Drip, drip, drip...It’s not your leaky faucet. It’s your nose.
A runny nose caused by a cold or a seasonal allergy is one thing, but chronic rhinorrhea—a constant nasal drip for no apparent reason—is another. You may feel a chronic drainage in the back of your throat, or you may find yourself constantly dabbing your nose with a tissue.
To understand what’s causing your nose to drip and what you can do about it, you should first know that ‘rhinorrhea’ and ‘rhinitis’ are not exactly the same thing. “Rhinitis is a generalized term that describes a complex of symptoms, including of paroxysms of sneezing, runny nose, nasal obstruction and post-nasal drainage caused by inflammation or irritation of the nasal membranes,” explains Dr. Elyra Figueroa, an SSM Medical Group physician specializing in allergy and immunology. “Nonallergic rhinitis (or chronic rhinorrhea) specifically describes rhinitis symptoms with no apparent cause, and it does not self-resolve.”
Dr. Raymond Slavin, a SLUCare physician specializing in allergy and immunology, further explains how runny noses are not all the same: “With a cold, a runny nose is generally over in just a few days,” he says. “Rhinorrhea due to an allergy remains for weeks or months or, in some cases, year-round if the person is allergic to a pet or dust mites. In addition, with allergic rhinitis, you generally have other symptoms, including nasal congestion, sneezing and itching of the nose and eyes.”
Then there’s runny nose caused by a condition known as ‘perennial nonallergic rhinitis,’ which describes sensitivities to nonspecific irritants that don’t appear in common allergy tests. Slavin notes that patients who develop this condition do not test positive for reactions to typical allergens.
Determining what’s causing your drippy nose largely is a case of assessing any accompanying symptoms and tracking the symptoms' duration. The condition is considered chronic if it continues for more than six weeks, Figueroa says. Chronic rhinorrhea is difficult to pin to a specific trigger, such as an allergen, but “changes in the central nervous system’s control of the blood vessels in the nose may make the nose more sensitive to changes such as physiological changes in the body, pregnancy, menopause, emotional triggers, and strong odors, such as chemicals or perfumes,” she says.
Allergy testing is the first step in identifying possible causes of an ever-dripping nose. Once allergens are ruled out, physicians may examine the patient for structural issues with the nose, such as a deviated septum or foreign body lodged in a sinus. However, assuming there are no physical abnormalities, chronic rhinorrhea can be tricky to manage since its cause is elusive.
“The symptoms may be empirically treated with various medications such as decongestants, prescription nasal sprays and saline nasal sprays,” Figueroa says. “It is very important to caution patients against using Afrin (an over-the-counter nasal decongestant spray) for longer than two to three days due to the long-term effects of it use. Afrin is excellent in immediately relieving the discomfort of congestion, but overuse can make the congestion worse.”
Slavin recommends use of newer over-the-counter antihistamines, such as Claritin, Allegra and Zyrtec, for symptom control. He notes that these medications are non-sedating and safe for use over long periods of time. Prescription nasal sprays also can be used on an ongoing basis without the ‘rebound effect’ common to Afrin and similar over-the-counter drugs.
Figueroa concludes, “I always make sure to reassure the patient that once we find an optimal treatment approach for their symptoms, their quality of life will improve.”