non-allergic rhinitis

How many times have you had nasal symptoms, and you have gone to an allergist, but no allergy has been found?

Have you ever felt a sore throat, runny nose or nasal congestion, occasionally itchy eyes, and sometimes problems with your ears?
















The summer season is over, and the pollen count is now too low even to count!

So it can no longer be associated with hay or hayfever, so what is it?

If this has happened to you, then it is likely we are talking of a different diagnosis.

𝐍𝐨𝐧-𝐚𝐥𝐥𝐞𝐫𝐠𝐢𝐜 𝐫𝐡𝐢𝐧𝐢𝐭𝐢𝐬 is often also known as noninfectious, perennial eosinophilic rhinitis and non-allergic rhinitis with eosinophilic syndrome.⁣
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Many conditions can cause it.⁣

1. Eosinophilic
   
2. Autonomic
3. Drugs
4. Hormonal
5. Food
6. Atrophic
7. Primary mucus defect
8. Primary ciliary dyskinesias
9. Systemic/Inflammatory
   
10. Immunodeficiency
11. Malignancy
12. Granulomatous diseases
13. Structural abnormalities
14. Idiopathic

As we have reached the cold season, it will be common to see children (not as often in adults) with nasal congestion when exposed to cold air.⁣
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Some medication can also lead to nasal symptoms.⁣

• Among others, Aspirin can lead to rhinitis and be associated with non-atopic Asthma and the development of nasal polyps. Though it is more often seen in adults than in children.⁣
  
• Adults who often use nasal decongestants should also be careful as one of the common side effects is a rebound nasal congestion, called rhinitis medicamentosa. As with Aspirin, this is more common in adults and rarely seen in children.⁣

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Treatment wise, and apart from antihistamines, it should be the same as with Allergic Rhinitis.⁣
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The best and first-line treatment are nasal steroids.⁣⁣
And which ones to use?⁣⁣

1. Age 3 years and above - Mometasone furoate (Nasonex) - my choice⁣⁣
   
2. Age 6 years and above - Fluticasone furoate (Avamys)⁣⁣
3. Age 12 years and above - Fluticasone and Azelastine (a combination of steroid and antihistamine - Dymista)⁣⁣

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For your eyes, there are a couple of choices:⁣⁣

1. Any age - Sodium cromoglicate (a mast cell stabilizer)- my choice⁣⁣
   
2. Age 3 years and above - Olopatadine⁣ (a combination of mast cell stabilizer and antihistamines)⁣
   
3. Some patients like to use artificial tears as the main choice - though better for allergic rhinitis.⁣

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It is crucial first to achieve a diagnosis, so appropriate treatment can be done, as other therapies might be needed, including treatment of the primary cause.⁣
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For this condition, it is essential good cooperation between an Allergy Doctor and an ENT specialist.

What is also extremely important is to use the right technique for any nasal spray.

• Also, remember to cross your hands.
  
• Right hand to the left nostril.
• Left hand to your right nostril.
  

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