Rhinitis means the lining of the nose is inflamed. You may have blocked nose, runny nose, mucus running from the nose into the throat (post nasal discharge), sneezing and an itchy nose.

Rhinitis can be allergic on non-allergic. Allergic rhinitis means your immune system is reacting to things that you breathe in (allergens) by making an allergic immune response including antibodies. Blood tests can diagnose allergic rhinitis by measuring the level of these antibodies in the blood. People with allergic rhinitis often have asthma, eczema and conjunctivitis.

Allergic rhinitis can be seasonal (hayfever) or perennial (this means every day of the year). Common allergens causing hayfever are grasses and pollens. Common allergens causing perennial allergic rhinitis are dust mite, pets and moulds in soils.

Non-allergic rhinitis can be triggered by irritants like cold temperatures, low humidity, hot or spicy foods, alcohol, strong chemical smells or odours, smoking or wood smoke and hormonal changes (pregnancy, menstruation) and is more common as people get older.

What treatments work?

 For all kinds of rhinitis these three treatments work well:

  1. Avoiding the allergen or irritants.
  2. Rinsing the allergens and irritants away with saline.
  3. Steroid nasal sprays used every day while symptoms are active.

For allergic rhinitis there are two extra treatments:

  1. Anti-histamines: you can use eye drops, tablets or nasal sprays.
  2. Immunotherapy.

It’s safe to use all these medications on the same day and for people with severe rhinitis, it’s common to need to use all medications on days when your symptoms are severe.

1. Identify and then avoid the allergen or irritant

A blood test can identify allergic triggers and you can keep a diary of symptoms to identify non allergic triggers. Some things are easy to avoid, like horses. Other things like dust, grass, pollen and moulds are everywhere and are impossible to avoid. Stopping smoking always helps. For evidence based advice about allergen minimisation measures in your home see www.allergy.org.au

2. Rinsing the allergens and irritants away with salt water

You can use salt rinses after an exposure (e.g. horse riding or gardening) or you can use them regularly, once or twice a day. Swimming in the ocean has the same effect. Rinses are more effective that mist sprays. Mist sprays are more convenient when you are travelling or at work.

Good brands are FLO and FESS rinses. See the saline rinse page and click here to watch a you tube video on saline nasal rinsing.

3. Steroid nasal sprays

Steroid nasal sprays are more effective than antihistamine tablets for allergic rhinitis and work for non-allergic rhinitis too. The sprays are used every day for 3-6 months or until symptoms have completely gone. Treatment can start again when symptoms come back. For patients with perennial rhinitis, it’s safe to use the sprays every day. For seasonal rhinitis, put a reminder on your calendar to start you steroid nasal spray two weeks before the usual start of your hay-fever season. For many people in South West Victoria, symptoms start in August and end in January.

There are lots of brands of steroid sprays. The safest and most effective are sprays than contain mometasone, fluticasone or ciclesonide. Currently, mometasone and fluticasone are the cheapest and can be purchased from the pharmacy without a prescription. Common brand names are Nasonex and Flixonase. Take this information to your pharmacist and ask them to help you choose the cheapest option containing fluticasone or mometasone.

Technique is important to prevent drying of the skin inside the nostril. This can cause minor bleeding. If this happens, stop the spray for 7 days and squirt Nasalate ointment into the nostril four times a day for a week, then start the spray again. You can buy Nasalate from the pharmacy without a prescription. Watch a video here to get your technique for spraying right.

If your symptoms aren’t well enough controlled with a steroid nasal spray, you can add an anti-histamine tablet. See the next section. Or, you can ask your doctor for a prescription for a combined steroid-antihistamine spray.

Use 1-2 sprays each nostril daily until symptoms improve (3-6 months), then stop. Start again when symptoms return. Adults and children over 6 can use 1-2 sprays, kids under 6 can use one spray per day

4. Antihistamines

Anti-histamine tablets can be used once or twice a day whenever symptoms are present. There are also antihistamine nasal sprays and eye drops, although they may not be as effective as using tablets.

Always choose a non-sedating anti-histamine. There are lots of brands advertised on TV (Zyrtec, Claratyne) and it’s safe to use a chemist brand if it’s cheaper. The drugs to ask for are cetirizine, loratidine, desloratadine, fexofenadine.

5. Immunotherapy or desensitisation

An allergist is a physician who has specialised in treating allergic diseases. The allergist can identify your allergens using blood and skin prick tests. You will then be advised on whether immunotherapy would work for you. The treatment involves having regular injections or daily tablets under the tongue, containing your allergen. The treatment takes three years. Your immune system gradually stops reacting to the allergen and your symptoms improve. You still need to use saline rinses, steroid nasal sprays and antihistamines during the treatment.

For more information see www.allergy.org.au and www.maccsmedicalgroup.com.au

6. Other medications

Monteleukast is a tablet that can help children with allergic rhinitis and asthma.

Atrovent Nasal spray can be tried if other medications haven’t worked.

Rinar spray is used for severe non-allergic rhinitis not controlled by steroid nasal spray. rhinoscience.com.au

Decongestant nasal sprays can cause worsening symptoms and aren’t recommend for more than 3 days in a row on more than 2 occasions per year.

Rhinitis and asthma

Many people with asthma also have rhinitis. Treating rhinitis symptoms well has a positive effect on asthma and makes serious asthma attacks less likely. For more information about asthma and rhinitis see www.allergy.org.au 

For more information about thunderstorm asthma and hayfever