Nonallergic rhinitis is diagnosed based on your symptoms and ruling out other causes, especially allergies. Your doctor will perform a physical examination and ask questions about your symptoms.
He or she may also recommend certain tests. There are no specific, definite tests used to diagnose nonallergic rhinitis. Your doctor is likely to conclude your symptoms are caused by nonallergic rhinitis if you have nasal congestion, a runny nose or postnasal drip, and tests for other conditions don't reveal an underlying cause such as allergies or a sinus problem.
In some cases, your doctor may have you try a medication and see whether your symptoms improve.
Ruling out an allergic cause
In many cases, rhinitis is caused by an allergic reaction. The only way to be sure rhinitis isn't caused by allergies is through allergy testing, which may involve skin or blood tests.
- Skin test. To find out whether your symptoms might be caused by a certain allergen, your skin is pricked and exposed to small amounts of common airborne allergens, such as dust mites, mold, pollen, cat and dog dander. If you're allergic to a particular allergen, you'll likely develop a raised bump (hive) at the test location on your skin. If you're not allergic to any of the substances, your skin looks normal.
- Blood test. A blood test can measure your immune system's response to common allergens by measuring the amount of certain antibodies in your bloodstream, known as immunoglobulin E (IgE) antibodies. A blood sample is sent to a medical laboratory, where it can be tested for evidence of sensitivity to specific allergens.
In some cases, rhinitis may be caused by both allergic and nonallergic causes.
Ruling out sinus problems
Your doctor will also want to be sure your symptoms aren't caused by a sinus problem related to a deviated septum or nasal polyps. If your doctor suspects a sinus problem may be causing your symptoms, you may need an imaging test to view your sinuses.
- Nasal endoscopy. This test involves looking at the inside of your nasal passages. This is done with a thin, fiber-optic viewing instrument called an endoscope. Your doctor will pass the fiber-optic endoscope through your nostrils to examine your nasal passages and sinuses.
- Computerized tomography (CT) scan. This procedure is a computerized X-ray technique that produces images of your sinuses that are more detailed than those produced by conventional X-ray exams.
Treatment of nonallergic rhinitis depends on how much it bothers you. For mild cases, home treatment and avoiding triggers may be enough. For more-bothersome symptoms, certain medications may provide relief, including:
- Saline nasal sprays. Use an over-the-counter nasal saline spray or homemade saltwater solution to flush the nose of irritants and help thin the mucus and soothe the membranes in your nose.
Corticosteroid nasal sprays. If your symptoms aren't easily controlled by decongestants or antihistamines, your doctor may suggest a nonprescription corticosteroid nasal spray, such as fluticasone (Flonase) or triamcinolone (Nasacort). Prescription-only corticosteroid nasal sprays are also available.
Corticosteroid medications help prevent and treat inflammation associated with some types of nonallergic rhinitis. Possible side effects include nasal dryness, nosebleeds, headaches and throat dryness.
- Antihistamine nasal sprays. Try a prescription antihistamine spray such as azelastine (Astelin, Astepro) and olopatadine hydrochloride (Patanase). While oral antihistamines don't seem to help nonallergic rhinitis, nasal sprays containing an antihistamine may reduce symptoms of nonallergic rhinitis.
- Anti-drip anticholinergic nasal sprays. The prescription drug ipratropium (Atrovent) is often used as an asthma inhaler medication. But it's now available as a nasal spray and can be helpful if a runny, drippy nose is your main complaint. Side effects may include nosebleeds and drying of the inside of your nose.
- Decongestants. Available over-the-counter or by prescription, examples include pseudoephedrine-containing drugs (Sudafed) and phenylephrine (Afrin, Neo-Synephrine, others). These medications help narrow the blood vessels, reducing congestion in the nose. Possible side effects include high blood pressure, heart pounding (palpitations) and restlessness.
Over-the-counter oral antihistamines, such as diphenhydramine (Benadryl), cetirizine (Zyrtec), fexofenadine (Allegra) and loratadine (Claritin), typically don't work nearly as well for nonallergic rhinitis as they do for allergic rhinitis.
In some cases, surgical procedures may be an option to treat complicating problems, such as a deviated nasal septum or persistent nasal polyps.
Lifestyle and home remedies
Try these tips to help reduce discomfort and relieve the symptoms of nonallergic rhinitis:
Rinse your nasal passages. Use a specially designed squeeze bottle, such as the one included in saline kits, bulb syringe or neti pot to irrigate your nasal passages. This home remedy, called nasal lavage, can help keep your nose free of irritants. When used daily, this is one of the most effective treatments for nonallergic rhinitis.
To prevent infection, use water that's distilled, sterile, previously boiled and cooled, or filtered using a filter with an absolute pore size of 1 micron or smaller to make up the irrigation solution. Also be sure to rinse the irrigation device after each use with similarly distilled, sterile, previously boiled and cooled, or filtered water and leave open to air-dry.
- Blow your nose. Regularly and gently blow your nose if mucus or irritants are present.
- Humidify. If the air in your home or office is dry, set up a humidifier in your work or sleep location. Be sure to regularly clean the humidifier according to the manufacturer's instructions. You can also breathe in the steam from a warm shower to help loosen the mucus in your nose and clear your head of stuffiness.
- Drink liquids. Drinking plenty of liquids, including water, juice, and caffeine-free tea, can help loosen the mucus in your nose. Avoid caffeinated beverages.
Some small studies have shown repeated applications of capsaicin — the ingredient responsible for the heat in hot peppers — to the inside of the nose can ease nasal congestion. The treatment is often given multiple times on the same day, and relief has been shown to last as long as 36 weeks. But larger studies are needed.
Preparing for your appointment
Here's some information to help you prepare for your appointment.
What you can do
- Be aware of any pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as not taking medicine for your congestion beforehand.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins or supplements you're taking.
- Write down questions to ask your doctor.
Preparing a list of questions for your doctor will help you make the most of your time together. List your questions from most important to least important. For nonallergic rhinitis, some basic questions to ask your doctor include:
- What's the most likely cause of my symptoms?
- What tests do I need?
- Is my condition likely temporary or long-lasting?
- What treatments are available, and which do you recommend for me?
- I have these other health conditions. How can I best manage these conditions together?
- Is there a generic alternative to the medicine you're prescribing?
- Are there brochures or other printed materials I can take with me? What websites do you recommend?
Don't hesitate to ask other questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, including:
- Have you had a cold or other illness recently?
- When did you begin having symptoms?
- Do you have symptoms all the time or do they come and go?
- How severe are your symptoms?
- Does anything seem to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- What medications have you tried for your symptoms, and has anything helped?
- Do your symptoms worsen when you eat spicy foods, drink alcohol or take certain medications?
- Are you typically exposed to fumes, chemicals or other airborne irritants?