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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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Pregnancy and Allergies

A woman’s body experiences many changes when pregnant. Some women may develop allergies during pregnancy. It’s more common for women to already have allergies before conception.

Can allergies worsen during pregnancy?

About one-third of moms-to-be find their allergy symptoms get worse during pregnancy. The same number of women said their allergies stayed the same. Another one-third found their symptoms actually improved during pregnancy.

Common Symptoms

Symptoms are basically the same for those not pregnant which includes: itchy, watery eyes; sneezing; sore or itchy throat; runny nose and sinus congestion.

Stuffy Nose

Many pregnant women can develop stuffy noses. Nasal congestion normally starts in the second trimester cause mucus membranes to swell and soften. Some doctors call it pregnancy rhinitis.

Pregnancy rhinitis can feel like a cold or an allergy. It can also cause nosebleeds during pregnancy and even a post nasal drip that can cause coughing and even gag at nighttime. Typically, pregnancy rhinitis goes away after the pregnancy ends.

What is the difference between allergies and pregnancy rhinitis? For those who have allergies, symptoms experienced included congestion, coughing, sneezing and itchy eyes. If itchiness and sneezing isn’t causing issues, it could be hormone-related pregnancy congestion. Discuss any issues you are having with your doctor.

Allergy Medicines for Pregnant Women

Women need to be very careful taking any medications during pregnancy and most importantly during the first trimester. It’s important to discuss any allergy medications with your doctor. Reducing allergens in the home without using medications could be a first line of defense for the mom-to-be. Allergy proofing the home, avoiding allergy triggers and trying a saline nasal spray, nasal irrigation or nasal strips.

After the first trimester – oral antihistamines treat nasal and eye allergy symptoms of allergic rhinitis.

Considered safe for pregnancy according to multiple studies – Loratadine and cetirizine are second-generation antihistamines. These drugs do not cause drowsiness like first-generation oral antihistamines do – chlorpheniramine, diphenhydramine and tripelennamine.

Corticosteroid nasal sprays are mostly safe and can be prescribed to pregnant women with moderate to severe allergy symptoms that last more than a few days. Budesonide is considered the safest. Mometasone and fluticasone are also considered safe.

Decongestant nasal sprays can cause issues. Some studies point to a risk of birth defects when pregnant women use these products. They are not recommended during pregnancy especially in the first trimester.

Pregnant women should avoid any antihistamine nasal sprays since there is not enough research to prove their safety.

Always discuss which nasal spray might be right and any medication risks to the pregnant woman and her baby with her physician.

Allergy Shots during Pregnancy

Women can continue allergy shots that began before they were pregnant. They should stay at the current dose during pregnancy and if there are any reactions, the allergist may reduce allergy shot dosage. Generally, it is best not to begin allergy shots during pregnancy which can trigger changes in an already-changing immune system and may cause a systemic reaction.

Anaphylaxis treatment is the same during pregnancy as for non-pregnant women with food, insect venom or latex allergy. Use epinephrine at the first sign of symptoms.

Breastfeeding and Allergy Medications

Medications used during pregnancy can be continued while nursing. The baby gets less medicine through the breast mile than in the womb. Your allergist can discuss the best medications for nursing moms to use.

Do Allergies Cross Over to the Baby while Pregnant?

Allergy symptoms experienced by the mom during pregnancy are not believed to have an impact on the baby and developing allergies. Genetics play a major factor in developing allergies. For children with a parent or sibling with allergies, they have an increased risk of getting allergies.

A pregnant mother’s diet can be a factor in developing the child’s allergic rhinitis, food allergies, asthma or eczema. One study found that moms who ate plenty of food-based vitamin D reduced the child’s risk of developing allergic rhinitis. Foods with lots of vitamin D include dairy products, cereals, fish, eggs and mushrooms.

Reducing Allergy Symptoms without Taking Medications

Stay away from people who are smoking which can make allergies worse. Plus, secondhand smoke is not good for mom or her baby.

Pollen Allergies – stay inside as much as possible. Try wearing wrap-around sunglasses to keep pollen out of the eyes. Coming back inside, take off shoes, washing hands and face and changing clothes will help keep the pollen off. Put clothes in the wash. Shower and wash hair before bedtime to reduce nighttime symptoms.

Dust allergies – have someone clean the home regularly (if possible) and use a HEPA filter vacuum. A wet mop and a sweeper can help avoid stirring up the dust. Microfiber is better than a duster to trap the dust.

Pet allergies – for those allergic to their own pets, try to make one room that is pet-free.

Avoidance diets do not prevent allergic disease according to the American Academy of Pediatrics. This means that pregnant women shouldn’t worry about avoiding common food allergens such as peanuts, tree nuts, milk or wheat. Studies have shown that consuming peanuts, milk and wheat in the first and second trimesters can reduce the risk of a child developing a peanut allergy, allergic rhinitis and asthma. Unfortunately, no specific diet or food can prevent allergic disease.

Always discuss with your doctor before making any changes in diet during pregnancy.

The post Pregnancy and Allergies appeared first on Oklahoma Allergy and Asthma Clinic.

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