Rhinitis and hay fever

What is rhinitis?

Rhinitis is inflammation of the lining of the nose. It causes a blocked nose, runny nose and often itching and sneezing. People often refer to this as “sinus” but the sinuses are not necessarily involved. The nose becomes blocked in rhinitis mainly due to swelling of structures in the nose called inferior turbinates.

What causes it?

Nasal allergies (“allergic rhinitis”) are very common and often referred to as hay fever, but the symptoms can be present all year round depending on what you are allergic to. Common allergens in Australia are house dust mite, cat dander, various pollens, fungi and cockroach but many others are possible and skin prick allergy testing is the best way to find out which allergies are present.

Non-allergic rhinitis is a general term for other causes of rhinitis but often people have symptoms triggered by perfumes and chemicals, cigarette smoke and cold air / air conditioning.

How is it assessed?

The first step is discussing the symptoms and whether there are any triggers which make the nose worse. Examination of the nose often includes using a small endoscope to see the nasal lining. Further tests may include allergy tests and / or CT scans.

What is the treatment?

For allergic rhinitis, we usually trial a nasal steroid spray if this hasn’t been done already by your GP. They are very safe medications and can be used long term if they are effective. However, they are slow to work and we would generally recommend a 1-2 month trial if they are to be used. Antihistamine tablets are probably a little less effective than the nasal steroid sprays but they work quickly, and can be used in addition to the nasal sprays.

Allergy avoidance is often not particularly effective for nasal allergies, but there are measures you can take, particularly for house dust mite.

Desensitisation, also known as immunotherapy may be an option for long term management of nasal allergies.

For non-allergic rhinitis, the standard steroid nasal sprays may be ineffective but there are some other alternatives which may help.

Surgery is used to reduce the size of the inferior turbinates to improve the nasal airway. Surgery is generally effective for a blocked nose but you may still need treatment for the other symptoms of itching, sneezing and runny nose. The common procedures for rhinitis are turbinate reduction with or without septoplasty but surgery is individualised and other procedures may be recommended.