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APRIL 2013 • FACTS
Rhinitis
Allergic and Nonallergic
Spring is here again. The birds are singing and it’s warming up. Most of us are
happy about this, but some may be dreading springtime. This is because some
people have more problems with allergies in the spring. Plants are growing and
flowers are blooming—and the pollen count is rising.
But it’s important to remember that some allergy-like symptoms aren’t
always caused by allergies. And treatment outcome depends on pinpointing
all the allergic and nonallergic triggers. This is because the more simultaneous
triggers the person is exposed to, the worse the symptoms are likely to be.
Identifying and avoiding all the triggers can go a long way toward helping
a person feel better.
Common allergic and nonallergic symptoms
Symptoms that are common in people who have allergies and in those who
don’t include:
• Chronic sneezing
• Runny nose
• Stuffy nose
• Postnasal drip
People with these symptoms have either allergic rhinitis or nonallergic rhinitis.
Allergic rhinitis occurs when the immune system reacts to a foreign protein
such as pollen or dust mite droppings. People with allergic rhinitis are said
to have allergies. Nonallergic rhinitis does not involve the immune system.
Finding out if it’s allergic or nonallergic
rhinitis
There are 2 types of diagnostic tests that can help. One is a skin test. The
other is a blood test. If either test is negative, the person might have nonallergic
rhinitis.
A skin test requires a separate puncture for each allergen that might be
causing the symptoms. With the blood test, there is only one skin puncture.
Doctors can choose which allergens to include in the blood test, thus tailoring
the test for each person. Blood testing is especially useful when the person1:
Nonallergic rhinitis
triggers
• Airborne odors or irritants such as
dust, smog, perfume, hair spray, cleaning
solutions, secondhand smoke
• Changes in temperature or humidity,
cold air
• Emotional or physical stress
• Hormonal changes, especially in women
• Hot or spicy foods, alcoholic drinks
• Medicines such as aspirin, ibuprofen,
ACE inhibitors, beta-blockers, sedatives,
antidepressants, birth control pills, and
erectile dysfunction drugs
• Overuse of decongestant nasal sprays
• Viral infection
Allergic rhinitis triggers
• Animal dander
• Chemicals in shampoos, detergents,
cosmetics
• Cockroach droppings
• Dust mite droppings
• Foods
• Insect stings (eg, bees, wasps, fire ants)
• Medications such as penicillin
• Molds
• Nickel
• Poisonous plants (eg, poison ivy, oak,
or sumac)
• Pollen
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Rhinitis
FACTS
Rhinitis facts
• Has a widespread skin disease
• Has a high risk of anaphylaxis (a severe, systemic reaction to the
allergen challenge) from skin testing
• Is receiving medications (eg, beta-blockers, angiotensin-converting
enzyme inhibitors, and some antihistamines and tricyclic antidepressants)
that interfere with skin testing
• Is uncooperative due to a mental or physical impairment
The blood test can be used for patients 3 months of age and older, regardless
of skin condition. There is no need to stop current medications before drawing
a blood sample.
Additionally, nasal endoscopy or a computerized tomography (CT) scan
can be used to look for a structural abnormality that might be causing
nonallergic rhinitis.
Treatment—avoiding the triggers
The most important thing is to avoid the trigger(s). This is true for both allergic
and nonallergic rhinitis. So, narrowing down the possibilities using a medical
history and diagnostic testing is crucial. When total avoidance isn’t possible,
other things can be used to help the patient feel better.
Some tips for avoiding allergens
Once the allergic and nonallergic triggers are identified, the affected person can
try to avoid them. Avoiding them should help him/her feel better. Here are just
a few ways to avoid the triggers:
• Use an air conditioner and have someone change the filters regularly;
this helps decrease pollen, molds, and house dust mites.
• Consider using a dehumidifier to help prevent mold and keep humidity
constant.
• When landscaping, choose nonflowering plants that require little water;
this helps decrease pollen and molds.
• Vacuum or dust each week; this helps decrease pet dander, dust mites,
and cockroach droppings.
• Use allergen-proof covers for mattresses and pillows; this helps decrease
pet dander and house dust mites.
• Stay away or wear a mask when grass is being cut or a room is being
cleaned; this helps decrease contact with pollens, molds, pet dander,
and house dust mites.
• Don’t overuse decongestant nasal sprays; overuse can trigger the very
symptoms the person is trying to prevent.
• Get plenty of sleep, exercise, and eat a healthy diet; this helps avoid
viral infections.
• Allergic rhinitis is more common (about
3 times) than nonallergic rhinitis.2,3
• 10% to 30% of the world’s population
have allergic rhinitis.4
• In 2007, there were 13.4 million visits
to a doctor, hospital, or emergency room
for allergic rhinitis problems.5
• $11.2 billion were spent on allergic
rhinitis treatment in 2005.6
• 4 million workdays are lost each year
because of hay fever.7
• People with allergic rhinitis have 3
additional doctor office visits, 9 more
prescriptions filled, and $1500 more in
healthcare costs in 1 year than people
without it.
References
1. Bernstein IL, Li JT, Bernstein DI, et al. Allergy
diagnostic testing: an updated practice parameter. Ann
Allergy Asthma Immunol. 2008;100(Suppl 3):S1-S148.
2. Bachert C, van Cauwenberge P, Olbrecht J, et al.
Prevalence, classification and perception of allergic and
nonallergic rhinitis in Belgium. Allergy. 2006;61:693-698.
3. Mølgaard E, Thomsen SF, Lund T, et al. Differences
between allergic and nonallergic rhinitis in a large
sample of adolescents and adults. Allergy. 2007;
62:1033-1077.
4. Allergy statistics. American Academy of Allergy,
Asthma, and Immunology website. www.aaaai.org/
about-the-aaaai/newsroom/allergy-statistics.aspx.
Accessed February 28, 2013.
5. Schappert SM, Rechtsteiner EA. Ambulatory medical
care utilization estimates for 2007. National Center
for Health Statistics. Vital Health Stat 13(169). 2011.
www.cdc.gov/nchs/data/series/sr_13/sr13_169.pdf.
Accessed February 28, 2013.
6. Soni A. Allergic rhinitis: trends in use and expenditures,
2000 and 2005. AHRQ Statistical Brief #204. http://meps.
ahrq.gov/data_files/publications/st204/stat204.pdf.
Accessed February 28, 2013.
7. Allergy statistics and facts. WebMD website.
http://www.webmd.com/allergies/allergy-statistics.
Accessed February 28, 2013.
8. Bhattacharyya N. Incremental healthcare utilization
and expenditures for allergic rhinitis in the United States.
Laryngoscope. 2011;121:1830-1833.
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