Got Allergies? Maybe It's Actually Non-Allergic Rhinitis

USA Today published a story on Aug 22, 2010 describing a condition called "Non-Allergic Rhinitis" or "Vasomotor Rhinitis" which essentially is having pretty much all the symptoms of classic nasal allergies, but caused NOT by allergies!

Such symptoms include:

- Runny nose
- Nasal congestion
- Post-nasal drainage
- Nasal obstruction
- Sinus pressure
- Sneezing
etc

These individuals also report that their nasal symptoms are triggered not only by pollen and dust, but also perfumes, strong odors, cigarette smoke, chemicals, cold air, high wind, humidity, and certain foods, especially spicy ones.

The way I try to explain this condition from those suffering from it is to consider their nasal lining to be hypersensitive... so hypersensitive that things which ordinarily shouldn't cause any problems, do.

The best way to address this condition is by avoiding known triggers and keeping the nose clean by regular saline washes. The saline washes are quite important in that they clean out the substances which are irritating the nose (much like washing your skin reduces the irritation if you get poison ivy).

Some patients may benefit from medications like anti-histamine and steroid nasal sprays, but such medications do not work as well as for those suffering from classic nasal allergies.

Barrier type of medications like ponaris may also be helpful. Such medications work by creating an oily barrier such that the irritating substances don't actually touch the lining itself when breathed in (much like chapstick on lips).

Some patients with non-allergic rhinitis and large turbinates may benefit from a surgical procedure called turbinate reduction, but rarely cure the problem. At best, there is perhaps a 50% reduction in symptoms.

One should also be aware that you can have BOTH allergic and non-allergic rhinitis.

Read the USA Today article here.

Mucus in Throat or the Phlegmy Throat!!!

NOTE: A more complete discussion on this topic can be found here.

A common complaint of patients seeing an ENT doctor is for a persistent phlegmy throat or sensation of mucus in the throat. Other symptoms that a patient may complain of include constant throat-clearing, cough, raspy voice, and a lump sensation in the middle of the throat (aka, globus).

Reflux (Acidic or Non-acidic)

In the VAST majority of patients with this complaint, it is due to a disorder called "laryngopharyngeal reflux" or LPR for short. This disorder is due to reflux whether acidic or non-acidic from the stomach that travels up to and settles in the throat region. This mucus collection can even be seen on fiberoptic endoscopy as shown in the picture here. Of note, most patients with LPR do NOT complain of heartburn, nausea, indigestion and other symptoms commonly associated with reflux.

The treatment is the same as for the more common and related GERD disorder except that treatment usually takes much longer... sometimes for as long as 6 weeks to 3 months. Some over-the-counter medications one can try are listed at the end of this article.

To read more about this disorder as well as treatment options, click here.

Post-Nasal Drainage

Sometimes, the throat mucus can come from the nose. In these patients, they literally feel the drainage travelling from the nose and down into the throat. Often, when one looks in the back of the throat, the drainage can be seen. Treatment for this drainage depends on what it is caused by. If due to sinusitis, antibiotics is the treatment. If due to allergies, allergy treatment is recommended. If due to vasomotor rhinnitis, nasal sprays such as atrovent, patanase, and astelin may be quite helpful. In these patients, turbinate reduction may quite helpful to reduce the amount of drainage.

Food "Sensitivities"

Uncommonly, food "sensitivities" can cause excessive throat mucus to develop. The most common culprit is dairy products (many folks develop lots of phlegm in the throat when drinking lots of whole milk for example). Other common triggers include egg and wheat. Treatment for this problem is mainly avoidance.

To be clear, we are NOT talking about food allergies.


Zenker's Diverticulum

Even more rarely, there may be an anatomic abnormality in the throat called a Zenker's Diverticulum. Basically, this abnormality is a pouch that protrudes from the esophagus (swallowing tube) which catches food and mucus preventing it from going down towards the stomach. At random times, the contents in the pouch may suddenly regurgitate causing aspiration as well as mucus collection in the throat.

Treatment is surgical. Click here for more info.

Read more about these and other cause of phlegmy throat conditions here.

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Medications that may help reflux: