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Constant Runny Nose? It Might Not Be Allergies
Fact checked by Nick Blackmer
Key TakeawaysChronic rhinosinusitis is a persistent inflammatory condition that causes the sinuses to swell for more than three months.
Chronic rhinosinusitis and seasonal allergies share symptoms, including runny nose, phlegm in the throat, and sneezing, making it tricky for a primary care provider to diagnose the condition.
Chronic rhinosinusitis can be treated, but experts recommend seeing an ENT specialist to get to the bottom of symptoms.
As we segue from winter illnesses to spring allergies, runny noses may feel perpetual. If you're finding allergy medications aren't helping with your drippiness, it's time to consider whether you're experiencing a different condition.
Your runny nose could be from chronic rhinosinusitis, a persistent inflammatory condition that causes the sinuses to swell for more than three months.
You could even have allergies and chronic rhinosinusitis at the same time. According to a recent study that included 219 patients, 91.3% were diagnosed with allergic rhinitis—also known as seasonal allergies. Nearly half of the patients (45.2%) who had allergic rhinitis were also diagnosed with chronic rhinosinusitis.
Since a runny nose is a symptom of both chronic rhinosinusitis and seasonal allergies, it's common for people to assume it's from allergies. While over the counter (OTC) allergy medications can treat allergies, they won't be much help for people who have chronic rhinosinusitis. If left untreated, chronic rhinosinusitis can make breathing uncomfortable, affect your quality of sleep, and decrease productivity.
Here's how to tell if your runny nose might be chronic rhinosinusitis and what you can do about it.
Related: How Do You Know If You Have Allergies?
Signs a Runny Nose Isn't AllergiesThere are some telltale signs that those pesky springtime allergens floating around might not be the reason your nose is running like a tap. For one, if your runny nose lasts longer than you'd expect from allergies and/or OTC allergy medications aren't helping it, those are some indications that allergies might not be the underlying cause.
"As healthcare providers, we're very suspicious that people who have these long-term nasal symptoms could have chronic rhinosinusitis," Jayant Pinto, MD, director of rhinology and allergy at University of Chicago Medicine, told Verywell. "People who take antihistamines, intranasal steroids, or nasal spray and don't get better are people we suspect might have chronic inflammation of the sinuses that needs other treatment."
While it may not be as common, it's worth noting that sometimes, a runny nose can be caused by serious conditions, such as a tumor in the nose or a cerebrospinal fluid leak, Zara M. Patel, MD, professor of otolaryngology and director of endoscopic skull base surgery at Stanford University School of Medicine, told Verywell. Since there can be many causes, Patel recommends visiting an ear, nose, and throat (ENT) specialist for a thorough workup.
Related: How to Get Relief From Allergy Symptoms
How Is Chronic Rhinosinusitis Treated?OTC allergy medications are often enough to provide relief from allergy symptoms, but they don't usually help with chronic rhinosinusitis. The good news is that rhinosinusitis tends to be responsive to treatments as long as the specialist you're working with (usually an otolaryngologist or rhinologist) has looked into all the possible causes and chosen the most effective treatment.
Approaches can be different for each person based on their symptoms and overall health, but common chronic rhinosinusitis treatments are antibiotics or steroids along with nose and sinus cavity sprays.
"Intranasal steroids, which are a standard first step, could control the inflammation in the nose," said Pinto, adding that steroids, which reduce inflammation in the nose, can help people with both allergies and chronic rhinosinusitis. A saline wash using a neti pot can also be useful because it clears out the nasal passage.
You can progress to more intense treatments if needed.
"If these options are not enough to definitely resolve the problem, sinus surgery is the next step," said Patel, adding that surgery can clear out current inflammation and get a patient back to a normal baseline.
However, surgery is only one component of treatment and "does nothing to change the underlying reactivity or disease process which led to the inflammation in the first place, so there has to be a plan in place for how to control that underlying reactivity after surgery to prevent relapse," said Patel.
