Allergic vs. Non-Allergic Rhinitis in Fibromyalgia and ME/CFS

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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.

Symptoms of Non-Allergic Rhinitis

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

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 allergic rhinitis, sensitization to an environmental allergen cannot be detected by blood or skin testing. Symptoms may be caused directly by irritation and inflammation, and non-allergic rhinitis can come in many forms.

Diagnosis

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.

Negative allergy testing to environmental allergens combined with a history and physical examination consistent with nonallergic rhinitis can lead to a diagnosis. Depending on your symptoms, your physician may also order a sinus CT scan to look for a chronic sinus infection or a blockage as alternative causes.

Treatments

Oral 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:

  • Nasal corticosteroid spray, such as Nasarel (flunisolide) or Flonase (fluticasone)
  • Saline nasal spray
  • Anticholinergic nasal spray (for a drippy nose), such as prescription Atrovent (ipratropium)
  • Nasal irrigation with a saline solution (using a syringe, water pick, or neti pot)

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

Effect of Allergies on Fibromyalgia and ME/CFS

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

It's important to know that non-sedating antihistamines are available and can be equally as efficacious as their sedating counterparts. For example, fexofenadine (generic Allegra) does not cross the blood-brain barrier and provides 24-hour relief for many allergy symptoms. In contrast, when taken at equal potency, diphenhydramine (generic Benadryl) makes most people feel quite tired.

A Word From Verywell

If you suffer from fibromyalgia or ME/CFS and have allergies or non-allergic rhinitis, 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.

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Article Sources
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  2. Frieri M, Argyriou A. Is there a relationship between fibromyalgia and rhinitis?. Allergy Asthma Proc. 2012;33(6):443-9. doi:10.2500/aap.2012.33.3596

  3. Sin B, Togias A. Pathophysiology of allergic and nonallergic rhinitis. Proc Am Thorac Soc. 2011;8(1):106‐114. doi:10.1513/pats.201008-057RN

  4. National Health Service. Non-allergic Rhinitis.

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