Non-allergic rhinitis is a chronic nasal condition characterised by inflammation of the nasal passages without an identifiable allergic cause. Unlike allergic rhinitis (hay fever), which occurs when your immune system overreacts to specific allergens, non-allergic rhinitis involves nasal symptoms triggered by various non-allergic factors such as environmental irritants, weather changes, certain foods, or medications. This condition can occur at any age. The symptoms can be troublesome, and standard allergy treatments may not provide adequate relief, underscoring the importance of proper diagnosis and targeted treatment.
Allergic Rhinitis Treatment in Singapore
If you’re struggling with persistent nasal congestion, a runny nose, or sneezing without any apparent allergic triggers, you may be dealing with non-allergic rhinitis. This condition affects individuals in Singapore, causing daily discomfort and may impact quality of life. Unlike allergic rhinitis, which responds to specific allergens, non-allergic rhinitis requires a different approach to diagnosis and treatment. ENT specialists can help evaluate this condition and provide treatment options tailored to your particular symptoms and triggers.
*Individual results and timelines may vary.*
Dr Gan Eng Cern
MBBS
MRCS (Edin)
mmed (orl)
FAMS
What is Non-Allergic Rhinitis?
Types of Non-Allergic Rhinitis
Vasomotor Rhinitis
A common form of non-allergic rhinitis, vasomotor rhinitis occurs when blood vessels in the nasal passages become sensitive to environmental triggers. Temperature changes, strong odours, and humidity fluctuations can cause the nasal tissues to swell, which may lead to congestion and drainage.
Drug-Induced Rhinitis (Rhinitis Medicamentosa)
This type develops from prolonged use of nasal decongestant sprays. The nasal passages can become dependent on these medications, creating a cycle of rebound congestion that may worsen symptoms when the medication wears off.
Hormonal Rhinitis
Hormonal fluctuations during pregnancy, menstruation, or thyroid disorders can trigger nasal symptoms. Pregnancy rhinitis affects pregnant women and typically resolves after delivery.
Occupational Rhinitis
Exposure to workplace irritants such as chemicals, dust, or fumes can cause chronic nasal inflammation. This may occur in industries involving manufacturing, construction, or laboratory work.
Gustatory Rhinitis
This type occurs when eating certain foods, particularly hot or spicy dishes. The nasal passages produce excess mucus immediately during or after eating.
Causes & Risk Factors
Causes
- Environmental irritants (cigarette smoke, perfumes, cleaning products, air pollution)
- Weather changes (temperature fluctuations, humidity, barometric pressure changes)
- Viral infections that may damage nasal tissue
- Structural abnormalities (deviated septum, enlarged turbinates)
- Autonomic nervous system dysfunction that may affect nasal blood vessel regulation
Risk Factors
- Older age
- Female gender (hormonal influences)
- Prolonged exposure to occupational irritants
- Living in urban areas with higher pollution levels
- History of chronic sinusitis or nasal surgery
- Certain medical conditions (hypothyroidism, chronic fatigue syndrome)
- Regular use of certain medications (blood pressure medications, oral contraceptives)
- Stress and emotional factors
Signs & Symptoms
Mild Symptoms
- Intermittent nasal congestion
- Clear nasal discharge
- Occasional sneezing
- Mild postnasal drip
- Slight nasal pressure
Moderate Symptoms
- Persistent stuffy or runny nose
- Frequent throat clearing
- Reduced sense of smell
- Nasal voice quality
- Mild facial pressure or discomfort
- Interrupted sleep due to nasal congestion
Severe Symptoms
- Complete nasal blockage
- Severe postnasal drip causing chronic cough
- Significant sleep disruption
- Chronic fatigue from poor sleep quality
- Recurrent sinus infections
- Severe headaches from sinus pressure
Non-allergic rhinitis symptoms typically develop gradually and may fluctuate in severity based on exposure to triggers. Unlike allergic rhinitis, symptoms rarely include itchy eyes or throat, and they don’t follow seasonal patterns.
Experiencing these symptoms?
Consider consulting with an ENT specialist for proper evaluation and treatment options.
When To See an ENT Specialist
Consult an ENT specialist if your nasal symptoms persist for more than 10 days despite self-care measures, or if they significantly impact your daily activities and quality of life. Seek immediate medical attention if you experience severe facial pain, high fever, vision changes, or bloody nasal discharge, as these may indicate complications.
During your consultation, the ENT specialist may conduct a thorough evaluation, including your medical history, symptom patterns, and trigger identification. The examination typically involves nasal endoscopy to visualise the nasal passages directly and assess for structural abnormalities or signs of inflammation.
Early intervention may help prevent complications such as chronic sinusitis, ear infections, and sleep disorders, and help identify an appropriate treatment approach for your specific type of non-allergic rhinitis.
