DEAR DR. ROACH: The problem of nonallergic rhinitis apparently affects a lot of people, yet I cannot recall seeing it mentioned in your column. In our case, my wife has had sinus problems for almost 20 years. She has tried every over-the-counter as well as prescription antihistamine, several antibiotic treatments, three surgeries (deviated septum, tonsil removal, sinus cleaning) and even prednisone. Prednisone is the only drug that helps, but with the serious side effects of long-term usage she is able to take it only a few times a year for some relief when we go on vacation.
Have you heard of any treatments that would disable sinus fluid production? A friend mentioned having seen an advertisement for laser sinus surgery, but I have not been able to identify that source. — A.
ANSWER: Nonallergic rhinitis is a symptom complex that can be caused by several underlying causes, but the primary issues are any combination of runny nose, sneezing and nasal congestion, without a specific cause being found. Many people find that symptoms are worse with odor exposure, cold or dry air or hot or spicy foods. Ten percent to 40 percent of the population has it, and it usually starts after age 20, as opposed to allergic rhinitis, which usually starts at a younger age.
There are many treatments for nonallergic rhinitis. I often have prescribed azelastine, a topical (spray) antihistamine. However, in your wife’s case, she has gotten better with prednisone. You are right that prednisone has too many side effects to use it lightly, but the fact that she has improved predicts that she would do well with nasal steroids, such as fluticasone (Flonase) or another of the potent but poorly absorbed steroids. These work well where they are sprayed but are not well-absorbed into the bloodstream, so have small likelihood of causing side effects elsewhere in the body. I have seen several people with nosebleeds from chronic nasal steroids, however.