Runny nose driving you crazy?
Yeah. Me too.
But let me tell you what’s NOT the reason…
You didn’t suddenly develop airborne allergies in the middle of winter
It’s not a sinus infection
You aren’t leaking spinal fluid thru your nose (probably)
If you are having daily runny nose (clear, thin), nasal congestion (sensation of decreased airflow), or postnasal drip then read on… While allergic rhinitis is the most common reason for nasal inflammation (aka rhinitis), over 50% of patient with these symptoms may have a different type of nasal inflammation. In fact, 1/3 of people have more than one reason for their runny congested noses!
You are likely experiencing NONALLERGIC RHINITIS
This category can broken down further by cause:
Drug induced rhinitis (overuse of nasal decongestants like Afrin, but also potentially due to aspirin/NSAIDs sensitivity and some anti-hypertensive medications like beta-blockers and calcium channel blockers)
Gustatory rhinitis (runny nose or congestion with eating, even when not spicy! this can be due to food sensitivities)
Hormonal rhinitis (over 30% of women experience rhinitis of pregancy and post-menopausal women can also have increased nasal inflammation due to changes in hormone levels)
Infectious rhinitis (usually after a viral cold, can linger for several weeks)
Vasomotor rhinitis (think of it like an irritated nerve, impacted by weather changes or strong odors)
Occupational rhinitis (exposure to fumes, dusts, chemicals)
Atrophic rhinitis (due to over zealous nasal surgery and removal of turbinate mucosa)
Senile rhinitis/rhinitis of aging (pretty self explanatory, if not slightly offensive)
NARES (nonallergic rhinitis with eosinophilia syndrome; also called nasal allergy syndrome where you have all the signs of symptoms of allergic rhinitis, with a increase in nasal eosinophils, but allergy testing is negative)
Ok. Breathe. Through your nose if you can…
That’s a long list of other possible reasons for your nasal symptoms. So don’t let a negative allergy test make you feel lost. You can still find an answer!
In fact, nonallergic rhinitis can respond to some of the same medications used to treat allergic rhinitis. The key is to determine if you have “congestion dominant” or “rhinorrhea (runny nose) dominant” symptoms.
If you are congestion dominant try:
Nasal xylitol spray (brand Xlear)
Nasal steroid spray (brand Flonase, Rhinocort, etc)
Nasal antihistamine spray (brand Astepro)
GInger tea or juice (great for opening up a blocked nose)
If you are rhinorrhea (runny nose) dominant try:
Nasal anticholinergic spray (prescription only-Atrovent)
Nasal capsaicin spray (brand Sinus Plumber or Nasol *warning this treatment can burn temporarily)
Atringent herbs like nettle, chamomile, or lemon balm
Notice what I didn’t list?
Oral antihistamines like Zyrtec or Allegra. These are not going to help non-allergic rhinitis symptoms.
There are also devices that use cryotherapy/freezing (Clarifix) or radiofrequency (RhinAer) to help with these conditions. These procedures are performed by an ENT, often under some form of anesthesia.
But you know I can’t leave without saying this…
I encourage you to look to the root cause. By modifying your environment, habits or exposures, you can reduce or eliminate your need for nasal medications.
Look out for:
-Exposure to second hand smoke/vaping fumes
-Chemicals in household cleaners
-Fragrances in body care products (lotion, shampoo, cologne) and detergents, candles and incense
-Food sensitivities (dairy and gluten are most common)
-Alcohol
-Mold
It is helpful to work with a knowledgeable practitioner to help identify the cause of your symptoms and work together on a treatment plan!
**PS-Did I scared you with that talk of spinal fluid? While that is a possibility, it is extremely rare (0.00005% of the time), however if you have concerns, please reach out to your doctor or advanced practice provider right away.
