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Non-Allergic Rhinitis (Vasomotor)

Non-Allergic Rhinitis (Vasomotor)

Non-allergic rhinitis is a chronic condition that can occur at any age but is more common in adults. The most common symptoms are nasal congestion, post-nasal drainage, and headache, although runny nose, sneezing and itching of the nose may occur in some non-allergic individuals. Many non-allergic patients have recurrent sinusitis and middle ear infections or middle ear fluid collection.

Initial evaluation requires that surgical conditions (growths in the nose, crooked nasal septum, etc.) and general medical conditions (thyroid disease, pregnancy, etc.) are not responsible for the chronic symptoms. We recommend that ever patient have a family practitioner, internist, or pediatrician to follow them for their general medical care. If the history and physical examination are not positive for surgical or general medical problems, the patient most likely has the most common nasal problem of non-allergic or allergic nasal disease.

Non-allergic rhinitis is a very difficult topic to fully understand. The actual defect resulting in the symptoms commonly found is not known. We do know that the difficulty arises in the inability to correctly change the size of blood vessels and the quantity of mucus produced by mucus glands in the nose. Under normal circumstances the nose warms or cools the air entering the nose to 98 degrees F., increases the humidity to at least 80%, and filters unwanted substances resulting in relatively clean air at 98 degrees F. and 80% humidity entering the lungs regardless of current environmental conditions. These changes occur almost instantly with each breath. The non-allergic individual has lost the ability to make the necessary changes either from an ineffective blood vessel and mucus gland controlling mechanism, temperature and humidity sensing mechanism, or both. The end result is inappropriate blood vessel size and/or excess mucus production which can result in nasal congestion, post-nasal drainage, and headaches.

Many individuals with non-allergic nasal disease will have a significant amount of irritation, inflammation, and hyperreactivity in the nose contributing to the persistent, chronic nature of the disease.

Nasal allergy on the other hand usually presents with runny nose, sneezing, and itching but some patients can also have nasal congestion, post-nasal drainage, and headaches. With nasal allergy we usually see definite problems at certain seasons of the year or a correlation with exposures to dust, animal dander, mold or mildew exposures and in some patients’ extreme reactions to certain foods. Allergy symptoms also involving the eyes usually are redness, itching and watering of the eyes.

It is possible for an individual to have problems with both non-allergic rhinitis and allergic rhinitis, and this makes the problems at times more difficult to clearly diagnose and treat.

Several tests can be used to differentiate non-allergic rhinitis from allergic rhinitis. Skin testing, as one might expect, displays positivity in patients with allergic rhinitis, whereas a negative skin test will be obtained in patients with non-allergic rhinitis. In addition, the blood IgE levels and eosinophils (the allergy cell) are elevated in patients with allergic rhinitis but not in non-allergic rhinitis.

Non-allergic rhinitis often is triggered by drafts, temperature changes (especially cold air), by scented cosmetics (both men’s and women’s cosmetics), by cigarette and tobacco smoke, as well as fireplace smoke, scented or perfumed soaps. Many types of aerosol sprays, even scented deodorants can cause problems. Paint fumes, insecticides, bug sprays,
varnishes, and even the odor from new clothing, carpeting or furniture can cause problems. Kerosene, lighter fluids, oil and gas fumes can cause problems. House dust may act as an irritant, and should be avoided.

Do not overuse over-the-counter decongestant sprays or nose drops because these can cause “rebound” nasal congestion. All nasal decongestant sprays should be discontinued following 3 days of continuous use. Medications will be prescribed to help with this problem. A good part of the treatment is avoiding known problems and exposures, and working by trial and error to find medications that work best in your case. Medications that may be tried include: Astelin© nasal spray, decongestants, decongestant-antihistamine combinations, intranasal steroid sprays, and possibly an atropine-derivative nasal spray (Atrovent©).

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Not a Cold. Not the Flu. It’s Cedar Fever! Who Knew?

Runny nose, coughing, watery eyes – These are the symptoms Tess (not her real name) just couldn’t seem to shake.

The congestion set in after raking leaves.  Her first thought was, “Wow, I have caught a cold.”

But those pesky cold symptoms lingered.  She worried that perhaps she had contracted Covid, as some friends had tested positive for it recently. She felt fine but tested anyhow. Five negative Covid tests later, she was finally convinced it was not Covid.

