Rhinitis and nasal allergy

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Rhinitis means inflammation of the lining of the nasal cavity, usually causing nasal congestion/blockage, a runny nose, sneezing, and itchy nose and eyes.  

It is the most common long-term nasal condition, affecting up to 30% of the population to some extent.  For some patients, it takes the form of relatively mild seasonal stuffiness, runny nose and sneezing due to pollen allergy, known as hay fever.  

 

However for some patients the symptoms can be much more severe, due to multiple different allergies, or sometimes no allergy at all.  A specialist can help to diagnose the cause of your nasal symptoms, the type of rhinitis that you have, and the ideal treatment or treatments for your specific type of rhinitis.

Allergic or non-allergic?

Rhinitis can be divided into allergic rhinitis and non-allergic rhinitis (hay fever is a common form of allergic rhinitis, as is dust allergy).

As the name suggests, allergic rhinitis is due to your body's immune system over-reacting to an allergen - a substance which is almost alway airborne.  The commonest allergens causing rhinitis are pollen (e.g. grass or tree), dust, cat or dog dander and mould.

Non-allergic rhinitis has many different causes, including your genetic/family history, medications you take, and occupational exposure to some substances.  In some cases, no clear cause can be found.

Both common forms of rhinitis are strongly associated with asthma - patients with asthma are likely to also have rhinitis, and vice versa.  If you have both conditions, it is very important that both are treated together, to get the best possible control of your nasal and chest symptoms.

Diagnosing rhinitis

Rhinitis is diagnosed through a combination of your medical history (a series of targeted questions about your symptoms and your other medical problems), and clinical examination (looking at the inner lining of the nose for signs of inflammation).

In many cases it is helpful to conduct allergy tests, to determine whether your rhinitis falls into the allergic or non-allergic categories.  Allergy tests can also determine which specific allergens trigger your symptoms.  

 

The most common type of allergy test is a skin allergy test.  This takes around 15 minutes to conduct, is virtually painless and very safe, and gives instant visual feedback about your individual allergy profile.  Allergy tests can also be conducted from a simple blood test.

Treatment of rhinitis

The treatment of your rhinitis should be individualised according to your needs, taking into account the type of rhinitis you have, the time of year your symptoms occur, the severity of your symptoms, and your allergic triggers if relevant.

For some patients with milder symptoms, a simple antihistamine (anti-allergy) pill can control their symptoms.  For many patients the best treatment is a combination of regular nasal salt-water (saline) irrigation and a daily nasal steroid spray.  This is usually taken in the long term, and is a very safe treatment.

For some patients, other medications and/or sprays may be necessary to control their symptoms.  Some patients with very severe allergic rhinitis can also benefit from immunotherapy, which is a highly specialised treatment that aims to make the immune system more tolerant of the allergen that is causing the symptoms.

 

In treatment-resistant cases, it can be helpful to see a specialist to determine whether surgery could also play a role in improving your symptoms (although it is important to note that surgery cannot cure the underlying condition).