Rhinitis is the medical term for inflammation of the inner lining of the nose. Chronic means that the nasal inflammation is long term, lasting for more than four consecutive weeks. This is different from acute rhinitis, which only lasts a few days or up to four weeks.
Most often, chronic rhinitis is caused by allergies (also known as hay fever), but there are several other causes unrelated to allergies, including:
- irritants in the air
- other medical conditions like asthma or chronic sinusitis (inflammation of the sinuses)
Chronic rhinitis is usually categorized into two main groups depending on the underlying cause:
- Allergic rhinitis (hay fever) is caused by an allergic response to specific allergens, like pollen, dust, or pet dander. During an allergic response, your body’s immune system is overreacting to the presence of one of these allergens in the air.
- Non-allergic rhinitis is any form of rhinitis that doesn’t involve your body’s immune system. It’s often triggered by environmental issues, like air pollution, tobacco smoke, or strong odors. In some cases, a cause cannot be identified.
Chronic non-allergic rhinitis isn’t as common as allergic rhinitis. Chronic non-allergic rhinitis represents about one-fourth 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 to find out if your symptoms are likely caused by an allergy.
Allergic and non-allergic chronic rhinitis have many different causes. If your symptoms persist, see a doctor for a proper diagnosis.
Causes of allergic rhinitis
In allergic rhinitis, allergens present 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 include:
- dust mites
- pet dander
- cockroach residue
Pollen can be especially challenging at certain times of the year. Tree and flower pollens are more common in the spring. Grasses and weeds are usually produced in the summer and fall.
Causes of non-allergic rhinitis
Unlike allergic rhinitis, non-allergic rhinitis doesn’t involve the immune system. Non-allergic 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:
- strong odors
- tobacco smoke
- fluctuations in the weather such as cold or dry air
- upper respiratory infections, like a cold or the flu (however, these infections typically result in acute rhinitis)
- hot or spicy foods or drinks (gustatory rhinitis)
- medications, including:
- oral contraceptives
- overuse of nasal decongestant sprays (rhinitis medicamentosa)
- hormonal changes associated with pregnancy, menstruation, or thyroid conditions
- extensive sinus surgery
- structural problems that affect the nasal passages. including a deviated septum, enlarged turbinates, and enlarged adenoids
- other medical conditions, including gastrointestinal reflux (GERD), asthma, or chronic sinusitis
For some people, the specific cause of non-allergic rhinitis can’t be identified.
The main symptom of chronic rhinitis is nasal congestion. You may feel that you need to blow your nose all the time, but find that little mucus actually comes out. This is because their congestion isn’t caused by mucus buildup, but rather because the nasal passages are swollen.
Both allergic and non-allergic rhinitis share many of the same symptoms, but there are a few key differences.
|Symptoms||Allergic rhinitis||Non-allergic rhinitis|
|Itchy eyes, nose, throat||✔|
|Blueish discoloration under the lower eyelids (allergic shiners)||✔|
|Symptoms tend to be seasonal||✔|
|Symptoms tend to be year-round||✔|
Treatments involve a combination of medications and lifestyle changes. In rare cases, surgery may be necessary to alleviate the symptoms of chronic rhinitis.
Medications known as antihistamines can help treat the underlying cause of allergic rhinitis.
There are several other over-the-counter (OTC) and prescription medications available to help relieve some of the inflammation in the nasal passages. These include:
- OTC or prescription antihistamines work for allergies, and include oral medications and nasal sprays. These medications work best if they’re started before pollen enters the air each spring.
- OTC saline nasal sprays
- OTC decongestants. Don’t use these decongestants for longer than three days or it can cause a rebound effect, making your symptoms worse.
- OTC or prescription corticosteroid nasal sprays
- prescription anticholinergic nasal sprays
- allergy shots or sublingual immunotherapy for allergies
The best way to prevent and treat chronic rhinitis is to avoid the environmental allergen or trigger that is causing it. It’s not always possible to completely avoid an allergen or trigger, but 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.
- Purchase an air purifier.
- Change your heating and air conditioning filters often.
- Use a vacuum with a HEPA filter.
- Purchase 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.
Chronic rhinitis that is caused by structural problems with the nose and sinuses, like a deviated septum or persistent nasal polyps, may require surgical correction. Surgery is typically reserved as a last resort if several other treatment options don’t work.
Surgery to correct structural problems of the nose or sinuses is done by an ear-nose-throat (ENT) doctor, or otolaryngologist.
Nasal irrigation is one home remedy that may be useful for both allergic and non-allergic 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 absolutely certain that you use water that is distilled, sterile, previously boiled and cooled, or filtered in order to prevent dangerous infections.
To learn more about how to safely use a neti pot, follow these steps.
To keep the nasal passages lubricated and healthy, you can also try using a humidifier. Also make sure you’re drinking enough water and other caffeine-free liquids to encourage mucus drainage from the nose, and to reduce inflammation.
Capsaicin, which is derived from chili peppers is also sometimes touted as a treatment option for non-allergic rhinitis. However, only a few small low-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 your doctor before you try it.
If not treated, the chronic inflammation in the nose can lead to:
- Nasal polyps. These 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. This 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 over-the-counter decongestants or antihistamines, see your 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 your doctor how long you’ve had these symptoms and what treatments you’ve already tried.
While typically not serious, chronic rhinitis can make day-to-day life more difficult. The best way to treat chronic rhinitis is to avoid its triggers. If this isn’t possible, there are several medications available to 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 are a good treatment option for allergic rhinitis, but won’t work for non-allergic rhinitis.
Talk to your doctor if you’ve had nasal congestion that has persisted for more than four weeks and over-the-counter medications aren’t working.