Allergic Rhinitis

Year-round (perennial) triggers

• House dust mite — by a distance the commonest. The allergen is in mite droppings, concentrated in mattresses, pillows, carpets and soft furnishings. Worst on waking
• Pets — cat allergen is exceptionally persistent, remains in a house for months after the animal has gone, and is carried on clothing into homes with no pet at all
• Mould — damp housing, bathrooms, and the autumn leaf fall
• Occupational — flour, wood dust, latex, laboratory animals, isocyanates. Better away from work is the giveaway, and this has legal and reporting implications worth taking seriously

Seasonal triggers

Tree pollen from roughly February to May, grass pollen May to July — the commonest UK trigger — and weed and mould spores through late summer and autumn. Covered in detail on our hay fever page.

What makes it more likely

• A personal or family history of asthma, eczema or food allergy — the atopic pattern
• Around eight in ten people with asthma also have rhinitis, and the two behave as one airway

The important mimics — which is where the misdiagnosis happens

• Non-allergic rhinitis. Identical symptoms, no allergy. Triggered by temperature change, strong smells, alcohol or spicy food. Allergy testing is negative and antihistamines do little; nasal steroids and ipratropium still help
• Rhinitis medicamentosa — rebound congestion from decongestant sprays. Using an over-the-counter decongestant spray beyond about a week causes worsening blockage when it wears off, so people use more. We see people who have used these daily for years, convinced their allergy is severe, when the spray itself is now the entire problem
• Chronic sinusitis with nasal polyps — suspect where the sense of smell is lost early and blockage dominates
• A deviated septum — blockage that is one-sided and constant, unaffected by treatment
• Pregnancy rhinitis — hormonal, common, and resolves after delivery
• Blood pressure medication, some anti-inflammatories, and cocaine use

Allergic rhinitis is a clinical diagnosis made from the history, and a video consultation covers it well. Most people do not need any test.

What we ask

• Is there itch? The first and most discriminating question — it separates allergy from infection immediately
• Time pattern — year-round, seasonal, or year-round with a seasonal flare
• Worse on waking? Points to dust mite. Better on holiday? Points to something in the home. Better at weekends? Points to work
• Pets, damp, bedding, and what your job involves
• What you have already tried, at what dose, and for how long — nearly everyone has tried a nasal spray, and nearly everyone stopped it too early
• How you use the spray — see the treatment section; poor technique is the single commonest reason treatment fails
• Any chest symptoms — cough, wheeze, breathlessness on exertion. Rhinitis and asthma travel together
• Any use of over-the-counter decongestant sprays, and for how long

Tests — where they add something

• Specific IgE blood testing to named allergens — dust mite, cat, dog, grass and tree pollen, moulds. Useful when the trigger is genuinely unclear, when avoidance would mean a significant decision, or when immunotherapy is being considered. We can arrange this
• Total IgE alone is close to useless and we do not recommend it — a normal result does not exclude allergy and a raised one does not identify the trigger
• Skin prick testing is done in allergy clinics rather than remotely

Avoid the direct-to-consumer "food intolerance" and IgG panels sold online. They have no diagnostic validity, are not accepted by any allergy body, and reliably lead to unnecessary dietary restriction. We will not act on them and we would rather you did not pay for them.

What needs looking at in person

We cannot examine the inside of your nose. Persistent one-sided blockage, loss of smell, bleeding, or symptoms not responding to correctly used treatment need an ENT examination, and we refer.

House dust mite — realistic expectations

Single measures do not work. Only a combined approach makes a measurable difference, and even then the effect is modest, so treat this as an adjunct to medication rather than a replacement:

• Allergen-impermeable covers on mattress, duvet and pillows — the highest-yield single step
• Wash bedding weekly at 60°C. Lower temperatures do not kill mites
• Hard flooring rather than carpet in the bedroom, where you spend a third of your life
• Reduce humidity — ventilate, and dry washing outside where possible. Mites need moisture
• Vacuum with a HEPA filter, and not while the person with symptoms is in the room
• Soft toys through a hot wash, or a night in the freezer, for children

Pets

Removing the animal is the effective measure, and often not what anyone wants to hear. If it stays: keep it out of the bedroom entirely, wash hands after contact, and use HEPA filtration. Note that cat allergen persists in a house for months after the cat has gone — so no improvement in the first weeks does not mean the diagnosis was wrong.

Pollen

Shower and change clothes on getting home, keep windows shut in the early morning and evening when counts peak, dry washing indoors, and use wraparound sunglasses. A barrier balm around the nostrils genuinely helps.

Mould

Treat the damp rather than the symptoms. Ventilate bathrooms and kitchens, use extractor fans, and address condensation. Where the damp is a rented property's disrepair, that is the landlord's legal responsibility and worth pursuing.

Saline rinsing

Consistently underrated. A daily rinse clears allergen and mucus, and improves how well a steroid spray works. Use bought sachets or cooled boiled water — never water straight from the tap.

What is not worth your money

• Local honey. The pollen that causes hay fever is wind-borne grass and tree pollen, not the flower pollen in honey. Studies show no benefit
• IgG "intolerance" tests, and hair or kinesiology allergy testing
• Air purifiers as a standalone answer — modest at best, and no substitute for bedding measures
• Repeated antibiotic courses for clear nasal discharge

How do I know it is allergy and not just constant colds?

Itch and duration. Colds do not itch and colds end. Allergic rhinitis itches — nose, palate, eyes, ears — produces clear discharge without fever, and does not stop. Several "colds" a year that never quite clear is allergic rhinitis until proven otherwise, and antibiotics will do nothing for it.

Why doesn't my nasal spray work?

Almost always technique or timing. Aim it outwards towards the ear on that side, not up your nose; do not sniff hard; and use it every day for at least two weeks before judging it. Tasting it at the back of your throat means it went past the tissue it needs to treat. Used only on bad days it cannot work — it is preventive.

Are steroid nasal sprays safe long term?

Yes. Modern intranasal steroids have very low absorption into the body and are used for years safely, including in children, where the effect on growth is negligible with current preparations. The risks people worry about come from steroid tablets and injections, not sprays. Nosebleeds usually mean the angle is wrong rather than a problem with the drug.

Is it hay fever if it happens all year?

No — hay fever is the seasonal, pollen-driven form. Year-round symptoms point to house dust mite, a pet, mould or something at work. The treatment overlaps considerably, but the avoidance advice is entirely different, which is why the distinction is worth making.

Do I need allergy testing?

Usually not. Treatment is the same whatever the trigger, and the history normally identifies it. Testing is worthwhile when the trigger is genuinely unclear, when it would drive a real decision — rehoming a pet, changing job — or when immunotherapy is being considered. Specific IgE to named allergens is the useful test; total IgE alone tells you very little.

Does local honey help?

No. It is one of the most persistent myths in this area. Hay fever is caused by wind-borne grass and tree pollen; honey contains flower pollen carried by bees. The two are different, and trials show no benefit.

My decongestant spray stopped working and now I can't breathe without it.

That is rebound congestion — rhinitis medicamentosa — and the spray has become the cause. It is common, it is not your fault, and it is reversible. Coming off it takes a few genuinely uncomfortable weeks, usually with a steroid spray started first to cover the transition. Worth doing rather than continuing indefinitely.

Could this be affecting my asthma?

Very likely. Around eight in ten people with asthma have rhinitis, and the upper and lower airway behave as one. Treating the nose properly often improves asthma control and reduces reliever use — which is why we ask about your chest even when you have come about your nose.