by Gerald B. Goldstein, M.D.
Not infrequently, patients come to the office with complaints of nasal stuffiness, runny nose, and sneezing. Although these symptoms suggest allergy, in many cases the history fails to follow the pattern typical for seasonal hay fever, and the allergy skin tests may be negative as well. These patients are given the diagnosis of vasomotor or non-allergic rhinitis. On further review, they fail to have symptoms on contact with grass, when pulling weeds, or while playing with pets. Characteristically, they suffer with year-round nasal symptoms triggered by exposure to a variety of irritants such has smoke, perfumes, heavy dust concentrations, gasoline fumes, and automobile exhaust. Another set of non-allergic patients is bothered primary by various weather conditions such as wind, increased humidity, changes in barometric pressure, and last but not least, our arid Southwestern climate.
The exact cause for the above condition is difficult to pinpoint. Nervous pathways regulate nasal blood vessels and the glands which produce secretions. One can postulate that the nerve fivers are abnormally hyperresponsive to the irritants and weather factors mentioned above, and that the final result of this abnormal nerve excitation is a congested and/or very runny nose.
Since by definition, vasomotor rhinitis is not an allergic condition, patients with this problem are not good candidates for allergy injection therapy. We try to relieve symptoms with a combination of medication and environmental control. Decongestants and nasal steroid sprays, alone or in combination, often help nasal stuffiness. If antihistamines fail to dry excessive secretions, a new and recently available spray is specific for the nose that will not stop dripping. Irritant and weather factors are more difficult to control. These days it is easier to find cigarette-smoke-free areas, but it may be necessary for patients to leave places where people are wearing strong perfumes or where the odor of new carpets or other pungent scents are present. People sensitive to wind should avoid going out on blustery days and intolerance to dry climate can be helped with a bedroom humidifier and moisturizing saline nasal sprays. Non-allergic rhinitis may be as common as the allergic variety, making it’s understanding and treatment an important part of an allergy practice.
Posted in: Sinus Disease