NASAL ALLERGY

An abnormal reaction of the nasal tissues to certain allergens, which tends to start in childhood. Vasomotor
rhinitis starts in the 20s and 30s.

Causes

Predisposing

  • Hereditary: Family history of similar or allied complaints
  • Infections may alter tissue permeability
  • Psychological and emotional factors in vasomotor rhinitis

Precipitating

  • Changes in humidity and temperature
  • Dust mite, infections
  • Certain foods; drugs, e.g. acetylsalicylic acid
  • Alcohol, aerosols, fumes

Clinical features

  • Often present in school age children
  • Sometimes preceded or followed by eczema or asthma. Less common in persons >50 years old
  • Paroxysmal sneezing
  • Profuse watery nasal discharge
  • Nasal obstruction, variable in intensity and may alternate from side to side
  • Postnasal drip (mucus dripping to the back of the nose)

Investigation

  • Careful history is most important
  • Large turbinates on examining the nose

Differential diagnosis

  • Nasal infection
  • Foreign body
  • Adenoids (in children)

MANAGEMENT

  • Avoid precipitating factors (most important)
  • Reassure the patient
  • Antihistamines, e.g. Chlorphenamine 4 mg every 12 hours for up to 21 days, then as required
    thereafter if it recurs
  • Nasal decongestants, e.g. Pseudoephedrine or xylometazoline
  • Surgery may be required if there is obstruction of the nose
Caution
  • Do NOT use vasoconstrictor nasal drops, e.g. Pseudoephedrine and Xylometazoline for >7 days or
    repeatedly, since they can cause rebound congestion and alter the nasal environment making structures
    hardened