Rhinitis is inflammation of the nasal mucosa that causes symptoms like congestion; runny nose; cough; frequent sneezing; headache; and red, itchy, watery eyes.

In the majority of cases, rhinitis is caused by an allergy to dust, mites, or pet hair, however it can also be caused by the use of nasal decongestants (rhinitis medicamentosa).

Treatment of rhinitis varies based on the cause, and may involve the use of allergy medications in addition to maintaining a clean home environment free of allergens. Immunotherapy may also be indicated in cases where treatment with other medications is not enough.

Common symptoms

The main symptoms of rhinitis are:

Runny nose;
Frequent sneezing;
Red, swollen, and watery eyes;
Burning sensation in the eyes, nose, and mouth;
Persistent dry cough;
Headache;
Diminished senses of smell and hearing.

Rhinitis can increase the risk for other complications, such as ear infections and conjunctivitis, due to the accumulation of secretions in the nasal passages along with a compromised immune system.

What is the difference between rhinitis, sinusitis, and rhinosinusitis?

Rhinitis is inflammation of the nasal mucosa typically due to allergies, and involves symptoms like frequent sneezing, runny nose, watery eyes, and a burning sensation in the eyes, nose, and mouth.

Sinusitis, also known as a sinus infection, is inflammation of the paranasal sinuses and is more associated with bacterial infections. Sinus infection symptoms include facial pain and pressure due to accumulation of secretions in the sinuses.

Rhinosinusitis is inflammation of the nasal mucosa and the sinuses and presents with the same symptoms as sinusitis.

Confirming a diagnosis

The diagnosis of rhinitis is made by a otolaryngologist, allergist, or primary care provider based on an evaluation of symptoms.

Blood tests may also be ordered to check levels of immunoglobulin E (IgE), which may be elevated in the case of allergic rhinitis. Allergy testing may also be done to identify the specific allergen that is causing symptoms.

A diagnosis of allergic rhinitis can be made starting around 5 years of age, as results may be inaccurate before this time. If you suspect your child may be suffering from allergic rhinitis, try identifying what they are allergic to in order to take the necessary precautions.

Possible causes

The main causes of rhinitis include:

Allergies to mites, dust, mold, pollen, or animal hair, saliva, or urine;
Temperature changes;
Strong smells, like perfumes or cleaning products;
Cigarette smoke;
Spicy foods;
Conditions like gastroesophageal reflux disease (GERD) and asthma;
Alcohol use disorder;
Nose injury.

Rhinitis can also be caused by a viral or bacterial infection as well as the use of nasal decongestants, anti-hypertensives, or antidepressants.

Another cause of rhinitis is hormone changes, primarily related to pregnancy, menstruation, or the use of hormonal contraceptives.

Different types

Rhinitis can be classified into various types depending on the cause. The main types of rhinitis include:

1. Allergic rhinitis

Allergic rhinitis is the most common form of rhinitis, with runny nose being the primary symptom. Secretions are clear and either frequent or constant.

This type of rhinitis is primarily caused by allergens like mites, mold, or pollen, which trigger the release of histamine in the body that is responsible for symptoms.

2. Chronic rhinitis

If symptoms of allergic rhinitis last for more than 3 months, it may be that the allergic rhinitis has evolved into chronic rhinitis.

3. Vasomotor rhinitis

Vasomotor rhinitis, or nonallergic rhinitis, is inflammation of the nasal mucosa caused by excessive dilation of the blood and lymphatic vessels inside the nose. This type of rhinitis presents as a constantly runny nose with negative allergy testing.

In some cases, the best treatment option is surgery.

4. Rhinitis medicamentosa

Rhinitis medicamentosa happens when individuals self-treat, or use medications without proper medical guidance.

This is the case with the use of nasal decongestants, which are used by many people but can cause irritation of the nasal mucosa when used too frequently.

Treatment options

Treatment of rhinitis varies based on the cause, and should be managed by an otolaryngologist, allergist, or primary care provider.

The main treatments for rhinitis include:

1. Avoiding allergens

Avoiding contact with allergens helps treat and prevent allergic rhinitis.

Your healthcare provider may also recommend keeping your home environment clean by using a damp cloth to avoid stirring up dust; removing carpeting, curtains, and stuffed animals in the bedroom; and airing out the house.

In addition, it may be recommended to keep pets out of the house or the bedroom in order to prevent the accumulation of animal hair, which is a food source for mites and can also trigger allergies.

2. Using nasal irrigation

Nasal irrigation with normal saline (sodium chloride 0.9%) helps relieve symptoms of a stuffy nose by thinning out secretions and making them easier to clear.

Another option that your doctor may recommend is the use of saline drops or nasal spray, which also help with nasal hygiene and eliminating irritants and allergens.

3. Taking medications

Medications to treat rhinitis may be prescribed by your doctor or healthcare provider to help relieve symptoms of rhinitis, such as stuffy or runny nose, itchy eyes or nose, constant sneezing, or tearing.

The most common medications indicated for the treatment of rhinitis are corticosteroids like budesonide or beclomethasone (in the form of a nasal spray), and antihistamines like loratadine or hydroxyzine (taken in pill form).

Other medications include montelukast or zafirlukast, however these medications are not as effective as nasal corticosteroids and are usually indicated only in severe or refractory (rebound) cases, typically in combination with other medications.

For rhinitis caused by the use of nasal decongestants, your provider will likely recommend stopping the use of these medications.

4. Getting immunotherapy

Another form of treatment, called desensitizing immunotherapy, involves a vaccine for allergic rhinitis that may be recommended when other preventative measures and treatment options are not effective.

5. Receiving Botox injections

Injections of botulinum toxin (Botox) type A may be prescribed by your doctor for treatment of vasomotor (nonallergic) rhinitis.

This injection is administered by a doctor in the inferior and middle turbinates (bony structures) of the nose and helps reduce nasal secretions for up to 4 weeks, after which another dose is necessary.

6. Having surgery

Surgery for vasomotor (nonallergic) rhinitis may be recommended by your doctor to reduce the size of the inferior nasal turbinate or interrupt the vidian nerve.

This type of surgery improves symptoms of nasal congestion and runny nose, and can also be combined with the use of steroid nasal sprays.