Nonallergic Rhinitis is common, but overlooked!

Have you ever started sneezing all of a sudden and developed a runny nose on top of that; which worsens your day? The issue becomes more frustrating when this happens following your favourite cheese filled Burgher or Honey topped Apple pie and you start wondering why ‘me’!   

Patients presenting with these symptoms are most likely suffering from what is called Non-allergic rhinitis. This is a common medical condition with signs and symptoms resembling those of Allergic Rhinitis or Hay fever. This condition develops without any IgE mediated immune mechanism acting against a specific triggering factor. In fact, it doesn’t involve the immune system in order to drive a causative mechanism against an allergen (allergy causing agent).   

In order to discuss more on this topic, we thought of having a chat with Dr. Solith Senanayake, Registrar in Medicine, Department of Pharmacology, University of Sri Jayawardanapura.   

“All that sneezes are not allergies-that is the first thing to keep in mind” says Dr. Senanayake.   
NAR is best defined by the chronic presence of one or more of the four following cardinal symptoms of rhinitis in the absence of a specific etiology (such as an immunologic, infectious, pharmacologic, structural, hormonal, vascular, metabolic or atrophic cause:   

• Sneezing   
• Rhinorrhea   
• Nasal congestion   
• Postnasal drainage   

For it to be considered as chronic symptoms the condition should last for over a year.   

How does Non-allergic rhinitis occur?
The exact etiology for nonallergic rhinitis is unknown and often confirmed after ruling out other possible allergic conditions and infections. However, car exhaust, cigarette smoke, hair spray, perfume, latex, smog and dust can trigger the particular symptoms in most individuals. Some people may also develop nonallergic rhinitis following weather changes, consuming of hot and spicy food, consuming alcoholic beverages and drugs such as NSAIDS (Ibuprofen), antidepressants etc.   

“Even though, Nonallergic rhinitis can affect children and adults. It is more common among the middle-aged and involves symptoms which last longer than usual-may be around the whole year” underscored Dr. Senanayake.   

As far as the scientific basis is concerned, there is no clear-cut pathophysiology for non-allergic rhinitis, but several mechanisms have been proposed in order to explain what is happening within the body during the reactions following an exposure to certain substances.   

These include Entopy (local nasal IgE synthesis with negative skin tests), Nocioceptive dysfunction (hyperactive sensory receptors) and autonomic nervous system abnormalities (hypoactive or hyperactive dysfunction of sympathetic or parasympathetic nerves in the nose). Even though these terms sound a bit complex, the basic concept is that there is no involvement of the immune system in nonallergic rhinitis as opposed to allergic rhinitis.   

How would patients present?
Patients with this condition will often present with vague features which do not carry any evidence of usual allergic reactions.   

Stuffy nose, runny nose, Post nasal drip, impaired sense of smell, cough and phlegm will be the most common complaints where itching, reddening of eyes and difficulty in breathing may be quite unusual. In addition to these features related to rhinitis one may also complain of systemic symptoms such as body aches, sleep disturbances, memory problems etc.   

“However, it is always better to look for any triggering factor or allergen before jumping to the mere conclusion of non-allergic rhinitis because even health care professionals make the diagnosis by excluding the aforementioned, pathology,” he said.   

People with this condition would wish to know how they are treated for nonallergic rhinitis.   

Don’t be hesitant to seek medical advice
Nonallergic rhinitis might not be a dangerous problem or always affect the quality of one’s life like other health issues, but it is always better to identify the issue. By doing this you can avoid any triggering factors, if found which will keep the debilitating symptoms away.   

Treat the cause
Medical interventions for this condition usually depend on the underlying precipitating factors. Your doctor will do certain tests on you and for whom an allergic cause cannot be found by allergy skin testing or serum specific IgE immunoassay (Immunocap/RAST) for environmental aeroallergens are classified as having non-allergic rhinitis.   

For an example, if the triggering factor involves a viral infection, the patient will be advised to bed rest and stay hydrated until the infection resolves spontaneously, which in turn will improve the symptoms of non-allergic rhinitis.   

Avoid triggers
This is a MUST to practise in case you come across any specific cause which is thought to be initiating symptoms related to nonallergic rhinitis.   

For an example, you might need to change your current occupation in an Asbestos factory if you think the symptoms are caused by the recurrent exposure to dust and micro particles.   

If the symptoms are found to be occurring after having a particular medication, it is advisable to seek medical help to find an alternative drug which will not act as any triggering factor. 

 
Symptomatic treatment
Fortunately there are many drugs available to relieve these symptoms which should more or less be handled with care to be on the safe side; specifically with proper guidance of a health care professional.   

Ø Intranasal steroid sprays- These are most effective if the dominant nasal symptom is congestion, but they have also shown proven benefits for rhinorrhea, sneezing, and itching.   

•  Intranasal antihistamines   
•  Oral antihistamines   
•  Ipratropium- Helps to decrease the secretions by inhibiting the nasal parasympathetic mucous glands   
•  Decongestants   
•  Nasal saline irrigation   

Rinsing your throat and nose with salt water and taking antihistamines will reduce the night-time congestion and aid sleep.   

“Some individuals might have to take nasal sprays, decongestants or steroid sprays in case of chronic attacks. For example, if symptoms are identified to occur while on airplanes by previous experience, then intranasal steroids or antihistamine sprays should be used before boarding the plane”Dr. Senanayake said. 

When asked why people get affected later the doctor had this to say.

“Untreated nonallergic rhinitis can result in complications such as Sinusitis, Eustachian tube dysfunction, Otitis media, nasal polyps, impaired smell (anosmia) and Asthma and obstructive sleep apnea.   

“Even though, non-allergic rhinitis is not a life threatening condition, it is important to seek timely medical advice in order to go ahead and reduce the negative impact on the quality of life” concluded Dr. Senanayake.