Non-allergic rhinitis
The same blocked, runny nose as hay fever, but allergy is not the cause. Allergy testing comes back negative, and there is no allergen to avoid.
Instead, the nasal lining and its nerve supply have become over-responsive, so the nose reacts to ordinary things in the environment that other people do not notice. It is common, accounting for roughly a quarter to a third of people seen with long-term nasal symptoms.
Many people have both allergic and non-allergic rhinitis together, which is called mixed rhinitis. That is worth knowing, because it explains why treating the allergy alone sometimes only gets you part of the way.
Common triggers
- Weather and temperature change, especially cold air and wind
- Strong smells: perfume, cleaning products, paint, smoke
- Alcohol, particularly wine and beer
- Eating, especially hot or spicy food, which causes a clear watery drip during and just after a meal
- Dust, solvents and fumes at work
- Hormonal changes, such as pregnancy, or an underactive thyroid
- Some blood pressure, anti-inflammatory and antidepressant medications
- Overuse of decongestant nasal sprays
How it differs from hay fever
The pattern is a useful clue. Itch and repeated sneezing point towards allergy. Non-allergic rhinitis tends to cause blockage and a clear watery runny nose, with little itching, and eye symptoms are usually absent. It typically starts in adulthood rather than childhood, and runs all year rather than in a season.
The distinction matters, because antihistamine tablets do not work for non-allergic rhinitis. People often take them for years without benefit.
How it is treated
Where a trigger can be identified, avoiding it is the simplest treatment, and keeping a short diary for a fortnight often makes the pattern obvious. Where the trigger is unavoidable, such as cold air on a work site, treatment does the work instead.
Salt water rinses clear irritants and settle the lining. Daily steroid sprays help blockage and post-nasal drip, though less dramatically than they do in hay fever. If a clear watery drip is your main problem, there is a specific spray that blocks the nerve signal driving it, works within about fifteen minutes, and is often the treatment that has been missed. An antihistamine nasal spray, unlike antihistamine tablets, does work here.
Surgery is considered when symptoms persist despite a proper trial of treatment, usually about three months. It is aimed at the physical blockage and at the nerve supply, not at the underlying sensitivity of the lining, so sprays and rinses usually continue afterwards.
See a doctor promptly if you have
- Symptoms on one side only, or bleeding from one nostril
- Clear watery fluid dripping from one nostril, particularly on leaning forward, or a salty taste at the back of the throat
- Heavy crusting, a bad smell, or a sore inside the nose that will not heal
- Loss of your sense of smell
Patients under my care receive a detailed handout covering the specific sprays, technique and options that suit their pattern.
This page is general information and does not replace advice about your own case. Reviewed August 2026.