Allergic rhinitis is caused by substances that trigger allergies, called allergens. Specific allergens can be found both outdoors and indoors. When allergic rhinitis is caused by common outdoor allergens—such as airborne tree, grass and weed pollens or mold—it is often referred to as seasonal allergies, or "hay fever." The time and duration of the different pollen and mold seasons can vary, depending on where you live in the country.

Allergic rhinitis may also be triggered by common indoor allergens such as animal dander, indoor mold, or the droppings of cockroaches or house dust mites—microscopic creatures found in the home. When this is the case, these allergies are called perennial allergies, because symptoms may last year-round.

Symptoms of allergic rhinitis can include sneezing, congestion, a runny nose and itchiness in the nose, roof of the mouth, throat, eyes and ears. It usually appears in a person before the age of 20. In fact, allergic rhinitis may be diagnosed as early as the first year of life.

If you have symptoms of allergic rhinitis, your allergist can help you determine which specific allergens are triggering your reaction. He or she will take a thorough history and then use allergy skin testing to determine if you have allergies, and what your specific allergy triggers are. The results of the testing will then help guide treatment measures. If the test results determine that you are allergic to dust mites and not animal dander, you will need to attempt to reduce dust mite levels in your house, but don’t have to consider finding a new home for your dog.

If your allergy triggers are seasonal, your allergist will help you determine when the pollens or molds that trigger your symptoms are most prevalent. If the allergy test results show that your allergic triggers are perennial, your allergist can assist you in taking appropriate environmental control measures to reduce specific allergens. 

Your physician may also prescribe an allergy nose spray, non-sedating antihistamine, decongestant or other medications to lessen your allergic rhinitis symptoms. If your symptoms continue or if you have them for many months of the year, you and your allergist may also consider immunotherapy treatment, also called allergy vaccinations or shots. This treatment involves receiving injections periodically—as determined by your allergist—over a period of three to five years. This helps your immune system to become more and more resistant to specific allergens, and lessens the need for future medications.

Non-allergic rhinitis, or irritant rhinitis, is triggered by certain factors, such as strong smells, pollution, particulate matter in the air, smoke or other irritants. These substances differ from allergens in that they do not produce a reaction in an individual’s immune system. Symptoms of rhinitis can also be triggered by temperature and atmospheric changes. Non-allergic rhinitis usually afflicts adults and causes year-round symptoms, especially nasal congestion or "stuffiness" and headaches. If the rhinitis sufferer also has a very runny nose, the condition is often referred to as vasomotor rhinitis. Although medications cannot completely relieve symptoms, your doctor may prescribe decongestants or a steroid nose spray to lessen symptoms. Interestingly, regular exercise can also be helpful.

Symptoms of non-allergic rhinitis may also occur as a result of pregnancy, thyroid disorders or as a side effect of certain medications. When the symptoms are traced to a deficiency of thyroid hormone, thyroid medication can help.

Another type of non-allergic rhinitis, called eosinophilic non-allergic rhinitis, is named after the blood cell—the eosinophil—which distinguishes it from the other forms of non-allergic rhinitis. This type of rhinitis behaves like allergic rhinitis in that it causes frequent, recurrent bouts of sneezing and a runny nose. This disorder, which may seem to appear from out of the blue, can be provoked by changes in the environment such as air pressure variations or weather shifts. Allergy skin tests are negative with this type of rhinitis, and growths in the nose, called nasal polyps, are a common complication. Medications such as antihistamines, decongestants and topical cromolyn may be beneficial, but topical nasal corticosteroids provide the best relief for many patients.

Rhinitis medicamentosa occurs when non-prescription topical decongestants—over-the-counter nose sprays—are used in excess, often for more than three consecutive days. This form of rhinitis causes severe nasal congestion and is best treated by stopping use of the offending nasal spray. This often leads to temporary severe congestion, which can be helped by topical or oral corticosteroids.

Neutrophilic rhinosinusitis is usually triggered by a sinus or related infection. It may also be associated with viral infections such as a cold or flu. This form of rhinitis causes symptoms such as post-nasal drip and sinus pain, which may be treated with decongestants and nasal saline solution. Antibiotics are prescribed when the sinuses are infected, but not for simple colds.

Structural rhinitis is caused by structural abnormalities in the nasal septum. These abnormalities can be the result of an injury, such as a broken nose, or something that the person was born with, such as small or crooked nasal passages. Structural rhinitis may produce year-round congestion that usually affects one side of the nose more than the other. Surgery can aid in correcting this abnormality.

Symptoms of rhinitis can also be caused by nasal polyps—growths on the mucus membrane of the nose that can cause congestion and loss of sense of smell. They provoke symptoms year-round and usually begin between the ages of 20 and 40. Nasal polyps may be associated with aspirin sensitivity and asthma, and may cause recurrent sinusitis. Decongestants or corticosteroid nasal sprays or pills may provide temporary relief. Nasal polyps can be surgically removed, but they have a tendency to recur.

By learning about the causes and symptoms of various forms of rhinitis, you will be better able to identify your symptoms and triggers. Your allergist can assist by making an accurate diagnosis and developing an effective treatment plan for you.

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