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Rhinitis is inflammation of the lining of the nasal passages, which causes a blocked or runny nose. Unlike seasonal rhinitis – such as hay fever, which is only present for part of the year – having persistent rhinitis means you are stuck with these annoying symptoms all the time. The severity of symptoms can also vary; you can get a mild irritation in your nose that maybe only causes you a real problem now and again, or you can have constant sneezing and a blocked, itchy, and runny nose all day, every day. This can be distressing and can affect the way you enjoy life as well as your ability to study and work effectively.

The treatments available for persistent rhinitis largely depend on what is causing your symptoms. Options include avoiding anything that triggers an attack, or medical treatment such as antihistamines or steroids in the form of a nose spray or tablets. If you have very severe persistent rhinitis, you may be offered other treatments such as desensitisation or surgery.

This article on persistent rhinitis is by Kathryn Senior, a freelance journalist who writes health, medical, biological, and pharmaceutical articles for national and international journals, newsletters and web sites.


What causes persistent rhinitis?

The cause of persistent rhinitis can be either allergic or non-allergic. An allergy to house dust mites or animal dander (fur and skin) is the most common trigger for symptoms of allergic persistent rhinitis. Other less common allergic triggers – such as latex, dust or chemicals – can also cause the familiar itchy and runny nose. It is also possible for irritants such as smoke, strong smells, fumes, changes in temperature or humidity, and even food sensitivities to underlie persistent rhinitis.

Some medications or medical conditions can also sometimes cause symptoms, as can emotions and periods of extreme stress. In some people, there doesn’t seem to be any specific trigger for their persistent rhinitis – they are said to have idiopathic rhinitis.

How is it treated?

Your doctor can recommend and prescribe several medications to help you control your persistent rhinitis. Symptoms can ease over time or even stop completely, so it’s worth taking regular breaks from your treatment so see whether your persistent rhinitis returns.

  • Antihistamines control symptoms such as post-nasal drip, itchy eyes and sore throat, and are available as tablets, liquids or nasal sprays.

  • Decongestants reduce nasal congestion with an immediate effect. However, if you use them for more than 5–7 days, more severe congestion of the nose can develop – commonly known as the rebound effect.

  • Steroids can be used in the form of drops or a nasal spray. These can take a few days to work, so you may not see improvements immediately. You need to use them every day to keep symptoms under control. Steroids can be used together with antihistamines if needed. Your doctor will often give you a course of steroid tablets to treat severe symptoms in the short-term, such as during exams or if you have a job interview.

  • Other nose sprays include sodium cromoglicate and ipratropium bromide nose sprays. These also aim to cut down the inflammation and reduce symptoms.

  • Eye drops usually contain antihistamines and work quickly, so you can use them as regularly as you need to relieve eye symptoms. Mast cell stabilisers can also be formulated as eye drops. These are thought to work by preventing the release of histamine from mast cells in the lining of the nose. It is best to use your eye drops every day to prevent symptoms flaring up.

  • Immunotherapy (desensitisation) is sometimes used when symptoms are severe and not helped by other treatments. This involves injecting increasing levels of the allergen that causes the persistent rhinitis symptoms, allowing your immune system to become 'desensitised' to the allergen.

What about non-drug treatments?

Although the medications recommended for reducing the impact of persistent rhinitis on your life can work well, many people are worried about taking such medication in the long-term. Changing your habits and lifestyle can also be very beneficial and it is certainly worth trying some or all of the following:

  • Humidifiers moisten the air in your home, which helps to thin mucus and reduce congestion. A steam room or hot shower can have the same effect.
  • Drinking plenty of fluids – especially water – can also help relieve congestion.
  • Avoid irritants such as cigarette smoke, perfumes, household cleaning products and toiletries that can trigger persistent rhinitis symptoms.
  • An allergen-free environment is the best way to avoid persistent rhinitis. Remove dust from surfaces and the air by regular cleaning and using an air purifier, and wash bedding and soft furnishings often.

Complications

Nasal polyps (see below), sinusitis and asthma are all more serious complications of persistent rhinitis. Having a constantly blocked or congested nose or lots of nasal discharge can stop your sinuses from draining properly and this leaves them prone to infection. Sinusitis causes severe pain in the face, particularly around the cheekbones and above the eyebrows and may need antibiotics to help clear up the infection. Asthma is more likely in people who suffer with persistent rhinitis than those who don’t.

The use of surgery

Surgery is not a common standard or first-line treatment for allergic persistent rhinitis but it can be used to treated related problems such as nasal polyps, one of the most serious complications of persistent rhinitis. These grape-like swellings can grow from the lining of the nose or in the sinuses and also make the rhinitis worse, leading to a vicious cycle. If you have large polyps, you may need an operation to remove them but smaller ones can be withered away with steroid nose drops.

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