Allergies vs. Non-Allergy Rhinitis in Fibromyalgia and ME/CFS

Why Your Allergy Medication May Not Always Help

Walgreens Boots Alliance Inc. brand allergy pills are displayed for sale at a store in New York, U.S., on Wednesday, June 10, 2015. Credit: Bloomberg / Contributor / Getty Images

Do you sometimes get no relief from allergy medication? Or do your hay fever symptoms stick around all year? If so, it might not be your allergies causing all of your symptoms—you may have a condition called non-allergic rhinitis. About half of the people who have allergies have this as well.

Allergies are common in the general population, and studies show they're even more common in people with fibromyalgia (FMS) or chronic fatigue syndrome (CFS), also known as or Myalgic Encephalomyelitis or ME/CFS.

No one knows exactly why allergies accompany FMS and ME/CFS so much of the time. Some researchers theorize that it's part of the central sensitization associated with the conditions. Others believe that allergies are a risk factor for developing these illnesses; when combined with other factors such as genetics or immune irregularities, they could make you more prone to developing FMS or ME/CFS.

Symptoms of Non-Allergic Rhinitis

Symptoms of non-allergy rhinitis are similar, and sometimes indistinguishable from, those of allergies or a cold. They inlcude:

  • Runny nose
  • Constant sneezing
  • Dry nose or congestion
  • Post-nasal drip
  • Chronic cough
  • Itchy, watery, red eyes
  • Sinus headache

Differences Between Allergies and Non-Allergic Rhinitis

The causes of these symptoms are where the differences come in.

  • Allergies: When you have an allergic reaction, it's because your body has an abnormal reaction to a normally harmless substance. This causes your body to release histamine, which is one of the things that causes your symptoms.
  • Non-Allergic Rhinitis: This is a medical condition with an unknown cause that essentially mimics hay fever (allergic rhinitis). Basically, a typically harmless substance irritates and inflames the tissues in your nose for unknown reasons. Unlike in a true allergic reaction, however, your body does not release histamine. Instead, symptoms are caused directly by the irritation and inflammation. It can come in many forms.

    Diagnosing Non-Allergic Rhinitis

    You'll need to work closely with your doctor to get a diagnosis of non-allergic rhinitis. First, you need to provide a history of symptoms and medication use. Then, you'll need an allergy test for the things you believe trigger your symptoms.

    A negative allergy test, combined with your symptoms, medical history, and a physical exam, can lead to a diagnosis. You should also be checked for chronic sinus infection, which could be causing your symptoms.

    Treating Non-Allergic Rhinitis

    Antihistamine medications ("allergy pills") will not help non-allergic rhinitis. The best way to deal with your symptoms is to avoid the things that trigger them. That, however, isn't always possible. Here are some things that can help, at least partially:

    • Decongestant medications: Sudafed (pseudoephedrine), Sudafed PE/Actifed (phenylephrine)
    • Prescription steroid nasal spray: Nasarel (flunisolide) or Flonase (fluticasone)
    • Saline nasal spray
    • Anticholinergic nasal spray (for post-nasal drip and a drippy nose): Atrovent (ipratropium)
    • Nasal irrigation with a saline solution, using a syringe, water pick, or netti pot

    Your doctor may need to customize your treatment if these methods don't help.

    Effects of Allergies/Non-Allergic Rhinitis on Fibromyalgia and Chronic Fatigue Syndrome

    Some, but not all, studies suggest that a majority of people with FMS and ME/CFS have allergies and/or non-allergic rhinitis. The symptoms by themselves can lower your quality of life, and many allergy medications and decongestants can make you tired or disrupt sleep.

    When you have these symptoms on top of FMS or ME/CFS, a primary concern is that a stuffy nose, sneezing, and coughing can disrupt sleep. Poor sleep usually leads to an increase in pain, flu-like symptoms of ME/CFS and, of course, fatigue. It can lead to post-exertional malaise as well.

    Constant coughing or sneezing also is hard on your muscles and may trigger or increase pain symptoms.

    Your doctor can help you find treatments that work for you. If that treatment includes medication, talk to your doctor and pharmacist about interactions it may have with other medications you're taking.

    Sources

    Cleveland CH Jr, Fisher RH, Brestel EP, Esinhart JD, Metzger WJ. Chronic rhinitis: an underrecognized association with fibromyalgia. Allergy Proceedings: The Official Journal of Regional and State Allergy Associations. Sep-Oct 1992. 13(5):263-7.

    Baraniuk JN, Clauw D, Yuta A, Ali M, Gaumond E, Upadhyayula N, Fujita K, Shimizu T. Nasal secretion analysis in allergic rhinitis, cystic fibrosis, and nonallergic fibromyalgia/chronic fatigue syndrome subjects. American Journal of Rhinology. Nov-Dec 1998. 12(6):435-40. 

    Chronic Fatigue Syndrome. University of Maryland Medical Center (UMMC).

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