So, it was not Covid. It was not a cold, and it was not influenza either. What was it?

It turns out the culprit was not a virus at all.  Tess was suffering from something called Cedar Fever.

“Cedar Fever is not really a fever and it is not a virus,” said Maya Gharfeh, MD, FACAAI, FAAAAI. “It is an allergic reaction to pollen from cedar trees, which do grow in abundance in this state and region. For some, the pollen triggers an allergic reaction.”

Most people worry about allergies in the spring and summer, but for some people, like me, allergies can also occur and sometimes be severe in the winter months too.

Cedar Fever

If you live in Oklahoma, Texas, Arkansas or Missouri or somewhere where these trees are common and have a sensitivity to the pollen, you may notice seasonal allergy symptoms from these trees in the winter months.

Millions of cedar trees release large amounts of pollen each year, with pollen production typically reaching a peak in mid-January.  Tree experts know that when it is dry and windy, pollen cones open and release pollen grains. Some people have even captured video and pictures of the pollen clouds blowing off trees. 

What Are the Symptoms of Cedar Fever?

Dr. Gharfeh explained cedar fever is often confused with a cold or flu because of the time of year when it is most prevalent.

Cedar Fever symptoms are like many common allergy symptoms, and may include a runny nose or nasal congestion, itchiness, and sneezing. As the name suggests, some people may notice a warmer body temperature as part of their symptoms.

“We are talking about a mildly elevated body temperature or feeling slightly warm,” Gharfeh stressed. “If you are experiencing a high fever, it is likely that it is something more than allergies and you should see a primary care provider if those symptoms don’t fade.”

Here are a few other symptoms that sometimes occur with Cedar Fever:

  • Sore throat
  • Coughing
  • Difficulty smelling
  • Plugged ears
How Do You Treat Cedar Fever?

Cedar fever should not put you at risk for any health complications, but the symptoms can be uncomfortable.

“As with so many allergies, the appropriate treatment depends upon the patient and the severity of his or her symptoms,” Gharfeh explained.

Common treatments at home may include:

  • Prescription medications
  • Over-the-counter antihistamines
  • Over-the-counter medications

“For some simple over-the-counter medications are sufficient, but if you find that those medications are not enough, it might be time to talk with your doctor or an allergy specialist,” Gharfeh said. “At the Oklahoma Allergy and Asthma Clinic, we have 100 years of experience helping people navigate life with allergies. We are able to help determine the best treatment for your allergies, which may include stronger prescription medications.”

Prevention of Cedar Fever

Gharfeh explained that for those most susceptible to Cedar Fever, avoiding pollen as much as possible can help.  Here are a few strategies that may help:

  • Avoid outdoor activities when tree pollen counts are high
  • Close windows and change air filters often to reduce pollen levels in your home
  • If you need to do yard work, wear a mask to reduce exposure to cedar pollen
  • Vacuum and clean your home regularly to reduce indoor allergens

Tess has learned to watch the pollen counts displayed daily by the official Oklahoma Allergy and Asthma Clinic website, taking precautions when the tree pollen counts elevate, especially to medium (yellow on the graph) or higher.  The clinic’s pollen count is posted daily Monday through Friday and can be found here: https://oklahomaallergy.com/allergy-report/

With a simple pollen count check daily and some allergy medications, Tess finds she is better able to maneuver Cedar Fever season.

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Oklahoma Allergy and Asthma Clinic celebrates its 100th Anniversary this year. Founded in 1925, the clinic has a century of patient-focused, state-of-the-art allergy and asthma care. Today, the clinic is home to 13 allergy and asthma specialists, caring for tens of thousands of patients a year from across Oklahoma, the region and nation.  OAAC also has earned the Better Business Bureau’s Torch Award for Business Ethics, the Oklahoman’s Community’s Choice Award for Top Allergy Clinic, 405 Magazine’s Best OKC Allergy Clinic and the Journal Record’s Reader’s Rankings Award, among others. In addition, the clinic remains a staunch supporter of the community through organizations such as Allied Arts, United Way, the Oklahoma City Philharmonic and Museum of Art, Ronald McDonald House Charities of OKC, Toby Keith Foundation, Positive Tomorrows and more.

The post Not a Cold. Not the Flu. It’s Cedar Fever! Who Knew? appeared first on Oklahoma Allergy and Asthma Clinic.

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