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Non-Allergic Rhinitis (Vasomotor)

Non-Allergic Rhinitis (Vasomotor)

Non-allergic rhinitis is a chronic condition that can occur at any age but is more common in adults. The most common symptoms are nasal congestion, post-nasal drainage, and headache, although runny nose, sneezing and itching of the nose may occur in some non-allergic individuals. Many non-allergic patients have recurrent sinusitis and middle ear infections or middle ear fluid collection.

Initial evaluation requires that surgical conditions (growths in the nose, crooked nasal septum, etc.) and general medical conditions (thyroid disease, pregnancy, etc.) are not responsible for the chronic symptoms. We recommend that ever patient have a family practitioner, internist, or pediatrician to follow them for their general medical care. If the history and physical examination are not positive for surgical or general medical problems, the patient most likely has the most common nasal problem of non-allergic or allergic nasal disease.

Non-allergic rhinitis is a very difficult topic to fully understand. The actual defect resulting in the symptoms commonly found is not known. We do know that the difficulty arises in the inability to correctly change the size of blood vessels and the quantity of mucus produced by mucus glands in the nose. Under normal circumstances the nose warms or cools the air entering the nose to 98 degrees F., increases the humidity to at least 80%, and filters unwanted substances resulting in relatively clean air at 98 degrees F. and 80% humidity entering the lungs regardless of current environmental conditions. These changes occur almost instantly with each breath. The non-allergic individual has lost the ability to make the necessary changes either from an ineffective blood vessel and mucus gland controlling mechanism, temperature and humidity sensing mechanism, or both. The end result is inappropriate blood vessel size and/or excess mucus production which can result in nasal congestion, post-nasal drainage, and headaches.

Many individuals with non-allergic nasal disease will have a significant amount of irritation, inflammation, and hyperreactivity in the nose contributing to the persistent, chronic nature of the disease.

Nasal allergy on the other hand usually presents with runny nose, sneezing, and itching but some patients can also have nasal congestion, post-nasal drainage, and headaches. With nasal allergy we usually see definite problems at certain seasons of the year or a correlation with exposures to dust, animal dander, mold or mildew exposures and in some patients’ extreme reactions to certain foods. Allergy symptoms also involving the eyes usually are redness, itching and watering of the eyes.

It is possible for an individual to have problems with both non-allergic rhinitis and allergic rhinitis, and this makes the problems at times more difficult to clearly diagnose and treat.

Several tests can be used to differentiate non-allergic rhinitis from allergic rhinitis. Skin testing, as one might expect, displays positivity in patients with allergic rhinitis, whereas a negative skin test will be obtained in patients with non-allergic rhinitis. In addition, the blood IgE levels and eosinophils (the allergy cell) are elevated in patients with allergic rhinitis but not in non-allergic rhinitis.

Non-allergic rhinitis often is triggered by drafts, temperature changes (especially cold air), by scented cosmetics (both men’s and women’s cosmetics), by cigarette and tobacco smoke, as well as fireplace smoke, scented or perfumed soaps. Many types of aerosol sprays, even scented deodorants can cause problems. Paint fumes, insecticides, bug sprays,
varnishes, and even the odor from new clothing, carpeting or furniture can cause problems. Kerosene, lighter fluids, oil and gas fumes can cause problems. House dust may act as an irritant, and should be avoided.

Do not overuse over-the-counter decongestant sprays or nose drops because these can cause “rebound” nasal congestion. All nasal decongestant sprays should be discontinued following 3 days of continuous use. Medications will be prescribed to help with this problem. A good part of the treatment is avoiding known problems and exposures, and working by trial and error to find medications that work best in your case. Medications that may be tried include: Astelin© nasal spray, decongestants, decongestant-antihistamine combinations, intranasal steroid sprays, and possibly an atropine-derivative nasal spray (Atrovent©).

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Facts and Figures about Allergies

May is allergy and asthma awareness month. This information is from the Asthma and Allergy Foundation of America. 

What Is an Allergy?

  • An allergy is when your immune system reacts to a foreign substance, called an allergen. It could be something you eat, inhale into your lungs, inject into your body, or touch.
  • An allergic reaction can cause coughing, sneezing, hives, rashes, itchy eyes, a runny nose, and a scratchy throat. In severe cases, it can cause low blood pressure, breathing trouble, asthma attacks, and even death if not treated promptly.
  • There is no cure for allergies. You can manage allergies with prevention and treatment.
  • Allergies are among the country’s most common, but overlooked, diseases.

