It's a very common problem; allergic rhinitis affects around one in five people in the UK and persistent non-allergic rhinitis is also becoming more common in older people.
In allergic rhinitis, the body makes allergic antibodies called immunoglobulin E (lgE) in response to substances including: pollen; house dust mite faeces; pet dander; and moulds. When you inhale these allergens, the cells in the lining of the nose release a chemical made in the immune system called histamine, which causes symptoms of inflammation.
Allergic rhinitis can be seasonal as with hay fever, or year-round caused by allergens such as: house dust mite faeces (invisible to the naked eye and found in mattresses, pillows, cushions and carpets in dust); pets; moulds; or occupational exposure to chemicals, including latex.
In non-allergic rhinitis, triggers can include: smoke; chlorine in swimming pools; hormonal changes; an overactive thyroid; sensitivity to some foods or drinks (or possibly preservatives or colourants); and occasionally the side-effects of medicines, including beta-blockers, aspirin, the contraceptive pill and chlorpromazine (often used to treat mood disorders).
The symptoms of both allergic and non-allergic rhinitis include a runny nose (often persistent and sometimes referred to as ‘rhinorrhea’), itching, sneezing and nasal congestion. You might not sneeze as much with the non-allergic form, but you might experience more itchiness – particularly the eyes.
Other symptoms can include: a tickly throat; losing your sense of smell; facial aches and pains; headache; and watery red eyes. If symptoms are severe, they can disrupt your sleep and interfere with everyday life.
This is made by your GP listening to your description of symptoms and examining your nose. In severe cases, where the cause is unknown or symptoms are not resolved with standard treatments, you may need a referral to an allergy specialist for allergen tests.
Who gets rhinitis?
Those most at risk of allergic rhinitis are those with other atopic (allergic) conditions, such as asthma and eczema, and people with a family history of the condition (with first-born children often more affected). It peaks in childhood and adolescence, with 80 per cent of those with allergic rhinitis diagnosed before the age of 20. In the UK, 10 per cent of six to seven year-olds have the condition.
More adults than children suffer with non-allergic rhinitis, and it's becoming increasingly common in older people. Pregnant womenalso have an increased risk.
Allergen avoidance is generally the first step in treatment for allergic rhinitis, but as allergens tend to be inhaled, some aren't easy to avoid. You can steer clear of pets, but it's harder to avoid pollen, mould spores and dust mites. Allergy-proof mattress covers are widely available, but a large study found them to be ineffective.
Avoiding non-allergic triggers including smoke can help reduce symptoms. Washing the nose out with a saline solution can also ease congestion.
Mild to moderate allergic rhinitis should respond to over-the-counter antihistamines which reduce histamine production (some cause drowsiness and can affect your ability to drive so choose non-sedating ones). If the main symptom of allergic rhinitis is a blocked nose, your GP can prescribe a nasal corticosteroid spray.
For severe cases of allergic rhinitis, oral corticosteroids and nasal decongestants can also be prescribed.
‘Immunotherapy’, or ‘desensitisation’, is another possible treatment option for allergic rhinitis in more severe cases, when none of the above has been found to be effective. This is done by an allergy specialist and involves exposing you to tiny amounts of an allergen (either under the tongue or via injection) in increasing doses with an aim of building up tolerance.
The dietary supplements bromelain, quercetin and vitamin C may also be useful in treatment.