Merck Manual

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Marvin P. Fried

, MD, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine

Reviewed/Revised Jul 2023
Topic Resources
  • Colds and allergies are the most common causes of rhinitis.

  • Symptoms of rhinitis include a runny nose, sneezing, and stuffiness.

  • Typically, the diagnosis is based on the symptoms.

  • The various forms of rhinitis are treated in various ways, such as with antibiotics, antihistamines, surgery, desensitization injections (sometimes called allergy shots), and avoidance of irritants.

The Nose

Rhinitis may be acute (short-lived) or chronic (long-standing). Acute rhinitis commonly results from viral infections but may also be a result of allergies, bacteria, or other causes. Chronic rhinitis usually occurs with chronic sinusitis Chronic sinusitis Sinusitis is inflammation of the sinuses, most commonly caused by a viral or bacterial infection or by an allergy. Some of the most common symptoms of sinusitis are pain, tenderness, nasal congestion... read more (chronic rhinosinusitis).

Allergic Rhinitis

Symptoms of allergic rhinitis include itching, sneezing, runny nose, stuffiness, and itchy, watery eyes. People may have headaches and swollen eyelids and also may cough and wheeze.

A doctor may diagnose allergic rhinitis based on a person’s history of symptoms. Often, the person has a family history of allergies. More detailed information may be obtained from blood tests or skin testing.

The following treatments can help avoid or treat symptoms of allergic rhinitis:

  • Avoiding the substance that triggers the allergy prevents symptoms but is often not possible.

  • Nasal corticosteroid sprays decrease nasal inflammation caused by many sources and are relatively safe for long-term use.

  • Antihistamines help prevent the allergic reaction and thus symptoms. Older antihistamines dry the mucous membrane of the nose, but many of them also cause sleepiness and other problems, especially in older people. Some newer ones require a prescription but do not have as many of these side effects.

  • A saltwater solution flushed through the nose via a squeeze bottle or a bulb syringe (nasal irrigation) or using a saltwater spray as needed also can help symptoms.

  • Desensitization injections that contain small amounts of the substance that triggers the allergy (called desensitization immunotherapy, or sometimes allergy shots) help to build long-term tolerance to specific environmental triggers, but they may take months or years to become fully effective.

Antibiotics do not relieve the symptoms of allergic rhinitis.

Nonallergic Rhinitis

Acute viral rhinitis

Symptoms consist of runny nose, sneezing, congestion, postnasal drip, cough, and a low-grade fever.

Stuffiness can be relieved by taking decongestants, such as oxymetazoline or phenylephrine as a nasal spray or pseudoephedrine by mouth. These medications, available over the counter, cause the blood vessels of the nasal mucous membrane to narrow (constrict). Nasal sprays should be used for only 3 days because after that period of time when the effects of the medications wear off, the mucous membrane often swells even more than before. This phenomenon is called rebound congestion Rhinitis medicamentosa Rhinitis is inflammation and swelling of the mucous membrane of the nose, characterized by a runny nose and stuffiness and usually caused by the common cold or a seasonal allergy. Colds and... read more Rhinitis medicamentosa .

Antihistamines taken by mouth or as a nasal spray sometimes help control a runny nose, but some cause drowsiness and most cause other problems, especially in older people (see Aging and medications Aging and Medications Medications, the most common medical intervention, are an important part of medical care for older people. Without medications, many older people would function less well or die at an earlier... read more Aging and Medications ). Other medications such as mast-cell stabilizers, some of which also act as antihistamines, can control symptoms of allergic rhinitis.

Antibiotics are not effective for acute viral rhinitis.

Chronic rhinitis

Chronic rhinitis is usually an extension of rhinitis caused by inflammation or a viral infection. However, it also may rarely occur with diseases. These diseases include syphilis Syphilis Syphilis is a sexually transmitted infection caused by the bacteria Treponema pallidum. It can occur in three stages of symptoms, separated by periods of apparent good health. Syphilis... read more Syphilis , tuberculosis Tuberculosis (TB) Tuberculosis is a chronic contagious infection caused by the airborne bacteria Mycobacterium tuberculosis. It usually affects the lungs, but almost any organ can be involved. Tuberculosis... read more Tuberculosis (TB) , rhinoscleroma (a skin disease characterized by very hard, flattened tissues that first appear on the nose), rhinosporidiosis (an infection in the nose characterized by bleeding polyps), leishmaniasis Leishmaniasis Leishmaniasis is caused by 20 or more species of the protozoa Leishmania. Leishmaniasis includes several disorders that affect the skin, the mucous membranes of the nose, mouth, or throat... read more Leishmaniasis , blastomycosis Blastomycosis Blastomycosis is an infection, mainly of the lungs, caused by the fungus Blastomyces dermatitidis. People have a fever, chills, and drenching sweats and sometimes chest pain, difficulty... read more Blastomycosis , histoplasmosis Histoplasmosis Histoplasmosis is an infection caused by the fungus Histoplasma capsulatum. It occurs mainly in the lungs but can sometimes spread throughout the body. Histoplasmosis is acquired by inhaling... read more Histoplasmosis , and leprosy Leprosy Leprosy is a chronic infection usually caused by the bacteria Mycobacterium leprae or Mycobacterium lepromatosis. It results in damage primarily to the peripheral nerves (the nerves... read more Leprosy —all of which are characterized by the formation of inflamed lesions (granulomas) and the destruction of soft tissue, cartilage, and bone. Both low humidity and airborne irritants also can result in chronic rhinitis.