Diagnosis & Testing Methods
Diagnosing non-allergic rhinitis requires a systematic approach to rule out allergic causes and identify specific triggers. Your ENT Specialist can begin with a detailed medical history, focusing on symptom patterns, potential triggers, and medication use.
Nasal endoscopy
A nasal endoscopy allows direct visualisation of the nasal passages and sinuses, revealing inflammation, polyps, or structural abnormalities that may contribute to symptoms.
Allergy Testing
Allergy testing, either through skin prick tests or blood tests for specific IgE antibodies, helps exclude allergic rhinitis as the cause. If results are negative despite typical rhinitis symptoms, non-allergic rhinitis becomes more likely.
Imaging Studies
Imaging studies such as CT scans may be ordered if chronic sinusitis or structural abnormalities are suspected.
Additional diagnostic procedures might include rhinomanometry to measure nasal airflow resistance and acoustic rhinometry to assess nasal cavity dimensions. Some ENT specialists may recommend a trial elimination of suspected triggers or medications to confirm the diagnosis.
Treatment Options Overview
Nasal Saline Irrigation
Regular nasal irrigation with saline solution helps flush out irritants and excess mucus from the nasal passages. This treatment can be performed daily using a neti pot or squeeze bottle, and may provide relief for some patients. The isotonic or hypertonic saline solution may also help reduce nasal tissue swelling and support ciliary function.
Intranasal Corticosteroid Sprays
These prescription medications reduce nasal inflammation and are often considered for non-allergic rhinitis. Unlike systemic steroids, topical nasal sprays have minimal side effects when used correctly. Treatment typically requires several days to weeks for effect, and patients may experience improvement in congestion and rhinorrhoea.
Antihistamine Nasal Sprays
Azelastine and olopatadine nasal sprays can help reduce rhinorrhoea and nasal congestion in non-allergic rhinitis despite the absence of allergic triggers. These medications work through anti-inflammatory mechanisms beyond histamine blockade and may provide relief.
Ipratropium Bromide Spray
This anticholinergic nasal spray targets rhinorrhoea by reducing nasal secretions. It may be considered for gustatory rhinitis and cold-air-induced symptoms. The medication can be used as needed up to four times daily as directed by an ENT specialist.
Oral Decongestants
Short-term use of oral decongestants may help during severe congestion episodes. These medications work systemically to reduce nasal blood vessel swelling but may be used cautiously in patients with hypertension or heart conditions. Treatment duration may not exceed several days to avoid rebound effects.
Vidian Neurectomy
In severe cases unresponsive to conservative treatment, vidian neurectomy may be considered. This surgical procedure interrupts nerve signals that cause excessive nasal secretions and blood vessel dilation. Modern endoscopic techniques are available.
Every patient’s condition is unique.
Our ENT specialist will assess your specific situation and recommend the appropriate treatment.
Complications if Left Untreated
Untreated non-allergic rhinitis may lead to several complications that can impact health and quality of life. Chronic nasal congestion may result in recurring sinus infections (sinusitis) as mucus accumulates and bacteria can proliferate in blocked sinuses. This can cause facial pain and pressure, and may require repeated courses of antibiotics.
Persistent postnasal drip may lead to chronic cough, throat irritation, and hoarseness. The drainage can also trigger bronchitis in susceptible individuals. Sleep quality may be affected by nasal obstruction, potentially leading to snoring, sleep apnoea, daytime fatigue, and reduced concentration. These sleep disturbances may affect work performance and could increase accident risk.
Long-term mouth breathing due to nasal obstruction can lead to dental problems, bad breath, and throat dryness. Children with untreated non-allergic rhinitis may develop facial growth abnormalities and orthodontic issues. The chronic inflammation may lead to nasal polyp formation, potentially worsening symptoms and requiring surgical intervention.
Prevention
Whilst non-allergic rhinitis cannot always be prevented due to its varied causes, several strategies may help reduce symptom frequency and severity. Identifying and avoiding personal triggers can be beneficial – keeping a symptom diary may help track patterns related to weather, activities, or exposures. Common triggers to consider minimising include cigarette smoke, strong perfumes, cleaning products, and rapid temperature changes.
Maintaining optimal indoor air quality may help reduce exposure to irritants. HEPA air filters, humidity levels between 30% and 50%, and good ventilation can be considered. Regular cleaning may reduce dust and irritant accumulation, though avoiding strong-scented cleaning products is advisable.
For occupational rhinitis, appropriate protective equipment, including masks when exposed to workplace irritants, may be helpful. Discussing with your employer ways to improve ventilation or reduce chemical exposures where possible could be beneficial.
Stress management through relaxation techniques, regular exercise, and adequate sleep may help reduce symptom severity, as stress can potentially worsen vasomotor symptoms. Staying hydrated may help maintain healthy nasal mucus consistency and prevent excessive drying of nasal passages.
Individual responses to preventive measures may vary. Consult with an ENT specialist for personalised advice.
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Frequently Asked Questions (FAQ)
How is non-allergic rhinitis different from allergic rhinitis?
Non-allergic rhinitis causes similar nasal symptoms but isn’t triggered by allergens or immune system reactions. Allergy tests can be negative, and symptoms typically don’t include itchy eyes or seasonal patterns. Non-allergic rhinitis usually doesn’t respond well to antihistamines that work for allergies. The condition is triggered by irritants, weather changes, or other non-allergic factors rather than pollen, dust mites, or pet dander.
Can non-allergic rhinitis be cured permanently?
There’s no permanent cure for non-allergic rhinitis, but symptoms can be managed with appropriate treatment. Patients may achieve good symptom control through trigger avoidance and medications. Some individuals may experience symptom improvement over time, particularly if the cause was temporary (such as pregnancy rhinitis). Surgical options, such as turbinate reduction, can provide relief for structural issues contributing to symptoms.
How long does treatment for non-allergic rhinitis take to work?
Treatment response varies depending on the therapy chosen. Saline irrigation and decongestant sprays may provide relief. Intranasal corticosteroids typically require regular use for effect. Ipratropium bromide may work for a runny nose. Surgical interventions like turbinate reduction may show improvement as swelling subsides. Your ENT specialist can discuss realistic timelines for your specific treatment plan.
Is non-allergic rhinitis related to sinusitis?
They’re separate conditions, but non-allergic rhinitis can lead to chronic sinusitis if left untreated. The persistent nasal inflammation and congestion can block sinus drainage, creating an environment for bacterial growth and sinus infections. Patients with chronic sinusitis may also have underlying non-allergic rhinitis. Treating the rhinitis may help prevent recurrent sinus infections and improve overall nasal health.
Can children develop non-allergic rhinitis?
Yes, though it’s less common in children than adults. Viral infections, irritants, or structural factors such as adenoid hypertrophy may trigger paediatric non-allergic rhinitis. Children may have difficulty describing their symptoms, so parents may watch for mouth breathing, snoring, or frequent throat clearing. Treatment approaches are similar but adjusted for paediatric use, with emphasis on saline irrigation and avoiding irritants.
Will I need to use nasal sprays forever?
Not necessarily. Patients may require long-term maintenance therapy, whilst others may only need treatment during symptom flares. As you identify and avoid triggers, medication needs may decrease. Patients may transition from daily to as-needed use of medications. Regular follow-ups with your ENT specialist help optimise treatment and may reduce medication dependence over time.
Conclusion
Non-allergic rhinitis, while challenging to diagnose and treat, can be managed with appropriate medical guidance. Understanding your specific triggers — whether environmental, occupational, or physiological — is part of a comprehensive treatment approach. Contemporary therapeutic options, from nasal sprays to minimally invasive procedures, may provide relief for persistent symptoms that impact daily life. The key lies in obtaining an accurate diagnosis to distinguish between non-allergic and allergic rhinitis, and in developing a personalised treatment strategy.
Take the First Step Towards Better Health
Living with non-allergic rhinitis can be challenging, but you don’t have to face it alone. Our ENT Specialist has experience diagnosing and treating non-allergic rhinitis using evidence-based approaches.
Dr Gan Eng Cern
MBBS
MRCS (Edin)
mmed (orl)
FAMS
With over 15 years of experience, Dr Gan specialises in the comprehensive management of a broad range of conditions related to the ear, nose and throat (ENT), and head and neck.
Dr. Gan has contributed to the academic field as a Senior Clinical Lecturer at the Yong Loo Lin School of Medicine, National University of Singapore. He is recognised for his extensive research work, with numerous contributions to reputable international ENT journals. Dr Gan is also highly sought after as a speaker and has shared his surgical knowledge as a surgical dissection teacher at various prominent ENT conferences and courses.
- 2020 – Reader’s Choice Gold Award for Best ENT Specialist (Expat Living Singapore)
- 2016 – Best Educator Award (Eastern Health Alliance)
- 2016 – “Wow” Award (Patient Compliment)
- 2014 – Eastern Health Alliance Caring Award – Silver
- 2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College of Surgeons, Academy of Medicine Singapore for best scientific surgical paper)
- 2012 – Human Manpower Development Award (Ministry of Health, Singapore)
- 2007 – Singhealth Best Doctor Award
Qualifications
- MBBS – Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
- MRCS (Edin) – Member of the Royal College of Surgeons Edinburgh, United Kingdom
- MMed (ORL) – Master of Medicine in ENT (National University of Singapore)
- FAMS – Fellow of the Academy of Medicine Singapore
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