Vasomotor rhinitis: causes, symptoms and treatment of non-allergic runny nose

Rhinitis means inflammation or irritation of the lining of the nose. A Scottish NHS guideline for GPs defines it as inflammation of the lining of the nasal cavity, which can be intermittent or persistent, and says it is commonly associated with asthma. It lists symptoms including nasal obstruction or congestion, runny nose, reduced sense of smell, and sneezing and itching of the nose, palate or eyes.

The guideline divides rhinitis into allergic and non-allergic types. Non-allergic rhinitis includes viral rhinitis (the common cold), hormonal rhinitis (which can be associated with pregnancy), atrophic rhinitis with nasal crusting, rhinitis medicamentosa caused by chronic use of nasal decongestants, and vasomotor rhinitis. It describes the last as watery nasal discharge often without sneezing, reduced smell or obstruction, as opposed to allergic rhinitis.

Vasomotor rhinitis is therefore a diagnosis made after other causes have been considered. The name refers to the blood vessels (vaso-) and nerves controlling them (-motor) in the lining of the nose, which can overreact to non-allergic triggers.

NHS Wales lists the most common symptoms of non-allergic rhinitis as a blocked or runny nose, sneezing, an itchy nose and a reduced sense of smell. It adds that sometimes a crust may form inside the nose, which may have a bad smell and bleed if you try to remove it.

The Scottish guideline emphasises that vasomotor rhinitis is usually bilateral. If symptoms affect only one side it advises considering other causes, including a cerebrospinal fluid (CSF) leak, which is why one-sided persistent watery discharge needs medical assessment rather than self-treatment.

The sources are clear that the causes are varied and not always identifiable. NHS Wales lists common causes of non-allergic rhinitis, and the same list is a useful guide to triggers for vasomotor rhinitis.

There is no single test for vasomotor rhinitis. The Scottish guideline notes that a specific IgE (RAST) allergy test can be done in primary care, although many patients can clearly identify an allergic trigger and so it is often not necessary. In practice, a GP takes a history of symptoms and triggers, examines the nose, and considers whether allergy, infection, medicines or structural problems explain the picture.

NHS Wales advises seeing a GP if symptoms get worse, if you get asthma symptoms or your asthma gets worse, if symptoms affect your sleep and everyday life, if it is not clear what is causing them, or if treatments from a pharmacist are not working. It adds that you may be referred to a specialist for further tests and treatment if the cause is unclear or symptoms are severe.

NHS Wales says non-allergic rhinitis is not harmful but can affect your life, and you can often treat it without seeing a GP. It suggests avoiding triggers if you can, and asking a pharmacist about antihistamines, nasal sprays to unblock the nose and salt water nasal sprays or solutions to rinse the inside of the nose. It describes a homemade salt water rinse, to be repeated up to three times a day with a fresh solution each time.

For vasomotor rhinitis specifically, the Scottish guideline says treatment is with topical nasal steroid sprays initially, and if that does not control symptoms, adding a topical ipratropium bromide nasal spray may be considered. It adds that most patients have significant improvement with medical management and that surgical interventions are rarely used.

NHS Wales says a GP may prescribe stronger medicines such as prescription nasal sprays and may change any medicine you are taking that could be causing symptoms. Decongestant sprays should be used cautiously: the Scottish guideline describes rhinitis medicamentosa, in which chronic use of over-the-counter decongestants causes rebound congestion and stopping them needs a plan.

The Scottish guideline suggests routine referral to ENT for patients where there is diagnostic doubt after failed initial therapy. An ENT specialist can examine the nose with a small camera and consider conditions such as enlarged turbinates, polyps or a deviated septum, which can cause similar blockage.

ENT UK says that medication, such as saltwater washes, antihistamine tablets and steroid sprays or drops, is tried first for enlarged turbinates, and surgery is considered only if these do not help. For many people with vasomotor rhinitis the problem is managed entirely in primary care, through the NHS, with private ENT consultations an option for those who prefer them.

Because triggers differ between people, keeping a simple note of what brings on symptoms can help. Common patterns include a runny nose when eating hot or spicy food, moving between cold and warm air, or exposure to perfumes and smoke. Avoiding the trigger when possible is the first-line self-management step in the NHS Wales advice.

NHS Wales says non-allergic rhinitis often gets better on its own without any treatment, so reassurance is part of the plan. If it keeps affecting sleep or work, return to the GP rather than relying on repeated decongestant use.