Persistent rhinitis typically causes sneezing, and a blocked, itchy, and runny nose. An allergy is a common cause, but there are also non-allergic causes. Treatment options include: avoiding things that causes an allergy, an antihistamine nose spray, antihistamine tablets, and a steroid nose spray. Other treatments are sometimes used.
Rhinitis means inflammation of the nose. Common symptoms include: sneezing, a blocked or congested nose, a watery discharge (runny nose), and an itchy nose. Less common symptoms include: itchy throat, loss of smell, face pain, headache, and itchy and watery, red eyes. The most common cause of rhinitis is a cold. Hay fever is another common cause. Rhinitis affects both nostrils at the same time.
This means that rhinitis symptoms continue long-term. One definition that doctors use for persistent rhinitis is rhinitis symptoms that last for an hour or more on most days of the year. However, in practice there is great variation. In many cases the symptoms are present for some part of the day on most days. In some cases the symptoms come and go.
The severity can vary. Some people have mild nose irritation which comes and goes, and causes little trouble. On the other hand, some people become distressed by their regular, daily symptoms. Severe symptoms can affect your work, school, home and social life.
The causes of persistent rhinitis can be divided into allergic and non-allergic. An allergic cause for persistent rhinitis is the most common.
The most common cause of persistent rhinitis is an allergy to the house dust mite. However, allergy to pets or other animals is also common. Note: the thing that causes an allergy (house dust mite, dead animal skin, etc) is often known as the allergen.
Hay fever (caused by an allergy to pollen) is another type of allergic rhinitis. However, hay fever tends to be seasonal and not persistent because it occurs during a particular period each year. For example, the grass pollen season during late spring and early summer. See separate leaflet called 'Hay Fever' for more detail.
Symptoms of allergy in the nose are due to the immune system reacting to the allergen (such as pollen or house dust mite droppings). Cells in the lining of the nose release histamine and other chemicals when they come into contact with the allergen. This causes inflammation in the nose (rhinitis) and the typical symptoms.
There can be various other causes or triggers for persistent rhinitis. These triggers can cause a rhinitis in their own right, but they can also make symptoms worse if you already have an allergic rhinitis. They include the following:
In some people, no specific trigger for their persistent rhinitis may be found. This is called idiopathic rhinitis. Idiopathic means that there is no certain cause that has been found.
Persistent rhinitis is common. It can affect anyone of any age although it affects adults more commonly than children. It is becoming increasingly common in older people. Many people with persistent rhinitis say they have a persistent cold. However, colds are due to viral infections, and normally only last a week or so. Persistent rhinitis is not due to an infection.
Allergic rhinitis (be it hay fever or persistent rhinitis) tends to run in families. You are also more likely to develop allergic rhinitis if you already have asthma or eczema. Equally, if you have allergic rhinitis, you are more likely to develop eczema or asthma. The conditions asthma, eczema and allergic rhinitis are known together as atopic conditions or atopy. A tendency to atopy can run in families.
Usually not. Most cases are due to allergy, and the symptoms are usually typical. Your doctor can usually diagnose allergic persistent rhinitis by talking to you about your symptoms and your medical history. They may also examine your nose.
If allergic persistent rhinitis is suspected, your doctor or nurse will usually suggest treatment for your symptoms (see below). If the symptoms respond to treatment, this can help to confirm the diagnosis. Sometimes if the cause of persistent rhinitis is unclear, or when the diagnosis is in doubt, your doctor may suggest blood tests or skin prick allergy testing to look for the exact cause of your symptoms. See separate leaflet called 'Skin Prick Allergy Test' for more detail. Confirming the exact cause of any allergy may help if you want to try to avoid it (see below).
Other tests, such as a detailed examination of your nose, are sometimes needed to look for other possible causes of your symptoms, or if complications are suspected (for example, to check for a nose polyp). These can include X-rays and scans.
The following treatment options are for allergic rhinitis - the most common cause of persistent rhinitis. Non-allergic rhinitis can be more difficult to treat and depends on the cause. Steroid nasal sprays may be helpful. Treatments for non-allergic rhinitis are not discussed further here.
The commonly used treatment options for allergic rhinitis are: avoiding the cause of the allergy, antihistamine nose sprays, antihistamine tablets, and steroid nose sprays.
Note: if your rhinitis symptoms are not controlled on the medication that you are taking after 2-4 weeks, you should discuss this with your doctor. You may need to try a different treatment or add in another treatment.
If you have persistent rhinitis caused by an allergy, if you can avoid the cause of an allergy, symptoms should reduce and stop. However, this is not as easy as it sounds.
If you want further advice on how to reduce house dust mite, see separate leaflet called 'House Dust Mite and Pet Allergy' for more detail. However, treatment with a nasal spray or tablets (see below) often works so well that you may not have much motivation or need to avoid the cause of the allergy. Saying that, it is thought that if you have a pet or animal allergy and you do avoid any further contact, you may reduce your risk of developing asthma.
