Why aren't allergy medications working? Two words: Nonallergic Rhinitis

After trying multiple over-the-counter antihistamines, different doses, and perhaps even getting a medical prescription, you still may be asking “why aren’t my antihistamines working???”

There are plenty of myths about spring allergy season, and one of the most common is that only allergies can cause allergy-like symptoms. If your runny nose and sneezing aren’t going away after taking antihistamines, it may not be allergies at all. So, what could be causing spring allergy symptoms? The answer may be nonallergic rhinitis.

What is nonallergic rhinitis?

To understand what nonallergic rhinitis is, we must first understand what allergies are.

Having an allergy means that your immune system reacts to a substance that is harmless to most people (e.g. pollen, dog dander, cat dander, mold, etc.). If your immune system recognizes an allergen and views it as a threat, your body will release a chemical called histamine, which causes those irritable allergy symptoms. This is why antihistamines help to relieve symptoms; they suppress histamine in our system.

If there is no immune system reaction, then there is no histamine released. If there is no histamine, then antihistamines can’t relieve symptoms. If antihistamines aren’t working for you and you have allergy-like symptoms, it may not be a “bad allergy season,” but instead something nonallergic you’re reacting to.

Symptoms of nonallergic rhinitis include:1

  • Sneezing
  • Runny or stuffy nose
  • Coughing
  • As you can see, these symptoms are very similar to symptoms from allergies. It’s not uncommon for some healthcare providers to misdiagnose nonallergic rhinitis as allergic rhinitis. In fact, in one study, 65% of people who were prescribed antihistamines for allergies were deemed nonallergic.2

    What causes nonallergic rhinitis?

    Put simply, a substance that doesn’t cause your immune system to have an allergic reaction, yet still causes symptoms like runny nose or sneezing, may be a nonallergic trigger.

    Here are some examples:3,5

  • Pollution
  • Cigarette smoke
  • Cleaning chemicals (bleach, laundry detergent, etc.)
  • Perfume/cologne
  • Viruses
  • Your immune system isn’t allergic to cigarette smoke or perfume, but instead your body is irritated from the vapor, causing allergy-like symptoms.

    When it comes to allergies and nonallergic rhinitis, one of the best practices to reduce symptoms is to find out what’s causing your reaction and avoid it.

    How can you tell the difference between nonallergic rhinitis and allergic rhinitis?

    Due to the similar symptoms, discovering whether someone has allergic or nonallergic rhinitis can be challenging for some healthcare providers if they aren’t running a diagnostic test.4

    Luckily, specific IgE blood testing may help healthcare providers better understand your condition and get you the treatment you need. Specific IgE blood testing is a simple blood test that tells clinicians what you may be allergic to. It can also be used to help rule out the role of allergies if you are having allergy-like symptoms.

    What if my allergy test says I’m not allergic to anything?

    An allergy blood test that indicates that you aren’t sensitized to allergens may mean that something nonallergic is causing your reaction. Think, did you switch perfumes or cologne recently, have you been around someone who smokes, were you in traffic all day surrounded by pollution?

    Discovering what’s causing your symptoms starts with talking to your healthcare provider about getting a specific IgE blood test.

    Find out more about getting specific IgE allergy blood tested.

    Medically reviewed byRebecca Rosenberger
    MMSc, PA-C

    Rebecca Rosenberger is the Associate Director of U.S. Clinical Affairs & Education in the Immunodiagnostics Division at Thermo Fisher Scientific and a physician assistant specializing in allergy &immunology.

    Written by
    Luke Lemons

  • 1Settipane, Russell A., and Philip Lieberman. "Update on nonallergic rhinitis." Annals of allergy, asthma & immunology 86.5 (2001): 494-508.
  • 2Szeinbach SL, Williams B, Muntendam P, et al. Identification of allergic disease among users of antihistamines. J Manag Care Pharm. 2004;10(3):234-238.
  • 3Tantilipikorn, Pongsakorn, et al. “Efficacy and Safety of Once Daily Fluticasone Furoate Nasal Spray for Treatment of Irritant (Non-Allergic) Rhinitis.” The Open Respiratory Medicine Journal, vol. 4, no. 1, 2010, pp. 92–99.
  • 4Wheeler PW, et al. Am Fam Physician. 2005;72:1057-1062.
  • 5Quillen, David A., and David B. Feller. "Diagnosing rhinitis: allergic vs. nonallergic." American family physician 73.9 (2006): 1583-1590.

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