Related: What Are the Symptoms of Morning Allergies?
How to Tell If You Have Chronic RhinosinusitisPatel said that chronic rhinosinusitis is fairly easy for ENTs to diagnose. However, if you're seeing a non-specialist, like your primary care provider, it may be harder for them to spot it.
"Because primary care providers lack the special equipment and instrumentation ENT doctors have for looking deep inside the nose, the only way for them to correctly diagnose rhinosinusitis would be with a CT scan," said Patel. This can lead to patients being overdiagnosed with sinusitis because the symptoms often overlap with allergies. They may also be underdiagnosed and treated for a longer time than they would have been if they'd been able to see a specialist.
If you're perplexed about the reason for persistent runny nose, it's worth talking to your provider about. If they're not sure, they can refer you to a specialist.
"Because there are so many different etiologies of a runny nose, if the runny nose lasts longer than expected, or is not treated well by typical over-the-counter allergy medication, it's a good idea to see an otolaryngologist (ENT)," said Patel.
What This Means For YouIf you have a runny nose that isn't getting better with over-the-counter allergy medications and lasts longer than three months, experts recommend seeing an ear, nose, and throat (ENT) specialist to find out if a chronic condition, rather than allergies, might be causing your symptoms.
Read Next: The 7 Best At-Home Allergy Tests of 2024
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What Causes Allergies? What's The Best Treatment To Reduce Symptoms?
With spring in the air, allergies become a common issue for many people.
Seasonal allergies are usually caused by increased pollen in the air as trees and flowers begin to bloom. Pollen is a fine powder flowers produce to fertilize other plants of the same species. While it is not harmful, some people's immune systems perceive it as a threat and react by producing antibodies. This immune response is what we observe as allergies.
What are the symptoms of seasonal allergies?Often, people wonder if they are suffering from allergies or have a cold caused by a virus because the symptoms can overlap.
According to the US Centers for Disease Control and Prevention (CDC), the most common symptoms of seasonal allergies include congestion, runny nose, and sneezing. The health agency estimates that sixty million people suffer from these symptoms each year. Additionally, some suffer from allergic conjunctivitis, which is the inflammation of the lining of the eye (conjunctiva) due to exposure to allergens like those in pollen." Thirty percent of the population suffer from allergic conjunctivitis, which manifests as "red, watery, and itchy eyes."
Looking for relief?Antihistamines can be helpful if you experience seasonal allergies. While these drugs are available over the counter in the United States, it's recommended that you consult your doctor for a prescription to reduce the cost and gain access to generic yet highly effective drugs. Your doctor can run allergy tests to confirm if you are allergic to pollen, which can help to rule out infections.
It's essential to note that if you believe that bacteria cause your symptoms, it's crucial to speak with your doctor. Antibiotics won't cure your symptoms unless your allergies lead to a severe sinus infection, and they can contribute to the misuse of these vital drugs. Although symptoms may overlap, consulting a medical professional before taking any medication increases the likelihood of receiving the appropriate treatment to relieve discomfort.
Allergic Conjunctivitis: Everything You Need To Know
Types, Causes, Treatment, and More
Medically reviewed by Daniel More, MD
Allergic conjunctivitis (AC) is eye inflammation caused by a reaction to an allergen, such as pollen or mold spores. Exposure to allergens can cause the eyes to become red, watery, and itchy. It is a common condition in which the body overreacts to substances that are not usually harmful.
AC is different from other types of conjunctivitis based on what causes it. Two other types, bacterial conjunctivitis and viral conjunctivitis, are highly contagious, meaning they are easily spread from person to person. Conjunctivitis is also called pink eye.
Conjunctivitis affects the inside of the eyelids and the conjunctiva—the membrane that covers the eyeball. The conjunctiva is vulnerable to allergens, especially when pollen levels are high during spring and early fall.
This article will cover types of allergic conjunctivitis, causes, symptoms, treatment, and more.
