Rhinitis

What is rhinitis?

Rhinitis is the medical term for a nose that's swollen and irritated on the inside, leading to a blocked or runny nose and often sneezing. It can be triggered by an allergy, such as pollen or dust mites, or by non-allergic causes such as a cold, changes in temperature, or certain medicines.

What are the symptoms of rhinitis?

Common symptoms of rhinitis include:

• a blocked or runny nose
• sneezing, sometimes in bouts
• an itchy nose, and sometimes an itchy throat or roof of the mouth
• a reduced sense of smell
• a sore throat, or a feeling of mucus dripping down the back of your throat.

If your rhinitis is allergic, you may also have itchy, red and watery eyes, and your symptoms often start within minutes of coming into contact with the trigger.

What are the causes of rhinitis and who is at risk?

Allergic rhinitis happens when your immune system reacts to something you're allergic to. Common triggers include:

• pollen from trees, grass or weeds, which is what causes hay fever
• house dust mites
• dander, which is flakes of dead skin from animals such as cats and dogs
• mould
• wood dust
• flour dust
• latex.

You're more likely to develop allergic rhinitis if allergies run in your family, or if you have eczema or asthma.

Non-allergic rhinitis has a wider range of causes, including:

• viral infections such as a cold
• changes in temperature or humidity
• exercise
• smoke, perfume or paint fumes
• alcohol and spicy food
• hormone changes during pregnancy or puberty, or hormonal medicines such as HRT or the contraceptive pill
• an underactive thyroid
• certain medicines, including ACE inhibitors, beta blockers, aspirin and anti-inflammatory painkillers such as ibuprofen
• overusing decongestant nasal sprays.

Rhinitis is also commonly linked with asthma.

Are there different types of rhinitis?

Yes, rhinitis is usually grouped into two broad types, each covering several sub-types.

Allergic rhinitis happens because of an allergy, and can occur seasonally, as with hay fever, or all year round.

Non-allergic rhinitis covers several different sub-types, including:

• Viral rhinitis: This is caused by a cold
• Hormonal rhinitis: This is linked to pregnancy
• Vasomotor rhinitis: This causes a watery discharge, usually from both nostrils, without much sneezing or loss of smell
• Atrophic rhinitis: This causes crusting inside the nose and is more common in older people
• Rhinitis medicamentosa: This is caused by overusing decongestant nasal sprays
• Occupational rhinitis: This is caused by airborne particles at work, which can involve both allergic and non-allergic mechanisms
• Gustatory rhinitis: This is triggered by eating.

How is rhinitis diagnosed?

Your GP can usually diagnose rhinitis from your symptoms and any triggers you've noticed, and further tests aren't usually needed.

If it's not clear whether your symptoms are caused by an allergy, you may be offered a skin prick test or a blood test to help identify the cause.

Scans or X-rays are only likely to be arranged if it's thought your sinuses might be involved.

How is rhinitis treated?

Most people manage rhinitis well with self-care and medicines, without ever needing to see a specialist. Avoiding your triggers where you can, alongside doing salt water (saline) nasal rinses, can help ease symptoms, whatever type of rhinitis you have.

To make a salt water rinse at home:

1. Boil a pint of water and leave it to cool
2. Mix in 1 teaspoon of salt and 1 teaspoon of bicarbonate of soda
3. Wash your hands, then sniff a small amount into one nostril at a time from the palm of your hand, breathing through your mouth
4. Repeat up to three times a day, making a fresh solution each time.

Non-surgical treatment for rhinitis

Steroid nasal sprays are usually the most effective medicine for allergic and vasomotor rhinitis. They need to be used every day rather than only when symptoms flare up, and it can take up to 6 weeks to notice the full benefit.

Oral antihistamines work within hours and are particularly useful for hay fever, though older types can cause drowsiness, which alcohol makes worse.

If your symptoms don't settle with a steroid spray alone, adding a nasal spray that contains ipratropium bromide can help with a watery discharge, and a combined steroid and antihistamine spray is sometimes used for harder-to-treat allergic rhinitis.

Decongestant nasal sprays and drops can relieve a blocked nose quickly, but should only be used for a week, as using them for longer can leave your nose feeling permanently blocked.

A cold-related (viral) rhinitis usually settles on its own within about a week, helped by a decongestant spray and saline rinses if needed.

If your symptoms are caused by overusing decongestants (rhinitis medicamentosa), treatment means stopping the decongestant, often alongside a 2-month course of steroid nasal spray to manage the rebound congestion this causes.

Atrophic rhinitis, which causes crusting inside the nose, is usually treated with regular irrigation and gentle removal of the crusting, known as debridement.

For gustatory rhinitis, triggered by eating, a nasal spray containing ipratropium bromide can be used beforehand to prevent symptoms.

Surgical treatment for rhinitis

Surgery plays only a minor part in treating rhinitis. It may occasionally be considered for a small number of carefully selected patients, but it's rarely needed, and it's seldom possible to cure rhinitis completely in the long term either way.

When should I see a doctor?

See a GP if:

• your rhinitis symptoms get worse, or don't improve with pharmacy treatments
• you have asthma and it's getting worse
• your symptoms are affecting your sleep or everyday life
• you're not sure what's causing your symptoms.

If you have a watery discharge from one nostril only, mention this to a doctor promptly. In rare cases, a one-sided watery discharge can be a sign of a leak of the fluid that surrounds the brain and spinal cord, so this needs prompt assessment.