When nasal congestion, sinus pressure or rhinorrhea (runny nose) is caused by allergic antibodies (IgE) to pollens, molds, dust mites or animal dander, this is called allergic rhinitis (AR). When environmental irritants trigger nasal symptoms in the absence of allergic antibodies, this is called non-allergic rhinitis (NAR). Up to 70% of persons who have AR also suffer from NAR however, NAR can occur in persons who do not have AR. A common example of a trigger for NAR is tobacco smoke. Smoke exposure can mimic allergy but is not caused by allergic antibodies. For this reason, Allergists do not skin test with tobacco. Many persons with NAR complain that nasal symptoms result from exposure to strong chemical odors, perfumes, potpouri, fabric dyes, and diesel fumes. Many persons with NAR can have symptoms triggered by changes in air temperature, air pollution, alcohol / food consumption or even prescribed medications. Some patients with NAR are convinced that they have seasonal allergies since they have recognized that when the mold, Oak or Cedar pollens counts are high, they always have nasal symptoms. These particles can reach such high levels in the air that they can cause nasal irritation that appears to be allergic in nature. Only allergy testing can accurately define the true cause of nasal symptoms (AR vs. NAR). Medications such as Claritin, Zyrtec and Allegra are typically ineffective for symptom control of NAR unless they contain a decongestant (i.e. Zyrtec-D12). Typically, decongestants are not taken daily; as prolonged use leads to loss of effectiveness (tachyphylaxis) and may elevate blood pressure or worsen prostate problems. If NAR is the suspected cause of the nasal symptoms, medications such as nasal steroids (Nasonex / Flonase etc.) or topical antihistamines (Astelin or Astepro) may be effective for controlling congestion. Runny nose can sometimes be effectively managed with an anti-cholinergic medication (Atrovent nasal spray). These medications are often used in combination for optimal effect. Nasal steroids are usually prescribed for daily use while topical anti-histamines and anti-cholinergic spray can be used daily or only as needed.

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