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Types of Allergic ConjunctivitisSome types of allergic conjunctivitis are more common than others. Types include:
Seasonal Allergic ConjunctivitisSeasonal allergic conjunctivitis, also called allergic rhinoconjunctivitis, is the most common type of AC. It is caused by a reaction to pollens and spores during certain spring and summer months, mainly grass pollen in May and June and ragweed pollen in August and September.
Itching, watery mucus discharge, burning, and redness are common eye symptoms with seasonal AC. In people with hay fever, additional symptoms may affect the nose and throat.
Hay fever, also called allergic rhinitis, causes cold-like symptoms. An allergic response to outdoor and indoor allergens causes it.
Symptoms of hay fever include:
Perennial ConjunctivitisPerennial allergic conjunctivitis is a year-round condition that is caused by an allergic response to animal dander, dust, and other year-round allergens. Symptoms can be similar to those of seasonal allergic conjunctivitis but milder.
Contact ConjunctivitisA delayed hypersensitivity reaction can be seen with certain substances when they come in contact with the eye. These include:
The reaction can affect the eyelids, conjunctiva, and cornea.
Giant Papillary ConjunctivitisGiant papillary conjunctivitis (GPC) is a chronic inflammatory condition of the eye due to the eye's reaction to a foreign body. It is controversial as to whether it should be classified as an allergic reaction rather than a foreign-body hypersensitivity reaction.
It results in papillae (small, round bumps) that develop on the upper tarsal conjunctiva (the underside of the eyelid). The bumps develop when the upper tarsus rubs over a foreign object in the eye. Long-term use of soft contact lenses, having an artificial eye, or surgical stitches can cause GPC papillae.
GPC causes the affected eyelid to feel rough, red, or swollen. The papillae will then form and can grow to about the size of a pimple.
Additional symptoms include:
Atopic KeratoconjunctivitisAtopic keratoconjunctivitis (AKC) results from atopy—the genetic tendency to develop allergic conditions. For people with AKC, an abnormal hypersensitivity response leads to inflammation of the eyelid linings and the surface of the eyes.
The onset of symptoms will occur years after the atopy has developed. Symptoms may occur at any time of the year but tend to be worse in the winter months.
Symptoms of AKC include:
Eyelids that are thickened, crusted, and fissured
Sensitivity to light
Itchy eyes
Burning pain in the eyes
Increased tearing
Blurred vision
White discharge from the eyes
Vernal keratoconjunctivitis (VKC) is a recurrent inflammatory eye disease that occurs seasonally. It tends to present in children and young adults (ages 1 to 22) during the late spring to late summer months.
Eye symptoms of VKC will present in early to mid-childhood. The condition is characterized by cobblestone-like bumps on the upper eyelid and swelling and thickening of the conjunctiva.
Additional eye symptoms may include:
VKC tends to run in families. Risk factors include:
A family history of allergies
Being assigned male at birth
Having an allergic condition like asthma, eczema, and allergic rhinitis
Related: Is It Pink Eye or Allergies?
What Causes Allergic Conjunctivitis?Environmental allergens cause AC. It is common, affecting about 10% to 20% of the population. Between 40% and 60% of people with allergies have eye symptoms.
AC occurs when the immune system overreacts. This reaction triggers the body to produce histamine (a chemical reaction) to fight off foreign invaders.
Allergens that cause this type of response include:
Some people are at a higher risk for AC. This includes people who have allergies.
According to the Asthma and Allergy Foundation of America, more than 100 million people in the United States experience various types of allergies.
In 2021, 81 million Americans were diagnosed with hay fever, which equals around 26% of adults and 19% of children. If you live in an area where pollen counts are high, you likely will be more susceptible to AC than people in other regions.
Allergies tend to run in families. Research has long identified a genetic component for allergies, and there are distinct susceptibility genes for hay fever and allergic asthma.
