Why aren’t allergy medications working? Two words: Non-allergic Rhinitis

February 18, 2022  Luke Lemons  |  ✓  Medically reviewed by Rebecca Rosenberger MMSc, PA-C  

In addition to being a practicing Physician Assistant in the field of allergy and immunology for more than 20 years, Rebecca Rosenberger is the Associate Director for Clinical Affairs & Education, ImmunoDiagnostics at Thermo Fisher Scientific.

After trying multiple over-the-counter antihistamines and different doses, and perhaps even getting a medical prescription, you still may be asking “Why aren’t my antihistamines working?”

There are plenty of myths about spring allergy season, and one of the most common is that only allergies can cause allergy-like symptoms. If your runny nose and sneezing aren’t going away after taking antihistamines, it may not be allergies at all. So what could be causing spring allergy symptoms? The answer may be non-allergic rhinitis.

What is non-allergic rhinitis?

To understand non-allergic rhinitis, we must first understand allergies.

Having an allergy means that your immune system reacts to a substance that is harmless to most people (e.g., pollendog dandercat dandermold, etc.). If your immune system recognizes an allergen and views it as a threat, your body will release a chemical called histamine, which is involved in causing allergy symptoms. This is why antihistamines help to relieve symptoms; they suppress histamine in your system.

If your immune system doesn’t react to an allergen, then there is no histamine released. If there is no histamine, then antihistamines can’t relieve symptoms. If antihistamines aren’t working for you and you have allergy-like symptoms, it may not be a bad allergy season—but instead something non-allergic you’re reacting to.

Symptoms of nonallergic rhinitis include:1

  • Sneezing
  • Runny or stuffy nose
  • Coughing

As you can see, these symptoms are very similar to symptoms from allergies. It’s not uncommon for some healthcare providers to misdiagnose non-allergic rhinitis as allergic rhinitis. In fact, in one study, 65 percent of people who were prescribed antihistamines for allergies were deemed non-allergic.2

What causes non-allergic rhinitis?

Put simply, a substance that doesn’t cause an allergic reaction yet still causes symptoms such as a runny nose or sneezing may be a non-allergic trigger.

Here are some examples:3,5

  • Pollution
  • Cigarette smoke
  • Cleaning chemicals (bleach, laundry detergent, etc.)
  • Perfume/cologne  
  • Viruses

Your body doesn’t release histamine after exposure to cigarette smoke or perfume. Instead, it’s irritated from the vapor, causing allergy-like symptoms.

When it comes to allergies and non-allergic rhinitis, one of the best practices to reduce symptoms is to find out what’s causing your reaction and avoid it.

How can you tell the difference between non-allergic rhinitis and allergic rhinitis?

Due to the similar symptoms, discovering whether someone has allergic or non-allergic rhinitis can be challenging for some healthcare providers if they aren’t running a diagnostic test.4

Luckily, specific IgE blood testing may help healthcare providers better understand your condition and get you the treatment you need. Specific IgE blood testing is a simple blood test that helps clinicians determine what you may be allergic to. It can also be used to help rule out the role of allergies if you are having allergy-like symptoms.

What if my test is negative?

If your allergy blood tests do not indicate sensitization to allergens you are commonly exposed to, it may mean that a non-allergic irritant is causing your rhinitis. Think, did you switch perfumes or cologne recently, have you been around someone who smokes, were you in traffic all day surrounded by pollution?

Discovering what’s causing your symptoms starts with talking to your healthcare provider about getting a specific IgE blood test.

Find out more about getting specific IgE allergy blood tested, or complete our symptom tracker to help you identify key symptom insights you can then share with your healthcare provider.

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  1. Settipane, Russell A., and Philip Lieberman. "Update on nonallergic rhinitis." Annals of allergy, asthma & immunology 86.5 (2001): 494-508.
  2. Szeinbach SL, Williams B, Muntendam P, et al. Identification of allergic disease among users of antihistamines. J Manag Care Pharm. 2004;10(3):234-238.
  3. Tantilipikorn, Pongsakorn, et al. “Efficacy and Safety of Once Daily Fluticasone Furoate Nasal Spray for Treatment of Irritant (Non-Allergic) Rhinitis.” The Open Respiratory Medicine Journal, vol. 4, no. 1, 2010, pp. 92–99.
  4. Wheeler PW, et al. Am Fam Physician. 2005;72:1057-1062.
  5. Quillen, David A., and David B. Feller. "Diagnosing rhinitis: allergic vs. nonallergic." American family physician 73.9 (2006): 1583-1590.