A dose from an antihistamine nasal spray can rapidly ease itching, sneezing and watering (within 15 minutes or so). It may not be so good at easing congestion. Antihistamines work by blocking the action of histamine. This is one of the chemicals involved in allergy reactions. A spray can be used as required if you have mild symptoms. It can also be taken regularly to keep symptoms away.
Antihistamines taken by mouth (tablets or liquids) are an alternative. They ease most of the symptoms but may not be so good at relieving nasal congestion (blocked nose). Antihistamines taken by mouth are good if you have eye symptoms as well as nose symptoms. They are also usually given to small children instead of a nasal spray. A dose usually works within an hour. Therefore, one can be taken as required if symptoms are mild, or come and go. One can also be taken regularly if symptoms occur each day.
There are several brands of antihistamines that you can buy at pharmacies or get on prescription. Older brands such as chlorphenamine work well, but make some people drowsy, so they should not be taken if you are driving or operating machinery. There are several newer ones that cause less drowsiness. Ask your pharmacist for advice.
If you are pregnant or breast-feeding, it is advised to try to avoid antihistamines if possible. Treatment with a steroid nasal spray is usually tried first (see below). An antihistamine may sometimes be used if your symptoms are not controlled. Discuss with your doctor or pharmacist if you are pregnant or breast-feeding and have rhinitis.
A steroid nasal spray usually works well to clear all the nasal symptoms (itch, sneezing, watering and congestion). It works by reducing inflammation in the nose. A steroid nasal spray also tends to ease eye symptoms. It is not clear how it helps the eye symptoms - but it often does! Steroid nasal drops are also sometimes used.
It takes several days for a steroid spray to build up to its full effect. Therefore, you will not have an immediate relief of symptoms when you first start it. In some people it can take up to three weeks or longer to be fully effective. So do persevere. A steroid nasal spray tends to be the most effective treatment when symptoms are more severe. It can also be used in addition to antihistamines if symptoms are not fully controlled by either alone.
You need to use the spray each day to keep symptoms away. However, once symptoms have gone, the dose of a steroid spray can often be reduced to a low maintenance dose each day to keep symptoms away. There are several brands that you can buy at pharmacies, or get on prescription. Side-effects or problems with steroid nasal sprays are rare (read the packet leaflet for details).
The following are sometimes used. They tend to be used if there are problems with any of the above treatments. Sometimes one is used as an add-on treatment in addition to one or more of the above treatments if symptoms are not fully controlled:
If you have eye symptoms, if needed, you can use eye drops in addition to other treatments:
Rarely, a short course of steroid tablets is prescribed. For example, for students sitting exams, who have severe symptoms which are not eased by other treatments. Steroids usually work well to reduce inflammation. A short course is usually safe. However, you should not take steroid tablets for long periods to treat rhinitis as serious side-effects may develop. See separate leaflet called 'Steroid Tablets' for more detail.
This treatment is sometimes used, mainly in cases where symptoms are severe and not helped by other treatments. It is done using a series of injections of the allergen causing the rhinitis, in increasing quantities. The idea is that your immune system will become desensitised to the allergen. This means that the allergic response that your body mounts when it is exposed to the allergen in the future is reduced, so improving your symptoms. Another technique is being developed which involves placing the allergen under the tongue. However, this may not yet be widely available.
Surgery is not often used to treat allergic persistent rhinitis but if you develop complications such as nasal polyps (see below) it is sometimes needed.
Persistent rhinitis is an ongoing (chronic) condition that usually needs regular treatment to prevent symptoms. However, over time the condition may ease, and even go completely in some cases. It may be worth stopping treatment every six months or so to see if symptoms come back without the treatment. The treatment can be started again if symptoms return.
Of course, if you have persistent rhinitis caused by an allergy, if you remove the source of the allergy, your symptoms should reduce and stop. You may no longer need treatment.
Sinusitis is the most common complication of persistent rhinitis. The sinuses are small, air-filled spaces inside the cheekbones and forehead. They make some mucus which drains into the nose through small channels. Allergens can irritate the lining of your sinuses in the same way that they irritate the lining of your nose.
If you have a blocked or congested nose or lots of nasal discharge, it can stop your sinuses from draining properly into your nose. This means that the mucus in the sinuses becomes blocked and can be more easily infected. See separate leaflets called 'Sinusitis - Acute' and 'Sinusitis - Chronic' for more details.
Nasal polyps are sometimes a complication of rhinitis. A nasal polyp is a swelling that can grow from the lining of your nose. When it is fully grown it looks rather like a grape. One polyp can form or there may be a number of polyps together. Sometimes polyps can form in the sinuses as well. They are usually flesh-coloured, pale grey or pink.
If a polyp is big or if there are large numbers of polyps, a number of problems can develop. Your sense of smell may be affected or your nose may feel blocked, causing difficulty breathing. Sometimes polyps can block the drainage of your sinuses and lead to sinusitis as described above. Large polyps may need to be surgically removed but smaller polyps can often be treated with steroid nasal drops (see above) which help to shrink them.
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