ConditionEar, nose & throat
Rhinitis
Rhinitis is inflammation or irritation of the lining of the nose, causing a runny or blocked nose, sneezing, itching and post-nasal drip. It is one of the most common conditions in medicine. The main types are allergic rhinitis (triggered by pollen, dust mites, mold or pets), infectious rhinitis (usually a cold), and non-allergic rhinitis, triggered by weather, smells, food, hormones or overuse of decongestant sprays. Identifying the type matters because the most effective treatments differ.
Also called: Inflamed nasal lining, nasal inflammation, allergic rhinitis, non-allergic rhinitis, vasomotor rhinitis
At a glance
- What it is
- Inflammation of the nasal lining with runny nose, congestion, sneezing or itching.
- Main types
- Allergic, infectious, non-allergic (vasomotor, gustatory, hormonal, drug-induced, occupational) and mixed.
- How common
- Allergic rhinitis alone affects up to 1 in 4 adults; non-allergic rhinitis is also common, especially after 20.
- Diagnosis
- History, nasal exam and allergy testing.
- Treatment
- Steroid and antihistamine nasal sprays, saline rinses, trigger avoidance, and ipratropium for watery drip.
When to get help
Call 911 or go to the ER
- Swelling of the lips, tongue or throat, or trouble breathing with sneezing and hives (possible anaphylaxis)
See a doctor within a day or two
- Severe facial pain or swelling, swelling around an eye, or high fever with nasal symptoms
- Clear, watery drip from one nostril after a head injury or nasal surgery (possible spinal fluid leak)
- Rhinitis with worsening asthma or wheezing
Book a routine appointment
- Symptoms lasting more than 12 weeks, or recurring every season
- A blocked nose on one side only, nosebleeds, or bloody or foul discharge
- Loss of smell
- Using decongestant nasal spray for more than 3 days in a row and unable to stop
- Snoring and poor sleep from a blocked nose
Usually safe to manage at home
- A runny, stuffy nose with sneezing from a cold that is improving within 10 days
- Mild seasonal sneezing and itchy nose controlled with over-the-counter treatments
Types of rhinitis
| Type | Triggers | Typical features |
|---|---|---|
| Allergic rhinitis | Pollen, dust mites, mold, pet dander, cockroaches | Sneezing fits, itchy nose, eyes and throat, clear discharge; often seasonal; family history |
| Infectious rhinitis | Cold viruses, sometimes bacteria | Sore throat, fever, thicker mucus; lasts 7 to 10 days (common cold) |
| Vasomotor (non-allergic) rhinitis | Temperature or humidity changes, strong smells, smoke, alcohol | Congestion and drip without itching; negative allergy tests |
| Gustatory rhinitis | Hot or spicy foods | Watery runny nose while eating |
| Hormonal rhinitis | Pregnancy, puberty, hypothyroidism | Congestion; pregnancy rhinitis resolves after birth |
| Rhinitis medicamentosa | Overuse of decongestant nasal sprays | Rebound congestion after a few days of spray use |
| Drug-induced | Some blood pressure medicines, sildenafil-type drugs, NSAIDs, birth control | Congestion after starting the medicine |
| Occupational | Flour, wood dust, chemicals, lab animals | Symptoms at work that improve on days off |
| Atrophic rhinitis | Older age, previous nasal surgery | Dry, crusty nose with odor and a sense of blockage |
| Mixed rhinitis | Both allergic and non-allergic triggers | Common in adults |
Acute vs chronic rhinitis
Acute rhinitis lasts days to weeks and is usually a cold, also described as coryza. Chronic rhinitis lasts more than 12 weeks and is usually allergic or non-allergic.