Chronic rhinitis causes nasal obstruction and, in severe cases, crusting, frequent bleeding, and thick, foul-smelling, pus-filled discharge from the nose.

Decongestants may relieve symptoms. Any underlying infection requires a culture (examination of microorganisms grown from a sample of mucus to identify infection with bacteria or fungi) and appropriate treatment. If symptoms persist, biopsy (removal of a tissue sample for identification under a microscope) may be necessary to rule out cancer.

Atrophic rhinitis

Atrophic rhinitis is a form of chronic rhinitis in which the mucous membrane thins (atrophies) and hardens, causing the nasal passages to widen (dilate) and dry out. This atrophy often occurs in older people. People who have granulomatosis with polyangiitis Granulomatosis with Polyangiitis Granulomatosis with polyangiitis often begins with inflammation of small- and medium-sized blood vessels and tissues in the nose, sinuses, throat, lungs, or kidneys. The cause is unknown. The... read more Granulomatosis with Polyangiitis (formerly called Wegener granulomatosis) are also at risk. The cells normally found in the mucous membrane of the nose—cells that secrete mucus and have hairlike projections to move dirt particles out—are replaced by cells like those normally found in the skin. The disorder can also develop in people who had a significant amount of intranasal structures and mucous membranes removed during sinus surgery. A prolonged bacterial infection of the lining of the nose is also a factor.

Crusts form inside the nose, and an offensive odor develops. People may have recurring severe nosebleeds and can lose their sense of smell (anosmia).

Treatment is aimed at reducing the crusting, eliminating the odor, and reducing infections. Antibiotics, such as mupirocin ointment applied inside the nose, kill bacteria. Estrogens sprayed into the nose or taken by mouth and vitamins A and D taken by mouth may reduce crusting by promoting mucosal secretions.

Vasomotor rhinitis

Vasomotor rhinitis is a form of chronic rhinitis. Nasal stuffiness, sneezing, and a runny nose—common allergic symptoms—occur when allergies do not seem to be present. In some people, the nose reacts strongly to irritants (such as dust and pollen), perfumes, pollution, or spicy foods. The disorder comes and goes and is worsened by dry air. The swollen mucous membrane varies from bright red to purple. Sometimes, people also have slight inflammation of the sinuses. People do not have a pus-filled discharge or crusting.

Treatment of vasomotor rhinitis is by trial and error and is not always satisfactory. If inflammation of the sinus is not severe, treatment is aimed at relieving symptoms. Avoiding smoke and irritants and using a humidified central heating system or vaporizer to increase humidity may be beneficial. Nasal corticosteroid and antihistamine sprays sometimes help. Nasal decongestant sprays should not be used. However, decongestants taken by mouth may be used for a few days at a time when symptoms are worst.

Rhinitis medicamentosa

Rhinitis medicamentosa, also known as rebound congestion, is severe nasal congestion caused by the overuse (over 3 days of continuous use) of decongestant nasal sprays and drops (not from steroidal sprays). Treatment is by discontinuing the medication that is causing the condition and using a saline nasal spray. Corticosteroid nasal spray may also be used if needed.

Drugs Mentioned In This Article

Generic Name Select Brand Names
12 Hour Nasal , Afrin, Afrin Extra Moisturizing, Afrin Nasal Sinus, Afrin No Drip Severe Congestion, Dristan, Duration, Genasal , Mucinex Children's Stuffy Nose, Mucinex Full Force, Mucinex Moisture Smart, Mucinex Sinus-Max, Mucinex Sinus-Max Sinus & Allergy, NASAL Decongestant, Nasal Relief , Neo-Synephrine 12-Hour, Neo-Synephrine Severe Sinus Congestion, Nostrilla Fast Relief, Reliable-1 12 hour Decongestant, Rhinase D, RHOFADE, Sinex 12-Hour, Sudafed OM Sinus Cold Moisturizing, Sudafed OM Sinus Congestion Moisturizing, Upneeq, Vicks Qlearquil Decongestant, Vicks Sinex, Vicks Sinex Severe, Visine L.R., Zicam Extreme Congestion Relief, Zicam Intense Sinus
4-Way Nasal, Ah-Chew D, AK-Dilate, Anu-Med, Biorphen, Formulation R , Foster & Thrive Nasal Decongestion, Gilchew IR, Hemorrhoidal , Little Remedies for Noses, Lusonal, Mydfrin, Nasop, Nasop 12, Neofrin, Neo-Synephrine, Neo-Synephrine Cold + Allergy, Neo-Synephrine Extra Strength, Neo-Synephrine Mild, Ocu-Phrin, PediaCare Children's Decongestant, PediaCare Decongestant, PediaCare Infants' Decongestant, Sinex Nasal, Sudafed PE, Sudafed PE Children's Nasal Decongestant , Sudafed PE Congestion, Sudafed PE Sinus Congestion, Sudogest PE, Vazculep
Contac Cold 12 Hour, Dimetapp Decongestant, Drixoral, ElixSure Cold, ElixSure Congestion, Entex, Genaphed , KidKare , Myfedrine, NASAL Decongestant, Nasofed, Nexafed, PediaCare Infants' Decongestant, Pseudo-Time, Silfedrine, Sudafed, Sudafed 12 Hour, Sudafed 24 Hour, Sudafed Children's Nasal Decongestant, Sudafed Congestion, Sudafed Sinus Congestion, Sudogest, Sudogest 12 Hour, Sudogest Children's , Tylenol Children's Simply Stuffy, Zephrex-D
Bactroban, Centany, Centany AT
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