Persistent Rhinitis

What is rhinitis and what is persistent rhinitis?

Rhinitis means inflammation of the nose. Common symptoms include: sneezing, a blocked or congested nose, a watery discharge ('runny nose'), and an itchy nose. Less common symptoms include: itchy throat, loss of smell, face pain, headache, and itchy and watery red eyes. The most common cause of rhinitis is a cold. Hay fever is another common cause.

Persistent rhinitis
Persistent rhinitis means that rhinitis symptoms continue long-term. (Strictly speaking, for classification purposes, doctors use the term persistent rhinitis to mean that symptoms occur for more than four days per week, and occur for at least four weeks. However, in practice there is great variation. In many cases the symptoms are present for some part of the day on most days. In some cases the symptoms 'come and go'.)

The severity of symptoms can vary. Some people have mild nose irritation which comes and goes, and causes little trouble. On the other hand, some people become quite distressed by their regular, daily symptoms.

Persistent rhinitis is common. It can affect anyone of any age although it affects adults more commonly than children.

Many people with persistent rhinitis say they have a 'persistent cold'. However, colds are due to virus infections, and normally only last a week or so. Persistent rhinitis is not due to an infection.

What causes persistent rhinitis?

Allergic rhinitis
A common cause of persistent rhinitis is an allergy to house dust mite or to a pet.

  • House dust mite is a tiny creature that is present in every home. It mainly lives in bedrooms and mattresses, as part of the dust. It usually causes no harm, but some people are allergic to the tiny droppings (faeces) of the mite.
  • Pets - dander or hairs from a cat, dog, horse, hamster, etc, are the cause of the allergy in some cases.
  • Other allergies are less common. An allergy to something at work sometimes occurs. For example, to laboratory animals, or to latex or other chemicals. This may be suspected if symptoms ease at weekends or on holidays.

Symptoms of allergy in the nose are due to the immune system reacting to the allergen (such as pollen, mite droppings, or dander from a pet). Cells in the lining of the nose release histamine and other chemicals when they come into contact with the allergen. This causes inflammation in the nose (rhinitis).

Non-allergic rhinitis
There are various other causes or 'triggers' for the symptoms. These can cause a rhinitis in their own right, but they can also make symptoms worse if you already have an allergic rhinitis. They include the following.

  • Irritation of the nose by smoke, strong smells, fumes, changes in temperature or humidity.
  • Hormone changes during pregnancy, puberty, and after the menopause can sometimes cause nose symptoms.
  • Food and drink - mainly hot, spicy food, or alcohol. Sensitivity to certain food colourings or preservatives may be a cause.
  • Emotion such as stress or sexual arousal can affect the nose.
  • Medication - a side effect from certain medicines is a rare cause. These include: beta-blocker medicines, aspirin and other anti-inflammatory medicines, the contraceptive pill, and ACE inhibitors (angiotension converting enzyme inhibitors).
  • Other conditions of the nose sometimes cause similar symptoms. For example, nose polyps or chronic (persistent) sinusitis.

Are any tests needed?

Usually not. Most cases are due to allergy, and the symptoms are usually typical. Treatment is much the same, whatever the cause of the allergy. Allergy testing may be advised if treatment is not helping, or to confirm the exact cause of an allergy if you want to try and avoid it (see below).

Other tests such as a look into the nose are sometimes considered if a non-allergic cause is suspected (for example, to check for a nose polyp).

What are the commonly used treatments?

The following treatment options are for allergic rhinitis - the common cause of a persistent rhinitis. Treatments for other causes of rhinitis depend on the cause, and are not discussed further.

The commonly used treatment options for allergic rhinitis are: antihistamine nose sprays, antihistamine tablets, and steroid nose sprays.

Antihistamine nose sprays
A dose from an antihistamine nose spray can rapidly ease itching, sneezing and watering (within 15 minutes or so). It may not be so good at easing congestion. Antihistamines work by blocking the action of histamine. This is one of the chemicals involved in allergy reactions. A spray can be used 'as-required' if you have mild symptoms. It can also be taken regularly to keep symptoms away. There are different brands.

