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©).

Oklahoma City Ranks Ninth for Most Challenging Cities for Asthma

AAFA’s 2021 Asthma Capitals Report Lists Most Challenging Cities to Live in the U.S. with Asthma; Oklahoma City takes ninth place for 2021

The Asthma and Allergy Foundation of America (AAFA) recently rolled out its 2021 Asthma Capitals report. The report coincided with World Asthma Day, part of National Asthma and Allergy Awareness Month. AAFA’s Asthma Capitals report analyzes data from the 100 largest cities in the United States to determine its ranking. Allentown, Pennsylvania takes the top spot as the most challenging place to live for asthma in the 2021 report. Oklahoma City was ranked ninth and Tulsa was 24^th.

The ranking is based on three criteria: asthma prevalence, emergency department visits for asthma, and deaths due to asthma. The report also highlights risk factors including poverty, air pollution, access to specialists, pollen counts, medicine use, smoking policies, and the rate of uninsured residents in an area. AAFA previously identified existing “Asthma Belts” which continue to have a grip on the eastern half of the nation, however two western cities – Tucson, Arizona and Fresno, California, are also listed in the top 20 cities for this year’s report. The top 20 Asthma Capitals for 2021 are: 1. Allentown, Pennsylvania 2. Baltimore, Maryland 3. Richmond, Virginia 4. Milwaukee, Wisconsin 5. New Haven, Connecticut 6. Cleveland, Ohio 7. Philadelphia, Pennsylvania 8. Dayton, Ohio 9. Oklahoma City, Oklahoma 10. Tucson, Arizona 11. Worcester, Massachusetts 12. Springfield, Massachusetts 13. Columbus, Ohio 14. Birmingham, Alabama 15. Detroit, Michigan 16. Louisville, Kentucky 17. Hartford, Connecticut 18. Boston, Massachusetts 19. Fresno, California 20. Greensboro, North Carolina. To see the complete 100-city list, visit asthmacapitals.com.

“AAFA produces the Asthma Capitals report and similar research to help improve the lives of the estimated 25 million Americans living with asthma. It’s important to highlight areas which deserve our urgent attention and collective action. This includes the pressing need to develop more programs and policies that will effectively help us reduce stark disparities in asthma based on race, gender, income and where people live,” said Kenneth Mendez, CEO and president of AAFA. “This report also supports the need for climate action. Air pollution, extreme weather patterns, and natural disasters fueled by climate change continue to have a worsening impact on Americans living in certain communities. This is not only a critical area of investigation, but signals exactly where work needs to be done for those with the greatest needs.”

The report also calls attention to the role of the COVID-19 pandemic in determining the rankings. This includes some changes in health outcomes and risk factors like pollen exposure, medicine use, and emergency room visits. In 2020, fewer people experienced pollen allergies due to COVID-19 restrictions, recommendations to stay indoors, and other preventative measures like mask wearing. As a result, use of long-term asthma medicines were also down along with fewer people heading to hospital emergency rooms for asthma.

“The pandemic, economic recession, climate crisis, and racial injustice all had a significant impact on the asthma community in 2020. Despite some varying factors, asthma remains a serious public health threat with an average of 10 people dying each day. At AAFA, we reiterate that’s 10 too many. Most of these tragedies are preventable,” said Melanie Carver, chief mission officer at AAFA. “Stakeholders, policy makers, health officials, communities and individuals around the nation can use this information to join us in our mission to save lives.”

“It’s been an especially challenging year for allergies so far with high pollen and mold spore counts along with high allergy alert days,” said Oklahoma Allergy & Asthma Clinic Board-certified allergist Dr. Laura Chong. “All of these can be triggers for increases in asthma attacks too. It is important to get an evaluation to figure out your triggers and the best strategy to help optimize control of your asthma.”

The 2021 Asthma Capitals report is an independent research project of AAFA made possible in part by support from the Pharmaceutical Care Management Association (PCMA) Foundation. For the latest AAFA news and resources go to aafa.org.

The post Oklahoma City Ranks Ninth for Most Challenging Cities for Asthma appeared first on Oklahoma Allergy and Asthma Clinic.

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