Perennial allergic rhinitis: year-round allergic nose symptoms

Allergic rhinitis is inflammation of the inside of the nose caused by an allergic reaction. The NHS describes it as the nose becoming irritated by something you are allergic to, such as pollen, causing sneezing and other symptoms. Hay fever is the best-known form, and the NHS says it is caused by an allergic reaction to pollen.

Perennial simply means all year round. Perennial allergic rhinitis describes the same type of allergic reaction when the trigger is something that is present in the home or environment through the year rather than only during one pollen season. The sources used for this page do not use the term perennial themselves, but they list the triggers that fall into this group, so this guide uses the NHS lists of allergens to explain it.

The NHS contrasts allergic rhinitis with non-allergic rhinitis, which it says is caused by things like having a cold, very hot or cold temperatures and humidity. The treatments overlap, but the triggers and what you can do to avoid them differ.

The NHS lists the common allergens in allergic rhinitis. NHS inform notes that for hay fever the pollen season varies by plant: tree pollen is released during spring, grass pollen at the end of spring and beginning of summer, and weed pollen in late autumn. Triggers that are not pollen do not follow a calendar in the same way.

The NHS says the common symptoms are similar to a cold: sneezing, an itchy nose, a runny or blocked nose, itchy, red and watery eyes, a cough and an itchy roof of the mouth. It adds that this usually happens within minutes of coming into contact with something you are allergic to.

NHS inform lists other less common symptoms of hay fever that apply to allergic rhinitis more generally: loss of the sense of smell, facial pain from blocked sinuses, headaches, earache, and tiredness and fatigue. It also notes cough can be caused by postnasal drip, mucus dripping down the throat from the back of the nose.

The NHS says hay fever can last for weeks or months, unlike a cold, which usually goes away after 1 to 2 weeks. A cold-like illness that never really clears, or that returns every time you are in a certain room, is a useful clue that an allergy may be involved.

NHS inform says that hay fever can sometimes affect quality of life, disrupting productivity at school or work in severe cases, and that inflammation of the sinuses (sinusitis) is a common complication. Children may also develop a middle ear infection as a result of hay fever. NHS inform adds that if you have asthma, asthma symptoms may get worse when you have hay fever.

The NHS advises seeing a GP if you also have asthma and it is getting worse. Allergic conditions often cluster: the NHS says you are more likely to get an allergy if people in your family have them or conditions such as eczema and asthma.

The NHS says you can often treat allergic rhinitis without seeing a GP, and that avoiding triggers where you can is the first step. A pharmacist can advise on medicines such as antihistamines, decongestant nasal sprays or drops, steroid nasal sprays, and salt water nasal sprays or solutions to rinse out the inside of the nose.

Decongestants can be bought without a prescription but, the NHS warns, should not be used for longer than 5 days because they can make a blocked nose worse. It also says decongestants should not be used by children under 6. It gives a method for a homemade salt water rinse: boiled and cooled water with 1 teaspoon each of salt and bicarbonate of soda, sniffed gently into one nostril at a time, up to 3 times a day with a fresh solution each time.

The NHS suggests steps to reduce exposure: use synthetic bedding and covers and wash bedding at 60C and above, dust with a damp cloth and use a vacuum with a HEPA filter, wash pets regularly and groom them outside if possible, keep pets out of bedrooms, and keep your home dry and well ventilated, dealing with damp and condensation. It also suggests wraparound sunglasses to protect the eyes from pollen.

• See a GP if symptoms get worse, affect sleep or daily life, treatments from the pharmacist are not working, you also have asthma that is getting worse, or you are not sure what is causing your symptoms (NHS advice).

• A GP may prescribe prescription steroid nasal sprays or antihistamines, and may refer you to a specialist for tests and treatment if the cause is unclear or the symptoms are severe (NHS).

• For hay fever specifically, the NHS says that if steroids and other treatments do not work, a GP may refer for immunotherapy, which gradually builds immunity to pollen. For allergies generally it describes desensitisation as something only a medical professional should do.

The NHS says that if you think you may have an allergy, a GP may arrange allergy tests or refer you to a specialist allergy clinic. The tests it lists include a skin prick test, in which a small amount of the allergen is put on the skin to see whether it reacts, and blood tests.

Testing is mainly useful when it is not clear what is causing symptoms, or when avoiding a particular trigger such as a pet would be a major decision. A positive test alone does not mean that a trigger is responsible for your symptoms, so the result is interpreted alongside the history of when and where you are affected.

Most allergic rhinitis is handled by pharmacies and GPs, with referral to NHS ENT or allergy services when it is severe or the cause is unclear. Some people choose a private allergy clinic for testing. If you do, keep in mind that test results need clinical interpretation, and share them with your GP so treatment stays co-ordinated.