Constant Runny Nose? It Might Not Be Allergies

As we segue from winter illnesses to spring allergies, runny noses may feel perpetual. If you’re finding allergy medications aren’t helping with your drippiness, it’s time to consider whether you’re experiencing a different condition.

Your runny nose could be from chronic rhinosinusitis, a persistent inflammatory condition that causes the sinuses to swell for more than three months.

You could even have allergies and chronic rhinosinusitis at the same time. According to a recent study that included 219 patients, 91.3% were diagnosed with allergic rhinitis—also known as seasonal allergies. Nearly half of the patients (45.2%) who had allergic rhinitis were also diagnosed with chronic rhinosinusitis.

Since a runny nose is a symptom of both chronic rhinosinusitis and seasonal allergies, it’s common for people to assume it’s from allergies. While over the counter (OTC) allergy medications can treat allergies, they won’t be much help for people who have chronic rhinosinusitis. If left untreated, chronic rhinosinusitis can make breathing uncomfortable, affect your quality of sleep, and decrease productivity. 

Here’s how to tell if your runny nose might be chronic rhinosinusitis and what you can do about it.

Signs a Runny Nose Isn't Allergies 

There are some telltale signs that those pesky springtime allergens floating around might not be the reason your nose is running like a tap. For one, if your runny nose lasts longer than you'd expect from allergies and/or OTC allergy medications aren’t helping it, those are some indications that allergies might not be the underlying cause.

“As healthcare providers, we’re very suspicious that people who have these long-term nasal symptoms could have chronic rhinosinusitis,” Jayant Pinto, MD, director of rhinology and allergy at University of Chicago Medicine, told Verywell. “People who take antihistamines, intranasal steroids, or nasal spray and don’t get better are people we suspect might have chronic inflammation of the sinuses that needs other treatment.”

While it may not be as common, it’s worth noting that sometimes, a runny nose can be caused by serious conditions, such as a tumor in the nose or a cerebrospinal fluid leak, Zara M. Patel, MD, professor of otolaryngology and director of endoscopic skull base surgery at Stanford University School of Medicine, told Verywell. Since there can be many causes, Patel recommends visiting an ear, nose, and throat (ENT) specialist for a thorough workup.

How Is Chronic Rhinosinusitis Treated?

OTC allergy medications are often enough to provide relief from allergy symptoms, but they don’t usually help with chronic rhinosinusitis. The good news is that rhinosinusitis tends to be responsive to treatments as long as the specialist you’re working with (usually an otolaryngologist or rhinologist) has looked into all the possible causes and chosen the most effective treatment.

Approaches can be different for each person based on their symptoms and overall health, but common chronic rhinosinusitis treatments are antibiotics or steroids along with nose and sinus cavity sprays.

“Intranasal steroids, which are a standard first step, could control the inflammation in the nose,” said Pinto, adding that steroids, which reduce inflammation in the nose, can help people with both allergies and chronic rhinosinusitis. A saline wash using a neti pot can also be useful because it clears out the nasal passage.

You can progress to more intense treatments if needed.

“If these options are not enough to definitely resolve the problem, sinus surgery is the next step,” said Patel, adding that surgery can clear out current inflammation and get a patient back to a normal baseline.

However, surgery is only one component of treatment and “does nothing to change the underlying reactivity or disease process which led to the inflammation in the first place, so there has to be a plan in place for how to control that underlying reactivity after surgery to prevent relapse,” said Patel.

How to Tell If You Have Chronic Rhinosinusitis

Patel said that chronic rhinosinusitis is fairly easy for ENTs to diagnose. However, if you’re seeing a non-specialist, like your primary care provider, it may be harder for them to spot it.

“Because primary care providers lack the special equipment and instrumentation ENT doctors have for looking deep inside the nose, the only way for them to correctly diagnose rhinosinusitis would be with a CT scan,” said Patel. This can lead to patients being overdiagnosed with sinusitis because the symptoms often overlap with allergies. They may also be underdiagnosed and treated for a longer time than they would have been if they’d been able to see a specialist.

If you’re perplexed about the reason for persistent runny nose, it’s worth talking to your provider about. If they’re not sure, they can refer you to a specialist.

“Because there are so many different etiologies of a runny nose, if the runny nose lasts longer than expected, or is not treated well by typical over-the-counter allergy medication, it’s a good idea to see an otolaryngologist (ENT),” said Patel.