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©).

Itchy Eyes

Have your eyes been itchy and driving you crazy? It might not be what you think it is. Allergic conjunctivitis with hay fever, dry eye, pink eye or blepharitis could lead to wrong treatment and side effects.

With an estimated 50 million white blood “mast” cells, the eye can sense irritants and release histamine and other substances to defeat the irritants. Histamine stimulates eye nerve endings which irritates the eyes causing the itch.

Approximately 50 million people in the U.S. have allergies. Some are allergic to environmental triggers but the majority experience symptoms when grass, pollens and mold are in the air. Common allergens include pollen, dust mites, ragweed, mold, pet dander, perfumes, smoke and some fragrances or cosmetic ingredients.

When allergies target the eyes, the condition can be miserable. Eye conjunctivitis may get treated as part of a nasal allergy or it can be mistaken for other serious conditions like infectious conjunctivitis also known as pink eye, dry eye disease, blepharitis (inflammation of the eyelids), herpes virus or keratitis (corneal ulcer).

Making these distinctions is critical to ensuring the proper treatment is diagnosed, to quickly reduce the symptoms and reduce the potential risk of harm to the eyes. The American College of Allergy, Asthma and Immunology (ACAAI) warns that extended use of some nasal allergy medications can leave allergic eyes drier and even more irritated.

Usually if the eyes are itchy and watery, it’s probably an allergy with intense itching with tearing and redness.

Seasonal Allergic Conjunctivitis

Most of the eye allergies in the U.S. are seasonal conjunctivitis occurring in the spring, summer and fall. Symptoms include dark under the eye circles, light sensitivity and puffy eyelids.

Perennial Allergic Conjunctivitis

This condition is where eye allergies occur year-round but commonly caused by household/workplace irritants, dust mites, mold and pet dander. The symptoms are the same as seasonal conjunctivitis but usually less severe.

Vernal Keratoconjunctivitis

This year-round condition and worsen during pollen seasons and targets boys, young men, and people with asthma or eczema. Symptoms include the feeling of something in your eye and light sensitivity.

Atopic Keratoconjunctivitis

Another year-round atopic (sensitive to allergens) keratoconjunctivitis, this strikes older men who have allergic dermatitis (an immune reaction in the skin). Symptoms are eye burning and a thick mucus that accumulates on eyelids overnight.

Contact Allergic Conjunctivitis

Direct contact with potential allergens such as eye drops with preservatives can lead to this reaction. Symptoms can also cause discomfort wearing contact lenses and mucus discharge.

Giant Papillary Conjunctivitis

This severe condition leads to fluid sacs (papules) forming in the upper eyelid lining. Doctors can see them by turning the lids inside out. Other symptoms include blurry vision from mucus discharge, foreign body sensation, discomfort wearing contacts and a sense that contacts are moving, puffy or droopy eyelids.

What else could it be other than an eye allergy?

Pain in the eye or diminished vision are serious symptoms not typical for allergies. Dry Eye Disease (DED) allergy and DED are very similar. Pink eye causes red, painful eyes indicating infection of inflamed conjunctiva. Pink eye is very contagious and usually begins in one eye and generates a sticky secretion that coats the lashes. A swollen lymph not by the ear may also appear.

Pollen clogged tear grands can resemble blepharitis, a disorder of the eyelid’s oil producing glands. It can almost always be infectious and symptoms include irritation, redness, flaky eyelid skin and crusted lashes.

Karatitis is the inflammation of the cornea, and symptoms include redness, pain, watering, blurry or decreased vision and rarely itchiness. Herpes eye disease can lead to pain, tearing, redness, light sensitivity, and a skin rash or sore near the eye. Observation or special blood tests can confirm this disease.

Other itchy conditions include contact dermatitis, atopic eczema and psoriasis all have itching on the eyelid or the skin around the eye.

Prevention

Avoid a known allergen
Protect eyes with sunglasses, visored hats and swimming goggles
Wash hands when coming indoors (especially after handling animals)
Wash your face to clean off allergens
Soothe eyes with a cold compress
Try preservative free tear substitutes
Consider mite-proof bedding
Wash sheets and blankets in hot water weekly
Check for and eliminate mold by regularly cleaning the areas of your home where moisture may accumulate (base of the toilets, closets, mudrooms, HVAC filers, water filters, windowsills and gutters
Use air conditioning in your car and in your home
Leave your shoes at the door

Avoidance

Eye drops with herbal extracts
Eye products using preservatives
Window fans that draw in allergens
Indoor humidity exceeding 50 to 50 percent to discourage mold
Dry dusting or sweeping floors and spreading allergens
Wearing contact lenses too long
Rubbing eyes

If you think you might have an eye allergy, discuss this with your OAAC provider. There are many types of drugs and treatments available. Your OAAC allergist can find the right mix of medication and treatment to defeat the eye allergy itch.

The post Itchy Eyes appeared first on Oklahoma Allergy and Asthma Clinic.

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Non-Allergic Rhinitis (Vasomotor)

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