Sleepless nights, daytime drowsiness, irritability – these are just some of the ways rhinitis can impact your daily life. And we’re all likely to experience it at some point in our lives.
Rhinitis simply means “inflammation of the nose”, explains Paul Spraggs, an ENT surgeon at Hampshire Hospitals NHS Foundation Trust. It’s generally characterised by congestion, a constantly runny nose, and in some cases a reduced sense of smell. There are many reasons why it might flare up.
The condition can be split into allergic and non-allergic. Allergic rhinitis is more common – estimated to affect one in every five people in the UK. As the name suggests, the inflammation is caused by allergies, some of which tend to be seasonal (i.e. hay fever) and others year-long (i.e. allergies to mould, pets, house dust mites or cleaning substances).
Non-allergic rhinitis is caused by other factors such as: infection with the common cold; environmental reasons like extreme temperatures, humidity or exposure to pollution; hormone imbalances during pregnancy or puberty; snorting illegal drugs like cocaine; or taking medicines like HRT or contraceptive pill.
More patients are also turning up in hospital with self-induced rhinitis caused by overuse of nasal sprays like Sudafed or Vicks Sinex, says Spraggs, who is also a council member of the Royal College of Surgeons of England. “These are medicines you buy over the counter for short-term use in colds, but people tend to get addicted to them,” he says. “That causes a type of rhinitis we see in secondary care a lot, which is very difficult to treat.”
Allergic rhinitis causes cold-like symptoms like sneezing, itchiness and a blocked or runny nose, states the NHS. These usually start soon after being exposed to the allergy.
Non-allergic rhinitis symptoms are similar: a blocked or runny nose, sneezing (although this is generally less severe than in allergic rhinitis), mild irritation or discomfort in and around your nose, and a reduced sense of smell.
In rare cases, non-allergic rhinitis can cause a crust to develop inside the nose, which may produce a bad odour or cause bleeding if you try to remove it.
There isn’t a uniform process for diagnosing rhinitis because it could be as a result of a cold, in which case people tend to wait it out or self-medicate with antihistamines, nasal sprays or a nasal rinses.
If, however, your symptoms aren’t relieved and it’s impacting your quality of life, visit your GP. They’ll ask questions about the history of the issue and offer tailored treatment advice.
In cases where rhinitis is difficult to treat or you’re still suffering after GP support, you should be referred to a specialist department in hospital to have the issue investigated further. Don’t be afraid to ask for that referral. There, doctors will examine the nose more thoroughly and do blood tests to try identify whether there’s an underlying infection or specific allergen that is to blame.
Nasal steroid sprays can be used for both types of rhinitis if the issue is more severe – it’s worth noting this sometimes causes irritation, sore throats or nose bleeds. “Apart from in children, there are no long-term side effects of taking intranasal steroids at all, certainly with the sprays,” the ENT surgeon adds.
For mild allergic rhinitis, most people start by taking an over-the-counter antihistamine, says Spraggs. They might also choose to wash out their nose with a salt water solution, also known as “nasal douching”. This helps remove a build up of mucus from the nasal passages, reducing inflammation.
Douching is recommended prior to applying any corticosteroid nasal treatment, according to the British Society for Allergy & Clinical Immunology (BSACI), as it removes mucus and allows the spray to access more of the nasal passage. It’s a relatively new way to treat rhinitis, says Spraggs, and is effective in reducing symptoms as it clears the nose of pollen or allergens in the nose.
You can make your own solution at home. BSACI advises using 240ml of previously boiled and cooled water and mixing with 1/4 teaspoon of salt and 1/4 teaspoon of bicarbonate of soda. If you don’t want the fuss, Spraggs says Sterimar nasal spray is an effective option.
People with allergic rhinitis are also advised to make changes in their lives to avoid contact with what they’re allergic to, however this is often easier said than done. Refreshing your bedding more regularly can be good for easing dust mite allergies, for example, while taking showers after being outside during hay fever season can help to wash off any pollen from your body and hair. The same goes with non-allergic rhinitis – if you know what your trigger is, try avoiding it.
If you believe your rhinitis is caused by a medicine you’re taking, your doctor might be able to prescribe an alternative to see if it helps to reduce your symptoms. Don’t stop taking any prescribed medicine unless advised to.
It’s important to seek treatment for rhinitis when symptoms last for more than three months. Both allergic and non-allergic rhinitis can lead to other conditions, such as sinusitis, ear infections and nasal polyps (harmless sacs of fluid that grow inside the nasal passages and sinuses). People with chronic sinusitis might need surgery to treat the issue, and in some cases patients might need to take antibiotics to clear any infections that occur.
If the issue has been bothering you for a while, Spraggs recommends trying the intriguingly-named SNOT-20 test – a survey on your symptoms and how they impact your life – which can help you determine whether you need to seek extra support.
“Some people get very ill during the hay fever season or get very ill because of chronic perennial rhinitis due to mould or house dust mites,” says Spraggs. “It does have a significant effect on quality of life.”
If you’re concerned about rhinitis, speak to a pharmacist or your GP.