Those Seasonal Allergy Symptoms Might Not Be Allergies
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April showers bring May flowers—and for many people, congestion, sneezing, and itchy, watery eyes.
But sometimes, even in the spring, those seasonal allergy symptoms don’t stem from plant and tree pollen but rather from dust mites and pet dander.
And some people who believe they have allergies may actually have a common condition known as nonallergic rhinitis, a reaction that can be triggered by an infection, a sensitivity to chemicals or drugs, changes in weather patterns, and more.
Nonallergic rhinitis affects about a third as many people as seasonal allergies, or roughly 7 percent of the population. It usually shows up in adulthood, and it may be responsible for between 17 and 52 percent of seasonal-allergy-like symptoms.
“Nonallergic rhinitis is quite common in older adults, but it’s often mistaken for allergies or a cold because the symptoms are very similar,” says Janna Tuck, M.D., spokeswoman for the American College of Allergy, Asthma & Immunology.
For example, you may suddenly become congested, have a runny nose, or sneeze when you sit near a smoker or walk down the detergent aisle. Cold, dry air and food (especially spicy items) can set off similar symptoms.
Despite the prevalence of nonallergic rhinitis, a study of nearly 300 people published last month found that 37 percent of those who visited their local pharmacy and purchased over-the-counter allergy medication didn’t have a diagnosis of allergies from their doctor, and most had not consulted with the pharmacist, either.
Effective treatment for allergies and nonallergic rhinitis starts with identifying the cause.
What's Causing Your Symptoms?
If you suspect that your symptoms are caused by an allergy, you can often get confirmation—and relief—by taking the simple steps described below. But if you’re uncertain or the measures don’t help, talk with a doctor.
An office visit with your doctor and a few questions about your symptoms, environmental and occupational exposure, hobbies, overall health, and other factors should help narrow it down.
If necessary, an allergy skin test, which involves pricking the skin with a tiny amount of the suspected allergens, can confirm a diagnosis. A little redness shows that you have an allergy; no reaction suggests nonallergic rhinitis.
Be wary of any allergy test that’s not prompted by worrisome symptoms, a doctor’s exam, and your medical history. The free tests offered in pharmacies or home tests that you can buy often check for common allergens, including cat dander, cedar, dust mites, egg, and grass. But such tests are often misleading and can cause you to make unnecessary lifestyle changes.
The American Academy of Allergy, Asthma & Immunology (AAAAI) is so concerned about the potential overuse of those tests that it recently included them in the Choosing Wisely campaign, which highlights unnecessary and sometimes harmful medical care.
Seasonal Allergies or Nonallergic Rhinitis?
To see whether you have an allergy or something else, start by keeping track of your seasonal allergy symptoms, when you experience them, and what seems to trigger them.
Then see below to determine whether you’re likely to have an allergy or nonallergic rhinitis.
Allergies
Symptoms: Congestion, itchy and watery eyes, clear nasal discharge, sneezing, and scratchy or ticklish throat.
When: Outdoor allergies usually start in February or March and end in October. Indoor allergies often last year-round, though they can come and go.
Triggers: Pollen from trees, grass, and weeds; indoor and outdoor mold; pet dander; dust mites; flakes of dried skin; and cockroach feces, saliva, or body parts.
Nonallergic Rhinitis
Symptoms: Congestion, runny nose, and sneezing, but without the itchy eyes or sore throat.
When: Often lasts year-round, though periodically.
Triggers: Respiratory infections, changes in weather and temperature, cold or dry air, food (especially spicy items), alcohol, strong odors or fumes, tobacco smoke, perfume, air pollution, and certain medications. Notable medication triggers include aspirin; ibuprofen (Advil and generic); naproxen (Aleve and generic); certain blood pressure drugs; topical nasal decongestant sprays, such as phenylephrine (Neo-Synephrine Regular Strength and generic) and oxymetazoline (Afrin and generic); erectile dysfunction drugs, such as sildenafil (Viagra) and tadalafil (Cialis); and the enlarged-prostate drug tamsulosin (Flomax and generic).
Coping With Allergies
If you do have an allergy, the following recommendations often help.
Avoid allergens. For outdoor allergies, check pollen and mold spore levels with the AAAAI’s National Allergy Bureau. When counts are high, stay indoors with the windows shut and the air conditioning on.
For indoor allergies, use an air conditioner dehumidifier; remove carpeting from bedrooms; wash rugs, curtains, and bedding often; and vacuum regularly.
To control dust mites, encase your mattress, box spring, and pillows in allergenproof covers. Keep pets out of your bedroom. Fix leaks and ventilate rooms, and clean up mold promptly.
Use the right drug. For mild symptoms, the best first choice is often a generic version of an over-the-counter antihistamine, such as cetirizine, fexofenadine, or loratadine. All cost less than their brand-name counterparts (Zyrtec, Allegra, and Claritin, respectively).
Recent treatment guidelines by the American College of Allergy, Asthma and Immunology emphasize that for moderate to severe allergies, prescription and over-the-counter steroid nasal sprays, such as fluticasone (Flonase, Flonase Allergy Relief, and generic) and triamcinolone (Nasacort, Nasacort Allergy 24HR, and generic), are also very effective, though you should stop using them if they cause irritation or nosebleeds.
For certain allergies, you may also want to consider allergy shots or the latest in allergy prevention, sublingual immunotherapy (SLIT), which involves the use of small prescription doses of the offending allergen placed under the tongue to increase your tolerance to the allergen. Both shots and SLIT can be expensive, however.
Dealing With Nonallergic Rhinitis
Start by trying to avoid known triggers. If a drug is the culprit, ask your doctor about trying an alternative.
If you can’t avoid the trigger, first see whether a daily saline rinse—often applied using tools such as neti pots or bulb syringes—helps ease your symptoms. (You can buy sterilized saline rinse at the pharmacy. If you’re mixing it yourself, but sure to use bottled or distilled water, never tap.)
You can also consider using a spray that contains the prescription nasal antihistamine azelastine (Astelin, Astepro, and generic). Steroid sprays can also work well for persistent symptoms.
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