What Are the Symptoms of Allergic Conjunctivitis?AC typically presents in both eyes, but not always equally. The most common eye symptoms of AC are:
Nasal symptoms, including congestion, runny nose, sneezing, and post-natal drip, may also accompany eye symptoms.
Symptoms of AC may appear quickly once the eyes come in contact with an allergen. However, if eye drops or contact lenses cause AC, symptoms may appear after a few days.
People with seasonal allergic conjunctivitis will have symptoms during the early spring into the summer and sometimes in late summer and early fall. Perennial allergic conjunctivitis can cause symptoms at any time during the year, but symptoms can be worse during certain times of the year (i.E., when pollen levels are high).
Contact conjunctivitis and giant papillary conjunctivitis are not seasonal, so they can occur at any time of the year.
How Is Allergic Conjunctivitis Diagnosed?Your healthcare provider can diagnose AC by examining your eyes and asking you about signs and symptoms, including nasal symptoms. They will also check to see if an object or other substance (such as an eyelash) might be causing symptoms.
Additional tests may be requested, including:
Allergy skin testing: Allergy skin tests expose the skin to specific allergens and allow your healthcare provider to examine how your body reacts. If you are allergic, the skin where the allergen was placed will become swollen and red.
Blood test: Your healthcare provider may request blood work to check for antibodies against specific allergens, including pollen and mold.
Conjunctival scraping: This test involves scraping conjunctival tissue to examine it for white blood cells called eosinophils. These cells become activated in response to an allergic response.
Depending on the severity, AC can be treated with at-home remedies, over-the-counter (OTC) treatments, and prescription medications.
How to Find Relief at HomeSome home remedies might offer relief for AC. This includes:
Avoid allergens: Stay indoors when pollen levels are high. Wash your clothes frequently. Bathe or shower before bedtime.
Use cold compresses: Cold compresses on the eyelids can soothe swollen, irritated eyes.
Avoid contact lenses: Contact lenses should not be used until eye symptoms have resolved.
Do not rub your eyes: Rubbing the eyes can make eye inflammation and irritation worse.
Related: Relief for Eye Allergy Symptoms
OTC MedicationsOTC medications can offer symptom relief. Options include:
Artificial tears: Artificial tears can mimic natural tears to dilute the allergen and return eye moisture. They contain eye lubricants such as carboxymethylcellulose sodium. They are available as eye drops, gels, and ointments. Brand names for artificial tears include:
While artificial tears tend to be safe, it is still a good idea to check with your healthcare provider about using these medications long term. Long-term use may lead to chronic dry eye.
Decongestant eye drops: These drops quickly reduce redness by narrowing blood vessels in and around the eyes. Decongestant ingredients include phenylephrine.
These drops work well but are not recommended for long-term use because using these products for long periods can lead to "rebound redness." This means that the eyes become dependent on the drops and will experience redness when you stop using them.
Dual-acting antihistamine-mast cell stabilizing agents: Antihistamine-mast cell stabilizer eye drops are effective treatments for allergic conjunctivitis. They combine antihistamine and mast-cell-stabilizing activity and are considered first-line therapies for providing symptom relief and blocking inflammation related to AC.
OTC brand name antihistamine-mast cell stabilizer eye drops include:
Alaway (ketotifen)
Clear Eyes (olopatadine)
Pataday (olopatadine)
Zaditor (ketotifen)
Oral antihistamines: These drugs can improve AC symptoms, including itching, tearing, and redness. They include:
Allegra (fexofenadine)
Claritin (loratadine)
Clarinex (desloratadine)
Xyzal (levocetirizine)
Zyrtec (cetirizine)
Flonase Sensimist Nasal Spray and Flonase Allergy Relief Nasal Spray (fluticasone): Fluticasone is used to treat seasonal and year-round allergies. It can also help relieve allergy eye symptoms, including itchy, watchy eyes. It is considered a corticosteroid and works in the nose to block the effects of allergens.