How Common Are Allergies?

  • More than 50 million people in the U.S. experience various types of allergies each year.
  • Allergies are the sixth leading cause of chronic illness in the U.S.

How Many People Seek Medical Care for Allergies?

  • Allergic conditions are one of the most common health issues affecting children in the U.S.
  • Each year in the U.S., it is estimated that anaphylaxis (a severe allergic reaction) to food results in 90,000 emergency room visits.

How Many People Die From Allergies?

  • The most common triggers for anaphylaxis are medicines, food, and insect stings. Medicines cause the most allergy-related deaths.
  • Black people and older adults in the U.S. have the highest rates of death due to allergic reactions to medicines, food, or unknown allergens.

What Are the Costs of Allergies?

  • The cost of nasal allergies is between $3 billion and $4 billion each year.
  • Food allergies cost about $25 billion each year.

What Are Indoor and Outdoor Allergies?

  • Indoor and outdoor allergies can lead to sinus swelling/pain, itchy/watery eyes, nasal congestion, and sneezing. Airborne allergens can cause seasonal (sometimes called “hay fever” or “rose fever”) or constant (called “persistent”) allergies.
  • Many people with allergies often have more than one type of allergy. The most common indoor/outdoor allergy triggers are: tree pollen, grass pollen, weed pollen, mold spores, dust mites, cockroaches, cat and dog dander, and rodent urine.

How Common Are Seasonal Allergies?

  • In 2018, approximately 24 million people in the U.S. were diagnosed with seasonal allergic rhinitis (hay fever). This equals around 8% (19.2 million) of adults and 7% (5.2 million) of children.
  • Seasonal allergic rhinitis is an allergic reaction to pollen from trees, grasses, and weeds. This type of rhinitis occurs mainly in the spring and fall when pollen from trees, grasses, and weeds are in the air.
  • In 2018, white children were more likely to have hay fever than Black children.
  • The same triggers for indoor/outdoor allergies also often cause eye allergies.

How Common Are Skin Allergies?

Skin allergies include skin inflammation, eczema, hives, chronic hives, and contact allergies. Plants like poison ivy, poison oak, and poison sumac are the most common skin contact allergy triggers and cause symptoms days after the exposure. But skin contact with cockroaches and dust mites, certain foods, or latex may also cause skin allergy symptoms.

  • In 2018, 9.2 million children had skin allergies.
  • Children birth to age 4 are most likely to have skin allergies.
  • In 2018, Black children in the U.S. were more likely to have skin allergies than white children.

How Common Are Food Allergies?

Nine foods cause most food allergy reactions. They are milk, soy, eggs, wheat, peanuts, tree nuts, sesame, fish, and shellfish.

  • About 32 million people have food allergies in the U.S.8,9 o About 26 million (10.8%) U.S. adults have food allergies.8 o About 5.6 million (7.6%) U.S. children have food allergies.
  • In 2018, 4.8 million (6.5%) children under 18 years of age had food allergies over the previous 12 months.
  • In 2018, 6% of Black and Hispanic children had food allergies over the previous 12 months, compared to 6.6% of white children.7 o Food allergy has increased among U.S. children over the past 20 years, with the greatest increase in Black children.
  • Milk is the most common allergen for children, followed by egg and peanut.
  • Shellfish is the most common allergen for adults, followed by peanut and tree nut.
  • Sesame is a rising food allergy. It impacts an estimated 1 million people in the United States. It was declared a major allergen in the United States in 2021.

How Common Are Drug Allergies?

  • Severe drug reactions account for 3% to 6% of all hospital admissions worldwide. Drug allergy accounts for less than 10% of these severe drug reactions.
  • The most commonly reported drug allergy is to penicillin, with up to 10% of people saying they are allergic to these drugs. However, less than 10% of these people (or less than 1% of 3 the total population) are actually allergic to penicillin drugs when evaluated for these allergies.

How Common Is Latex Allergy?

  • About 4.3% of the general population has a latex allergy.
  • Latex allergy is more common in certain occupations. Approximately 9.7% of health care workers have a latex allergy.

How Common Is Insect Allergy?

People who have insect allergies are often allergic to bee, wasp, and ant stings. Cockroaches and dust mites may also cause nasal or skin allergy symptoms.

  • Insect sting allergies affect 5% of the population.
  • As many as 100 deaths occur each year in the United States due to insect sting anaphylaxis.

The post Facts and Figures about Allergies appeared first on Oklahoma Allergy and Asthma Clinic.

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