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How is chronic non-allergic rhinitis treated ?

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Practicing since : 1991
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I've been suffering with chronic non-allergic rhinitis for over 20 years with noe relief. It's has recently gottn worse because I can't even eat or drink with the congestion draining down my nose and throat. I've had laser surgery done on my nose some years ago and that made things worse. I've been to a ENT and had MRI and CAT scan done which showed nothing. I've been on allergy shot 3 different time and that didn't help. I've been to see a lung doctor and well and he coudn't find anything. Can you please help me? By the way I'm 43, 5'6 and I weight around 155.
Posted Sat, 21 Apr 2012 in Asthma and Allergy
 
 
Answered by Dr. Sumit Bhatti 3 hours later
Hi,

Thank you for your query.

1. To understand the type of chronic nonallegic rhinitis, in what percentage of total symptoms would you rate rhinorrhea (nasal discharge), sneezing and congestion? Are there any itching or eye symptoms? Are your symptoms present throughout the year or do they vary by season? Is there any specific trigger?

2. Your chronic post nasal drip must signify a stagnation and thickening of nasal secretions or an excess production due to some chronic irritation or inflammatory process, usually due to hypertrophied turbinates and also some problem in the sinuses.

3. I am assuming that true allergy has been ruled out by skin and blood tests. Get your blood checked for increased eosinphils, or better still, get an AEC (Absolute Eosinophil Count) done. Get your nasal secretions checked for increased eosinophils. Do you have any symptoms of acid reflux?

4. Rule out hormonal imbalance (especially if there is any worsening of symptoms during menstruation or any previous pregnancy), check for subclinical hypothyroidism. Rule out any occupational exposure to chemicals, irritant fumes, household cleaning agents. The relation of your symptoms to eating and drinking give rise to the possibility of Gustatory Rhinitis. Has a nasal spray containing Ipratropium been tried out?

5. It is surprising that your CT PNS (Para Nasal SInuses) & MRI Scans have picked up nothing. I would like to see these images if possible. You may share them via a free file sharing site such as WWW.WWWW.WW or WWW.WWWW.WW Alternately you may mail some images to YYYY@YYYY with 'Attn: Dr. Sumit Bhatti' as the subject line.

6. In such a situation Intrinsic or Vasomotor Rhintis and Allergic Fungal Rhinosinusitis (AFRS) may be responsible for your chronic rhinitis. Have you had a nasal endoscopy and if yes, what were the exact clinical findings? The color and appearance of the nasal lining (mucosa) givesa fairly accurate idea of the type of rhinitis. For example, in allergy it is reddish purple, in vasomotor rhinitis it is red and in long standing allergy, it is pale white. Bogginess indicates an active inflammatory process. Discuss this with your physicians.

7. Laser surgery involves tissue destruction at 400 to 600 degrees C which is also uncontrolled. Do you have any operative notes of that procedure? New technologies such as Radio-Frequency and Co-ablation coagulate tissue at under 100 degrees C and in more controlled fashion. These would be of use if you have significant nasal obstruction.

8. What specific medications are you currently on. I would use an anti histamine, an anti leukotriene, a steroid nasal spray (not a decongestant, which cause rhinitis medicmentosa) and steam inhalation for at least two weeks and then reassess.

Hope I have answered your query. You may need to fill in some information. If you have any follow up queries I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: How is chronic non-allergic rhinitis treated ? 21 hours later
To understand the type of chronic nonallegic rhinitis, in what percentage of total symptoms would you rate rhinorrhea (nasal discharge), sneezing and congestion? Are there any itching or eye symptoms? Are your symptoms present throughout the year or do they vary by season? Is there any specific trigger

I have a large amount of nasal discharge down the back of my throat when I attempt to eat or drink anything. I deal with this condition 24/7 365 days a year. There are no specific triggers.

Do you have any symptoms of acid reflux?
Sometimes I will burp when and while I'm eating.

Has a nasal spray containing Ipratropium been tried out?
I'm not sure if I have ever used any spray containing this ingredient.

It is surprising that your CT PNS (Para Nasal SInuses) & MRI Scans have picked up nothing. I would like to see these images if possible. You may share them via a free file sharing site such as WWW.WWWW.WW or WWW.WWWW.WW Alternately you may mail some images to YYYY@YYYY with 'Attn: Dr. XXXXXXX Bhatti' as the subject line.

I can check with the doctor for a copy of this information but at this time I don't have access to this information.

I am assuming that true allergy has been ruled out by skin and blood tests.
Yes, I've been tested several times and placed on the allergy shots but they didn't help.

Laser surgery involves tissue destruction at 400 to 600 degrees C which is also uncontrolled. Do you have any operative notes of that procedure?

I don't have any operative notes concerning this procedure.

At this time I'm taking an over the counter medication call Wal-dryl Severe Allergy & Sinus Headache it helps to dry me up some but I have to take it every four hours and even then sometime I will still have the sinus drainage when I'm eating or drinking.

I've made an appointment with a local ENT and I plan to take the information that you have shared with me to the appoinment.

From the research that I have done I think that I have Gustatory Rhinitis as well. Is there anything that I can do to treat this condition at home?

Is there any additional information that you can share with me about this condition?

Thanks for all your help.
 
 
Answered by Dr. Sumit Bhatti 9 hours later
Hi,

Thank you for writing back.

1. It is likely that you also have Rhinitis Medicamentosa due to regular use of Wal-dryl Severe Allergy & Sinus Headache. This will require treatment.

2. Gustatory Rhinitis is controlled by avoiding hot, spicy, pungent food, alcohol and exposure to tobacco smoke. You should take a trial with Ipratropium bromide nasal spray. It is also important to include anti-reflux medication (To reduce LPR or Laryngo Pharyngeal Reflux).

3. Discuss these issues with your physicians. Meanwhile, try and collect information on your CT / MRI Scans and previous procedures.

Wish you a speedy recovery,

Regards.

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