2. Antihistamines

Antihistamines are used to prevent histamine, a chemical that causes allergic symptoms.

May decrease sneezing, nasal itching, watery eyes and runny nose.

There are medicines that can be taken by mouth.  Medicines  like cetirizine, loratadine, and fexofenadine, and nasal antihistamines are useful.

Certain over-the-counter antihistamines for allergies may make a person sleepy. Before driving or operating machines, read the Product Label, particularly the first time taking a medicine. It is best to discuss with your doctor before consuming any medicine.

Some nasal steroids are required for severe congestion. They are not also equally effective in all forms of nonallergic rhinitis.

Your doctor will be able to suggest a suitable one if you have experienced certain symptoms or a medical history.

3. Saline nasal rinses

Saline rinse means salt water rinse which is used to flush out mucus and irritants from the nose. Can assist in breaking up thick mucus and relieving nasal discomfort.

You may use a commercially-prepared saline spray or a nasal irrigation device.

There's a need to pay attention to water safety when rinsing your nose. Tap, distilled, sterile or previously boiled and cooled water can be used. Avoid using untreated tap water to irrigate the nose.

Wipe the device clean following instructions, and let it dry between uses. Rinse if you experience pain, bleeding or discomfort, stop and seek advice.

Saline rinses may be used as an adjunctive therapy, but if chronic rhinitis is solely due to inflammation, this may not be enough.

4. Decongestants

Decongestants help to decrease swelling and can give temporary relief from blocked nose.

Beware however that decongestant nasal sprays can only be used for the brief term mentioned on the bottle or advised by a health professional. They may lead to rebound congestion if used for a long period of time.

There are risks associated with oral decongestants too. They can cause blood pressure to increase, change the heart rate or interfere with other medications. People with medical conditions should check with a clinician before using them.

If a person has used a nasal decongestant daily, consult with a physician regarding a regimen for controlling the rhinitis and selecting a more appropriate chronic therapy.

5. Other treatments

If the usual treatment doesn't help relieve pain, the doctor might try other medications. Some of them are:

Ipratropium nasal spray

May decrease nasal secretions in certain patients.

Combination nasal sprays

These are sprays that contain an antihistamine and a steroid which may be beneficial for people with persistent symptoms.

Allergen Immunotherapy

Immunotherapy using allergens (shots) or other treatments may be appropriate for individuals with known allergies.

Specialist assessment

Consultation with an ear, nose and throat (ENT) specialist may be recommended to assess any suspected nasal polyps, structural issues or a chronic sinus condition.

Allergic (hay fever) rhinitis and nonallergic (viral) rhinitis are not treated with antibiotics. Antibiotics can only be used if there's a bacterial infection that needs antibiotics.

Home remedies for chronic rhinitis.

You might be able to lessen the frequency of your symptoms by making some changes to your environment. Try to concentrate on triggers that appear to be relevant to you instead of on all possible remedies.

Reduce indoor dust

• Wipe down the house with a damp cloth and frequently wash bedding. If dust mites are a known allergen, your doctor might prescribe allergen-proof mattress and pillow covers.

• Vacuuming the room using a proper filter can help to lower the dust in the air, but no cleaning process eliminates all allergens.

Do not expose yourself to smoke or strong odors.

• Cigarette smoke, incense, perfumes, and cleaning fumes are irritating to sensitive nasal passages.

• If you find that a specific room freshener or cleaning spray makes your nose run, discontinue use of that product and check if your symptoms get better.

Be aware of weather and pollen levels.

• When pollen is a problem, see if the local pollen forecasts are available; in case of a high pollen day try to keep windows closed and change clothes after going outside.

• In cold weather, covering the nose with a scarf may help minimize exposure to cold air, which is a trigger.

Create a symptom calendar.

• Make note of when your nose gets blocked, when you sneeze and what you were doing before the symptoms started.

• For instance, you might find that getting rid of congestion is more difficult after cleaning, while you have a watery nose when eating spicy food. 

• These patterns can aid your doctor in identifying possible triggers.

Follow your treatment plan

• Follow doctors' instructions to use prescription nasal sprays, as directed, and allow time for them to be effective. 

• Do not increase the dose or keep changing medicines regularly if symptoms persist after regular treatment; instead, make an appointment to discuss this with the doctor.

• Don't use steam inhalation as a cure. The hot steam may cause burns, and also there is a little evidence of its effectiveness in treating chronic rhinitis.

When to seek medical attention?

Schedule an appointment if symptoms last several weeks, occur often, disrupt sleep or daily activities, or don't improve with proper treatment.

Some symptoms require immediate attention. These include:

• A blockage or discharge from a single nostril that doesn't clear up.

• Nosebleeds that happen over and over or blood coming out of the nose.

• Extremely painful swelling or pain in the face

• Fever with increased symptoms

• Loss of smell that has not been explained and has never happened before.

If it is one-sided, this does not necessarily mean that there is something seriously wrong, but it is still worth looking at and not continuing treatment at home.

If you have serious breathing trouble, swelling around your eyes and a change in vision, or a severe headache with neurological symptoms, get emergency medical help.

If you have asthma, seek medical advice when your breathing or asthma symptoms worsen. Some people have both rhinitis and asthma and/or require treatment for both.