Causes of Nasal Congestion Besides Allergies

While nasal congestion is commonly caused by allergic rhinitis, there are some nonallergic conditions that cause nasal congestion in children as well. Nasal congestion can be caused by structural abnormalities, such as septal deviation, concha bullosa, and adenoid hypertrophy, as well as chronic sinusitis and nonallergic rhinitis such as vasomotor rhinitis and secondary to gastroesophageal reflux disease.

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Structural Abnormalities

Whenever I see a child with nasal congestion that is not caused by allergies (meaning that the allergy testing is negative), I am always concerned about structural abnormalities as the cause. Typically, structural problems will cause nasal congestion that is mostly constant, and that doesn’t change from one nostril to the other. Structural abnormalities may include septal deviation, concha bullosa, and adenoid hypertrophy, and are usually diagnosed with the use of x-rays or a sinus CT. Treatment usually involves surgery, although studies have shown that intranasal steroids can improve nasal congestion in children with adenoid enlargement.

Chronic Sinusitis

Nasal congestion that is not caused by allergies may be caused by a chronic sinus infection. Unlike an acute sinus infection, a chronic sinus infection may mimic the symptoms of allergic rhinitis, especially nasal congestion. Diagnosis is made with the use of sinus x-rays or a sinus CT, or treatment can be considered empirically with a trial of antibiotics.

Nonallergic Rhinitis

Symptoms of nonallergic rhinitis can mimic those of allergies, but allergy tests are negative. Causes of nonallergic rhinitis may include vasomotor rhinitis and gastroesophageal reflux disease. Treatment of nonallergic rhinitis usually includes nasal sprays, such as nasal steroids and nasal antihistamines.

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