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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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How Can I Control Indoor Allergens and Improve Indoor Air Quality?

From the Asthma and Allergy Foundation https://aafa.org

Allergy and asthma control begins at home. Many people with allergies stay indoors when pollen and mold is high. But dust mites, pet dander and even cockroaches can cause problems indoors.1

The Environmental Protection Agency recommends three ways you can improve indoor air quality:2

  • Control your contact with indoor airborne allergens
  • Ventilate your indoor areas well
  • Use air cleaners to clean indoor air

Eight out of 10 people in the United States are exposed to dust mites. Six out of 10 are exposed to cat or dog dander. Cockroaches cause allergic reactions in people who live in the inner cities or southern parts of the United States. 3

Better air quality in your home, office, school and car can reduce allergy and asthma triggers.

What Size Are Allergens?

Allergens are substances that cause allergic reactions and trigger asthma symptoms in some people. The air spreads allergens around. They settle onto furniture and floors. They vary in size and are measured in microns (also called micrometers).4

Is It Possible to Control Indoor Allergens?

You can control indoor allergens with cleaning and reducing allergens in your home. The main sources of indoor allergens are:

  • Pets
  • Wall-to-wall carpet
  • Soft furniture
  • Stuffed toys
  • Bedding
  • Damp areas
  • Indoor plants
  • Mattresses that aren’t in allergy covers
  • Pillows and bedding you can’t wash in hot water

There may be more allergens on surfaces than in the air. Surface allergens enter the air easily when you disturb them by dusting or sitting.

Will Air Cleaning Devices Help?

Air cleaning devices might help. But the best way to improve your air quality is to get rid of the sources of allergens and irritants from your home. Take measures to avoid and reduce your contact with allergens. Also increase the flow of outdoor air into your home and reduce humidity as much as possible.

Reducing humidity decreases dust mites and mold growth. Air conditioners help reduce humidity too. They can also prevent outdoor allergens. Keep your windows and doors closed. Turn your air conditioner on recirculate. These steps can help reduce outdoor allergens like pollen and mold.

Air cleaners with CERTIFIED asthma & allergy friendly® filters can filter almost 98% of allergen particles in the air. Look for CERTIFIED asthma & allergy friendly® devices.

What Steps Can I Take to Control Indoor Allergens?

Control dust mites. Keep surfaces in your home clean and uncluttered. Bare floors and walls are best, especially in the bedroom where you spend one-third of your time. Avoid wall-to-wall carpet, if possible. If you must have carpet, use low-pile carpets or throw rugs you can wash. Also avoid heavy drapes and overstuffed fabric furniture. Replace drapes and blinds with roll-down shades or washable curtains.5

Use zippered allergen-resistant or plastic covers on your pillows, mattresses and box springs. These covers are very effective in controlling your contact with dust mites. Encasing mattresses works better than air cleaners to reduce allergy symptoms. Wash your bedding, uncovered pillows and stuffed toys in water 130 degrees Fahrenheit or hotter each week. Dry them in a hot dryer cycle to kill dust mites.

Vacuum once or twice a week. Vacuuming helps keep allergens low. But poor quality vacuums could put dust into the air. Look for CERTIFIED asthma & allergy friendly® vacuums. These vacuums have been tested and found to prevent allergens from going back into the air.

If you have allergies, wear a mask while doing housework. Use a cloth that is damp or treated with polish for dusting. Leave the house for several hours after cleaning it.

Prevent pet dander. Most doctors suggest that people who have allergies to animal dander not have pets with feathers or fur. There is no such thing as a hypoallergenic pet. People with pet allergies are allergic to animal dander which are shed skin cells that all animals have. Some animal dander has fewer allergenic proteins. This may lead to fewer or no symptoms.

Keep pets out of your bedroom. Close the doors to bedrooms when you are not home to keep pets out. Cover vents with dense material like cheesecloth. Animal allergens are sticky. Wash and change your animal’s favorite furniture and toys often.

Replace wall-to-wall carpet with bare floors or a low-pile carpet. Bathing and brushing your pets often may reduce symptoms. But avoid grooming your pets if you have animal allergies. If you must groom them, wear a mask.

Long-haired pets can also bring pollen inside in high pollen seasons like spring and fall.

If you suspect you have a pet allergy, see a board-certified allergist for allergy testing.

Prevent pollen from getting inside by keeping windows and doors closed. Use air conditioning in warm weather to control dust mites and reduce humidity. Change filters often.

Avoid mold spores. Reduce moisture around the bathroom, kitchen and other areas where there is a lot of water. Here are some ways you can reduce mold:

  • Don’t run your showers for a long time before bathing.
  • Use dehumidifiers to reduce both mold and dust mites.
  • Use humidity monitors.
  • Limit yourself to a few house plants.
  • Fix all leaks and other causes of damp areas.
  • If you see mold on a surface, clean it immediately. Wear a mask and clean the surface each week to keep it from returning.

Control cockroaches. Do not leave food or garbage uncovered. Use poison baits, boric acid and traps instead of chemicals. Chemicals may irritate your sinuses and asthma.

The post How Can I Control Indoor Allergens and Improve Indoor Air Quality? appeared first on Oklahoma Allergy and Asthma Clinic.

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