Prescription MedicationsIf at-home remedies and OTC treatments do not help relieve AC, your healthcare provider can prescribe stronger medications to manage symptoms.
Prescription treatments for treating AC might include:
Prescription dual-acting antihistamine and mast-cell-stabilizing agents: In addition to OTC options in this drug class, your doctor can prescribe more potent versions. Examples include Alamast (pemirolast eye drops), Alocril (nedocromil eye drops), Alomide (lodoxamide eye drops), and Opticrom, Crolom, and Gasrocrom (cromolyn eye drops and oral solution).
Allergy shots: If you have allergies that lead to AC, your healthcare provider might recommend allergy shots—a form of treatment called immunotherapy. Each shot contains small amounts of substances that trigger allergic reactions. Over time, the immune system gets used to the allergens and learns to not react to them.
Ocular steroid eye drops: Steroid eye drops can help relieve symptoms of AC. These drops can increase the risk of cataracts (clouding of the lens of the eye), so they should be given only for short periods.
Systemic oral decongestants, antihistamines, steroids, and immunotherapy drugs: These medications can be prescribed for severe AC cases.
Related: How to Treat and Prevent Your Eye Allergies
How Can I Prevent Allergic Conjunctivitis?The best way to prevent AC is to avoid exposure to environmental allergens. Unfortunately, common allergens, such as pollen, dust mites, and animal dander, can be difficult to avoid.
Some ways to reduce the effects of allergens are:
Stay indoors as much as possible: Staying indoors can help to reduce your exposure to pollen and airborne allergens.
Use an air purifier: Using a good quality air purifier in your home can help keep indoor air clean.
Bathe or shower before bedtime: This will remove potential allergens from the body; washing your clothes and linens frequently can also rid allergens from your environment.
Wash and brush pets regularly: This can help to reduce dander production.
Keep eyes lubricated: Using lubricating eye drops can reduce eye dryness and wash out allergens from the eyes to reduce your risk for AC.
Keep contacts clean: Contacts may trap debris, including allergens, which can irritate the eyes and/or interfere with the fit of the lenses.
Avoid touching your face and eyes: Touching the face and the eyes can lead to the transfer of allergens from the hands and fingers to trigger an allergic reaction. Try to reduce your hand-to-face contact as much as you can. In addition, wash your eyes and face regularly to avoid transferring allergens to the eyes and get rid of allergens.
According to the Centers for Disease Control and Prevention (CDC), allergy symptoms typically improve after the exposure to the allergen stops. Allergy medications and eye drops may also help relieve symptoms and reduce recovery time.
Complications are rare with AC. However, in the long term, allergic conjunctivitis could cause damage to the cornea (the clear dome of tissue at the front of the eye) and affect vision. Medications used to treat the condition may also increase the risk of cataracts.
When to Contact a Healthcare ProviderYou should see a healthcare provider if signs of AC do not improve in a few days or if at-home treatments are not helping. You should also reach out to your healthcare provider if you think your eye is infected and if you have pain with blinking.
Additional symptoms that warrant a healthcare provider visit include:
Signs that eye symptoms indicate a more serious problem and require immediate medical attention include:
Severe eye pain
Impaired vision
Appearance of halos around lights
Difficulty closing the eyelids because of swelling
Dark spots in the center of your field of vision
Difficulty focusing on nearby distant objects
If you are experiencing any of these symptoms, you should call 911 or visit a local emergency room.
SummaryAllergic conjunctivitis, a type of pink eye, results from exposure to allergens, including grass and plant pollen, mold spores, and household dust.
Symptoms include red, itchy, watery eyes. People with allergies are at an increased risk for AC. Allergies tend to run in families.
AC can make you miserable, but fortunately, there are various treatment options. These include avoiding triggers, taking OTC medications, including eye drops and antihistamines, and taking ocular and oral prescription medicines. AC can also be prevented by avoiding allergens, using air filters, and keeping your home clean and dust-free.
Read the original article on Verywell Health.
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