Antihistamine tablets (or liquid medicines)
Antihistamines taken by mouth (tablets or liquids) are an alternative. They ease most of the symptoms but may not be so good at relieving nasal congestion (blocked nose). A dose usually works within an hour. Therefore, one can be taken 'as required' if symptoms are mild, or come and go. One can also be taken regularly if symptoms occur each day.

There are several brands of antihistamines that you can buy at pharmacies or get on prescription. Older brands such as chlorphenamine work well, but make some people drowsy. There are several newer ones that cause less drowsiness. Ask the pharmacist for advice.

Steroid nose sprays
A steroid nose spray usually works well to clear all the nose symptoms (itch, sneezing, watering and congestion). It works by reducing inflammation in the nose. It takes several days for a steroid spray to build up to its full effect. Therefore, you will not have an immediate relief of symptoms when you first start it. In some people it can take up to three weeks or longer to be fully effective. So do persevere. A steroid nose spray tends to be the most effective treatment when symptoms are more severe.

Once symptoms have gone, the dose of a steroid spray can often be reduced to a low 'maintenence' dose each day to keep symptoms away. There are several brands which you can buy at pharmacies, or get on prescription. Side-effects or problems with steroid nose sprays are rare (read the packet leaflet for details).

Other treatment options

Other nose sprays
The following are sometimes used. They tend to be used if there are problems with any of the above treatments. Sometimes one is used as an 'add on' treatment in addition to one or more of the above treatments if symptoms are not fully controlled.

  • Sodium cromoglicate nose spray. Like steroid sprays, it takes a while to build up its effect, and needs to be taken regularly. It is thought to work by stopping the release of histamine from certain cells. One disadvantage is that it needs to be taken 4-5 times a day (steroid sprays are taken 1-2 times a day).
  • Ipratropium bromide nose spray may be worth a try if you have a lot of watery discharge. It has no effect on sneezing or congestion.
  • Decongestant nose sprays that you can buy at pharmacies are not usually advised for more than a few days. They have an immediate effect to clear a blocked nose. However, if you use one for more than 5-7 days, a 'rebound', more severe congestion of the nose often develops. One may be useful for a few days to clear a blocked nose when you first use a steroid nose spray. The steroid can then get to the lining of the nose to work.

Avoiding the cause of the allergy
If you can avoid the cause of an allergy, symptoms will stop. This is not as easy as it sounds.

  • If you are allergic to house dust mite, you may find that symptoms are less severe if you reduce the number of mites in your home. This is hard work and involves using bedding covers, and regular cleaning and vacuuming with particular attention to your bedroom and bedclothes. However, it is impossible to keep your home completely clear of house dust mites.
  • If a pet is the cause, then for some people it is easy to give up the pet. However, for others it would be a great sadness to lose a pet. It may help if you keep pets out of the main living areas, and in particular, out of your bedroom.

If you want further advice, a separate leaflet gives details on how to reduce house dust mite. However, treatment with a nose spray or tablets often works so well that you may not have much motivation or need to avoid the cause of the allergy.

Treatment for severe symptoms
Rarely, a short course of steroid tablets is prescribed. For example, for students sitting exams who have severe symptoms which are not eased by other treatments. Steroids usually work well to reduce inflammation. A short course is usually safe. However, you should not take steroid tablets for long periods to treat rhinitis as serious side-effects may develop.

Immunotherapy (desensitisation)
This treatment is sometimes used, mainly in cases where symptoms are not helped by other treatments. It is done using a series of injections to 'desensitise' the immune system. Another technique is being developed which involves placing the allergen under the tongue.

How long is treatment needed for?

Persistent rhinitis is an ongoing (chronic) condition that usually needs regular treatment to prevent symptoms. However, over time the condition may ease, and even goes completely in some cases. It may be worth stopping treatment every six months or so to see if symptoms come back without the treatment. The treatment can be started again if symptoms return.