There are two types of rhinitis; allergic and non-allergic rhinitis.
Allergic rhinitis – where your nose gets irritated by something you’re allergic to, such as pollen, causing sneezing and other symptoms.
Common symptoms are similar to a cold and include:
- An itchy nose
- A runny or blocked nose
- Itchy, red and watery eyes
- A cough
- The roof of your mouth being itchy
Non-allergic rhinitis – happens when the inside of your nose becomes irritated, causing a blocked or runny nose.
- A blocked or runny nose
- An itchy nose
- A reduced sense of smell
- Don’t ignore your symptoms
When we have a cold it causes us to have blocked nose, runny nose, cough, catarrh, sneezing and snoring. Maybe because we are used to rhinitis being there for a week or so after a cold and then going away that people tend to play down rhinitis. However, it has a major effect on our quality of life. It causes headache, tiredness, poor sleep, loss of taste and smell and can make us feel quite run down and low.
When people come to see me, they have often had these symptoms for a month or two. The sooner you start to get help for this , the easier it is to treat.
Keep a symptom diary
Sometimes it is very easy to find a cause – hayfever, contact with animals, chemicals or dust. In other cases it is hard to find a cause.
It is worth keeping a diary where you list the symptoms and what you have been doing and eating and if relevant the environmental conditions.
This diary may need to be done for at least 2-3 months before you have enough evidence to identify an association. If it is successful, either avoidance or prophylactic treatment prior to exposure to the trigger can reduce the impact of this condition on your activity and quality of life.
Consider environmental causes
These are a common and preventable cause of rhinitis. Avoidance is usually the main option for treatment.
- Dust – It is quite common for people to develop rhinitis when they work or are living in or close to a building site. The dust causes the nasal lining to swell and become congested leading to symptoms
- Air conditioning – It is increasingly common for work places to be air conditioned. This can lead to symptoms of rhinitis. The dry environment causes irritation to the nasal lining causing mucus production and nasal congestion
- Pollen – Individual plants and trees pollinate at different months of the year. This is why people can get hay fever from March until September , depending on what pollen they are allergic to
The symptom diary, mentioned earlier, can help identify the problem months and preventative treatment as well as relieving the symptoms at that time can help.
Other things that can help include:
- Checking the weather, monitoring the pollen count in the affected months can help
- In the problem months, the pollen count is likely to be highest in the morning and early evening. Avoiding being outside and keeping windows and doors shut at these times can limit the effect of the pollen
- Having a shower and washing hair and changing clothes after being outside can limit the amount of pollen on your body and can reduce symptoms
Remember, it is likely that the period of time when you are affected maybe only 4-8 weeks and it is only during this time that you need to take precautions.
House dust mites
Dust mites are one of the commonest causes of allergies. There are ways of reducing the mites and their impact:
- Allergy-proof bedding can reduce the effect
- Regularly cleaning furniture, cushions and toys using a vacuum with a HEPA filter
- Changing to more easily cleaned flooring and blinds
Pets can be a cause of rhinitis. Whilst it is hard to remove the symptoms if the pet remains in the house, there are ways to reduce the effects:
- Wash the pets regularly
- Wash the bedding and furniture that the pets use
- Groom dogs outside the house
- Keep bedrooms pet free
If you are visiting a house with a pet consider asking them to wash the animal and bedding before your visit and take a non-drowsy antihistamine before visiting (be careful as even non drowsy antihistamines can cause drowsiness in some people).
Damp and mould
Moulds do not cause allergies but the spores they release cause the symptoms. To prevent symptoms:
- Keep the building well ventilated and dry
- Dry clothes outside
- Ensure cupboards where clothes are stored are free of mould
Certain occupations involve contact with chemicals that can cause rhinitis. Employers should be aware of this and ensure adequate protection is in place. Painting and some hobbies expose people to chemicals that can cause symptoms of rhinitis. In most cases this is managed by avoiding the suspected chemicals, ensuring adequate ventilation and wearing appropriate protective equipment.
Try a nasal wash
These can be extremely cheap and effective at reducing the symptoms of rhinitis. There are several types of saline nasal rinses available and it is important that they are used correctly and that if necessary they are thoroughly cleaned regularly.
They can be used prior to using a decongestant or nasal steroid spray to increase effectiveness of these sprays. They can be purchased over the counter or online and can be prescribed by your doctor.
Use a decongestant
These are the commonest initial treatments for rhinitis and since the nasal steroids can take some time to work are a useful way of making sure that we have the right diagnosis. They can be purchased over the counter or online. They are sprayed into the nostril as directed but ONLY for 1 week. Unfortunately, if used for too long they can cause worsening rhinitis. They normally start working very quickly and offer great relief of the symptoms.
Antihistamines are very effective at preventing the symptoms of rhinitis. They are preventatives and relievers but may need to be taken regularly to be effective. Whilst they are usually non-drowsy tablets, there are still a few people who are made drowsy by the tablets so do be careful and do not drive or operate machinery if you are affected. Changing to an alternative antihistamine usually helps.
Nasal steroids if the nasal wash, decongestant and antihistamine have not been effective you may benefit from a steroid nose spray, this is a preventer not a reliever and is often required to be taken for at least 3 months. They also can take 2-4 weeks to begin to be effective. They don’t have many side effects but can rarely cause nasal irritation
Oral steroids – If symptoms are severe and you cannot wait for the longer acting treatments to kick in, your GP could try a short course of oral steroids. These can be very effective but do have side effects whilst on and when coming off the medication.
Consider other medication
There is a group of medications that are licenced for relieving the symptoms of rhinitis especially in patients with asthma. This group, called antileukotrienes can be very effective. Anticholinergic nasal sprays can control runny noses but some conditions, such as glaucoma, can be worsened by their use.
The advice and medication in 1-9 will manage 90% of people with rhinitis. However, in the other 10% nothing seems to help. In this group it is worse asking your GP to refer you to see an ENT specialist. They will confirm the diagnosis and can discuss other treatments including surgery to the nose.
Dr Adam Simon is lead GP at Private GP Extra. To book an appointment with one of our doctors, please call 0161 428 4464.