Symptoms
- runny nose (rhinorrhea)
- stuffy or blocked nose
- sneezing
- itching of the nose, eyes, ears or roof of the mouth (more typical of allergy)
- post-nasal drip, throat clearing and cough
- reduced sense of smell
- tiredness and poor sleep, mouth breathing and snoring
- dark circles under the eyes ("allergic shiners") in children
Related conditions
- Sinusitis: rhinitis often comes with sinus inflammation (rhinosinusitis)
- Nasal polyps: soft growths causing blockage and smell loss
- Asthma: many people with allergic rhinitis have asthma, and treating rhinitis can improve asthma control
- Ear problems: fluid behind the eardrum, especially in children
- Deviated septum: structural blockage that can worsen symptoms
Diagnosis
- History: timing, triggers, seasons, pets, workplace, medicines and spray use
- Nasal examination, sometimes with a nasal endoscope
- Allergy testing: skin-prick tests or blood tests for specific IgE
- CT scan of the sinuses only if chronic sinusitis or structural problems are suspected
Treatment
Self-care
- Saline nasal rinses or sprays: clear mucus and irritants; useful for all types
- Avoid triggers: keep windows closed during high pollen counts, use dust-mite covers, wash bedding hot, keep pets out of the bedroom, avoid smoke and strong odors
- Humidifier for dry air, kept clean
Medicines
| Medicine | Best for | Notes |
|---|---|---|
| Steroid nasal sprays (fluticasone, budesonide, mometasone, triamcinolone) | Allergic and non-allergic rhinitis, congestion | Most effective single treatment; work best used daily; full effect in 1 to 2 weeks |
| Antihistamine nasal sprays (azelastine, olopatadine) | Allergic, vasomotor and mixed rhinitis | Work within minutes; bitter taste |
| Oral non-drowsy antihistamines (cetirizine, loratadine, fexofenadine) | Allergic rhinitis, sneezing and itch | Little effect on non-allergic rhinitis |
| Ipratropium nasal spray | Watery runny nose, including gustatory rhinitis | Dries secretions; prescription |
| Decongestant nasal sprays (oxymetazoline) | Short-term severe blockage | No more than 3 days to avoid rebound |
| Oral decongestants (pseudoephedrine) | Short-term congestion | Avoid with high blood pressure, heart disease, glaucoma or prostate problems |
| Leukotriene antagonists (montelukast) | Allergic rhinitis with asthma | FDA warning about mood and behavior changes |
Follow the label dose for over-the-counter products, and ask a pharmacist if you are pregnant or have other conditions.
Other treatments
- Allergen immunotherapy: allergy shots or under-the-tongue tablets for persistent allergic rhinitis, reducing symptoms long term
- Stopping decongestant sprays with a steroid spray to manage rebound congestion
- Changing medicines that cause congestion, with your doctor
- Surgery for structural problems such as a severely deviated septum, enlarged turbinates or polyps
- Cryotherapy or radiofrequency treatment of the nerves to the nose for chronic non-allergic runny nose in selected people
Frequently asked questions
What is the difference between allergic and non-allergic rhinitis?
Allergic rhinitis is triggered by allergens such as pollen or dust mites and usually causes sneezing and itching. Non-allergic rhinitis is triggered by irritants, weather, food, hormones or medicines and causes congestion and drip with little itching. Allergy tests are negative in non-allergic rhinitis.
What is vasomotor rhinitis?
Vasomotor rhinitis is a common type of non-allergic rhinitis in which the nose overreacts to temperature changes, strong smells, smoke, alcohol or stress, causing a runny or blocked nose. It is treated with nasal steroid or antihistamine sprays, ipratropium and trigger avoidance.
What is rhinitis medicamentosa?
Rhinitis medicamentosa is rebound congestion from using decongestant nasal sprays for more than a few days. The nose becomes more blocked when the spray wears off. It is treated by stopping the spray, often with a steroid nasal spray to ease the transition.
Can rhinitis be cured?
Infectious rhinitis clears on its own. Chronic allergic and non-allergic rhinitis usually cannot be cured, but symptoms can be well controlled. Allergen immunotherapy can provide long-term improvement in allergic rhinitis.
What is the best spray for chronic rhinitis?
Steroid nasal sprays are the most effective single treatment for most types of chronic rhinitis. Antihistamine nasal sprays help allergic and non-allergic rhinitis, and ipratropium is best for a constantly runny nose. Many people use a combination.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Allergy, Asthma & Immunology: Rhinitis; Rhinitis 2020 practice parameter update
- American Academy of Otolaryngology-Head and Neck Surgery: Clinical practice guideline - Allergic rhinitis
- NHS: Non-allergic rhinitis
- MedlinePlus: Allergic rhinitis; Runny nose
- Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines