Nasal Congestion

By Dr. Loretta Lanphier, ND, CN, HHP, CH

Does it always seem like you have a cold or some kind of a respiratory illness? The chances are it is not a cold, but rather a case of chronic nasal congestion or “rhinitis.” This is a very common condition that can be quite annoying, and perhaps you may be wondering what causes it and if there is anything that can be done to eradicate it. Let’s delve into the whys and wherefores of nasal congestion and see what we can find out.

What is Nasal Congestion?

Nasal congestion, also referred to as rhinitis, is a condition, often chronic, whereby your nose is consistently stuffed up and may be runny as well. Depending on the type of rhinitis you have, sneezing or sinus pressure may also be an ongoing problem. Many of these symptoms may mimic the common cold, which is technically the most common form of rhinitis found in the world. The difference is that colds are caused by viruses, and they are self-limiting in nature, usually lasting from three to ten days. The other most common types of rhinitis, allergic rhinitis and nonallergic rhinitis, are caused by environmental issues, allergens, hormonal changes, and other factors, but they are not the result of an infection as is the case with the common cold. They also are not limited in duration by the presence of an antigen. We will not directly address the common cold in this article, but instead will focus on the other widespread forms of rhinitis, those being allergic and nonallergic rhinitis. Perhaps it would be best to discuss each of these major types of rhinitis separately.

Allergic Rhinitis

You might recognize this form of nasal congestion by its more common name, hay fever. This is really a misnomer because it is very rarely caused by hay, and it does not cause a fever. The history of this term dates back to the early 19th Century when British physicians observed that many rural residents developed symptoms such as sneezing, itchy eyes, and a stuffy nose after harvesting hay. What they didn’t understand at the time was that the reactions were probably not from the hay itself, but rather an allergic reaction to mold or pollen in the hay. They also labeled it a “fever” because it also often caused nervousness, which was an Old English characteristic of what they called “fever.”

Allergic rhinitis or hay fever is one of the most common allergic reactions known to man, thought to affect approximately twenty percent of the population in the United States. Symptoms range from mild and intermittent to severe and ongoing. Allergic rhinitis is more of a nuisance that can make you miserable than a dangerous health condition. However, it can significantly impact your quality of life, affecting your sleep patterns, and making it difficult for you to function optimally on a daily basis. If left untreated, allergic rhinitis can also open the door to more serious allergies such as asthma or eczema.

What Are the Most Common Symptoms of Allergic Rhinitis?

Signs vary from person to person, often dependent on the allergen that is responsible for the condition. However, there are some common ones that are often found in folks with allergic rhinitis. These include:

  • Runny nose
  • Watery eyes
  • Sneezing
  • Itchy eyes
  • Nasal congestion
  • Itchy nose, throat, and/or roof of the mouth
  • Cough
  • Facial pressure or pain
  • Dark blue colored skin under the eyes that is often swollen and sometimes called “allergic shiners”
  • More severe cases can produce insomnia, agitation or irritability, and fatigue.

Many of these symptoms parallel those of the common cold, and it can be difficult at times to tell the difference. A few clues that can differentiate between the two are the fact that hay fever develops immediately after exposure to allergens, while it takes several days for a cold to appear after being infected with the virus; allergic rhinitis symptoms continue as long as the offending allergens are present, while a cold typically dissipates after five to seven days; there is no fever associated with allergic rhinitis, while colds are often accompanied by a low-grade fever; and finally, when you have hay fever, your nose will run with a thin, watery discharge, while colds usually exhibit a thicker discharge that is yellowish in color.

What Causes Allergic Rhinitis?

All forms of allergic rhinitis are caused by an allergic reaction. Allergies are an inappropriate response by the immune system. It mistakenly identifies an otherwise harmless substance, such as latex or pollen, as a harmful invader, and produces antibodies to attack it. Once your system has become “sensitized” to this substance, every time you are exposed to it your body launches into defense mode, and the chemicals produced (histamines) cause an inflammatory reaction. The result is symptoms such as a stuffed up or runny nose.

The most common allergens that trigger hay fever are of two main types: seasonal and perennial (year-round). The seasonal ones can appear any time throughout the year, but are most often found as follows:

  • Spring: Tree pollen
  • Late Spring and summer: Grass pollen
  • Autumn: Weed pollen
  • During warm-weather: Outdoor fungi and mold spores

The most common perennial offenders include:

  • Pet dander (composed of skin flakes and saliva)
  • Cockroaches
  • Dust mites
  • Fungi and mold spores found indoors and outdoors

Certain factors increase your risk for developing allergic rhinitis. Common ones are :

  • Family history: If there is a pattern of allergies in your family, you have a greater chance of developing them.
  • Age: While hay fever can strike at any age, it is most common initially in children or adolescents. As we age, our risk for all types of allergies generally decreases.
  • Gender: For reasons not fully understood, more males than females develop allergic rhinitis.
  • Exposure to tobacco smoke: Studies have shown that if this occurs during the first year of life, the risk for hay fever increases significantly. This is probably due to a reaction of the infant’s immature immune system.
  • Birth order: If you are the first-born, your risk is greater than that of your siblings.
  • Birth date: Babies born during pollen season (spring, summer, or fall) are also at increased risk for hay fever later in life.
  • Dust mites: Exposure to dust mites, especially at a young age, is also a risk factor.

Nonallergic Rhinitis

This second major form of rhinitis is also very common, impacting approximately 17 million Americans annually. Technically known as vasomotor rhinitis, the symptoms of nonallergic rhinitis are similar to those of her sister hay fever, but it is not caused by an allergic reaction. Thus, one of the first considerations when treating nasal congestion is to determine, via allergy testing or an elimination process, if it is caused by an allergen. One clue is that nonallergic rhinitis seldom exhibits itchiness of the eyes or throat as does allergic rhinitis. The most common signs of nonallergic rhinitis include:

  • Nasal congestion
  • Runny nose
  • Phlegm (postnasal drip) in the throat

While generally not a dangerous condition, nonallergic rhinitis can, if left untreated, lead to complications such as:

  • Middle ear infections, due to increased fluids and congestion in the nose and throat.
  • Chronic sinusitis or inflammation of the sinuses. This can produce pain and swelling in the face, nose, or near the eyes.
  • Nasal polyps, benign masses that can form in the mucous membranes of the nose. These can sometimes interfere with normal breathing through the nose.

What Causes Nonallergic Rhinitis?

There are many common causes for vasomotor rhinitis. These include:

  • Pollution: Environmental factors such as smog, dust, strong odors, chemical fumes, or tobacco smoke trigger nonallergic rhinitis in many individuals.
  • Extended us of nasal sprays or drops: Certain decongestant products create a dependence, and when discontinued the congestion gets worse than it was originally. This is referred to as rebound congestion. It is recommended that they are not used for more than two or three days in a row.
  • Foods and drinks: Alcoholic beverages and hot or spicy foods can produce rhinitis. This is why hot soup, especially on a cold day, can make your nose run.
  • Hormones: Changes in hormone levels due to thyroid dysfunction, pregnancy, menstruation, or menopause can also lead to nasal congestion. This is why nonallergic rhinitis is more common amongst women than men.
  • Stress, both physical and emotional, results in rhinitis in some cases.
  • Medications: Certain drugs have nonallergic rhinitis as a side effect. These include some blood pressure medicines, NSAIDs, antidepressants, and drugs for erectile dysfunction, such as Viagra.
  • Weather: Unusually hot or cold weather, or high humidity, can result in rhinitis as well.

Determining if your struggles with rhinitis are caused by allergens or not is a relatively easy process. There are two forms of testing:

  • Skin tests expose your skin to common allergens and look for a telltale reaction.
  • Blood tests can be used to determine the levels of certain antibodies that can indicate an allergic reaction(s) or the lack thereof.

Once allergens have been identified or eliminated, the next step is to decide on appropriate treatment for the rhinitis.

What Treatments Are Available for Rhinitis?

Allergic and nonallergic rhinitis is responsible for many visits to the doctor, and is thus big business for physicians and the pharmaceutical industry. There are numerous medications available to treat both forms of rhinitis, but I suggest you proceed with caution. Many of them have significant side effects that can include nosebleeds, increased blood pressure, drowsiness, dizziness, blurred vision, and even anaphylaxis (a life threatening allergic reaction). Below are some suggested alternatives to these medications that are much safer and often more effective.

Foods and herbs that are rich in flavonoids and have natural anti-inflammatory properties include:

  • Onions
  • Beans
  • Citrus fruits
  • Licorice
  • Garlic
  • Berries
  • Parsley
  • Vitamins and minerals that act as natural antihistamines include vitamin A, vitamin C, and zinc.
  • Other helpful tips include:
  • Drink plenty of purified water.
  • Use a humidifier to moisten the air.
  • Avoid the triggers or allergens that cause your nasal congestion, whenever possible.
  • Keep your nasal passages clear by blowing your nose often.

Rhinitis can be a real “pain in the nose,” but with some common sense its effects can be minimized. Occasional use of medications can be appropriate in some cases, but you will be much better off in the long run if you get to the root of the problem by eliminating causative factors, watching what you put into your body, and being proactive by making healthful lifestyle choices.

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