[Allergy & Asthma Corner]

There are several publications on allergic rhinitis but few on non-allergic rhinitis. Many adults are surprised and sometimes disappointed when I inform them of their non-allergic status (allergy tests all negative). Parents also respond in a similar manner when the children they suspected were allergic fail to have any identifiable allergic triggers.

Non-allergic rhinitis is a mixed bag of disorders that include:

-Perennial non-allergic rhinitis (PNAR)

-Rhinitis Medicamentosa -nasal damage from over-the-counter nasal sprays

-Atrophic Rhinitis- mostly occurs in the elderly and is associated with congestion and crusting, sometimes accompanied by a foul smell

-Infectious Rhinitis- bacterial or viral induced infection

-And other rare causes

PNAR is very common and represents 30 to 60 percent of patients referred to an allergy office. This type of nasal problem differs from allergic rhinitis in that all allergy tests are negative. Itching, sneezing and runny nose are less common symptoms. Patients often complain of nasal congestion and post nasal drainage. Triggers include cold air, drafts, tobacco smoke, fumes, weather changes, spicy food and alcohol.

Treatment is focused on avoiding trigger factors when possible and reducing symptoms with medications. Antihistamines and topical nasal steroids commonly used in allergic rhinitis are effective half the time in people with PNAR. Oral decongestants and nasal sprays indicated for non-allergic rhinitis or runny nose (Astelin, Atrovent nasal spray) may be more helpful. Nasal sinus rinses with saline (See May 19th posting) may also help manage PNAR. Regular aerobic exercise for 20 to 30 minutes 2-3 times weekly may reduce some of the symptoms.

PNAR does not warrant antibiotics or surgery unless there are associated complications or other underlying problems. Allergy shots are not an option since there are no established allergic triggers.

Don’t be discouraged if you or your child has non-allergic nasal problems. They actually have a better prognosis (outlook) not being allergic to environmental factors. You see, people with allergy problems are plagued not only by specific allergy triggers but also by the non-allergic (irritants, chemicals etc.) factors which bother folks with PNAR.

Furthermore, many people with PNAR respond to the above mentioned treatment schemes although your specialist or primary doctor may have to work at it for a while. So be patient, follow through with recommendations and follow-up with your doctor. Inform your doctor of your progress or any troublesome problems along the way.

Here is another source for information:

www.mayoclinic.com/health/nonallergic-rhinitis/DS00809