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Non-Allergic Rhinitis

Discussion in 'Immunological' started by dreampop, Feb 14, 2019.

  1. dreampop

    dreampop Established Member (Voting Rights)

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    Researching ME/CFS has been hard, in part, because there isn't always "obvious" areas to look and the symptoms are often global.

    I'm proposing an area of research that might be of interest is non-allergic rhinitis. I have this in chronic, un-remitting form not caused by allergies, and which accompanied the onset of my ME/CFS. There is one smallish study by Baraniuk that found 46% of patients have non-allergic rhinitis.

    I've noticed many patients with similar problems on the forums. And I think, in part, this adds to the patient's perception of an ongoing "flu" or immunological pathology. After all, fatigue and sinus congestion are what we think of most when we think of the flu. However, there is also research that neurological mechanisms can cause some forms non-allergic rhinits.

    So, it seems to be like an interesting and possible fruitful way to find tangible research progress as Braniuk says,
    I've never seen any research following this - a place in the body where you can actually see something is tangible wrong, and the mechanisms defunct. Biopsies can be made (mast cells, histamine, eusonophils, cytokines etc.). Receptors profiled with medications like lidocaine and capsaicin.

    I might be interested in trying to get researches involved in this topic if others feel the same way. For simplicity, I'd like to keep this thread about the theory and population impacts of rhinitis rather than personal experience. I will make this thread on PR as well, when I have recovered some energy

    Continuations;

    There are 7 classical NARs, but a new one emerging is autonomic NAR (also called vasomotor rhinitis). This is a recent study on it.

    I actually disagree with the authors speculation that GERD causes it, since I have adressed that symptom well. I think it's more likely autonomic dysfunction causes both GERD and NAR.

    So it may be that NAR is a symptom of autonomic dysfunction in those with ME/CFS. Would this make it redundant to study? Or would it offer greating understanding to the autonomic features of ME/CFS?
     
    Last edited: Feb 15, 2019
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  2. dreampop

    dreampop Established Member (Voting Rights)

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    If others agree, advocacy might be a better place to hold this thread? I don't know tbh.
     
  3. Lidia

    Lidia Established Member (Voting Rights)

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    I’d really like to discuss non-allergic rhinitis as well, as it is my daughter’s most persistent symptom. I think the immunological sub-forum is not the best place though, and believe the neurological and autonomic sub-forum would be more appropriate. My theory on non-allergic rhinitis being a symptom of autonomic dysfunction is based on its response to only one medication - alpha adrenergic receptor agonist xylometazoline. I think this is a big clue as to its cause. I’m not including vasomotor rhinitis in this, as I think this is different from the congested rhinitis in ME/CFS.

    Really interested in hearing more from others.
     
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  4. Ryan31337

    Ryan31337 Senior Member (Voting Rights)

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    Post-nasal drip (presumably rhinitis) has always been and remains an excellent sign-post to my current physical state.

    On better days its a small amount of clear phlegm present in the mornings. PEM states will increase quantity. At times of relapse (over-exerting constantly) it'll progress to thicker, green phlegm. At my worst it can contain blood. No other upper respiratory infection symptoms present to blame it on.

    Removing dairy from my diet and taking daily anti-histamines have stopped the daily occurrence, now it just happens with PEM.
     
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  5. dreampop

    dreampop Established Member (Voting Rights)

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    To some extent I agree, except broadly some NAR can be immunological, just not allergic. It's not clear what exactly is causing it in ME/CFS. I also agree it may be driven by autonomic dysfunction. Afrin is indeed a potent vasocontrictor, but it would be effective for congestion doesn't really help understand the cause of the congestion in the first place.
     
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  6. dreampop

    dreampop Established Member (Voting Rights)

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    You may also wish to read my edit to the initial post talking about autonomic NAR.

    For all NARs, a combination of Azelastine and a steriod spray are often helpful. Their affects are additive. Azelastine in particular seems to be the most effective despite it being primarily an antihistimine. The combination has been the only thing to talk the edge off for me, neither did anything alone interestingly enough. Ipratropium Bromide, an anticholinergic, has also been made into a nasal spray and is said to help with the symptom of rhinorrea in NAR, but not congestion. Capsaicin nasal sprays have also been proposed.
     
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  7. dreampop

    dreampop Established Member (Voting Rights)

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    That's interesting. Baraniuk found I believe, exercise induced POTS in some ME/CFS patients. So it may be autonomic dysfunction is an aspect of PEM, and contributes to this symptom in you.
     
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  8. Ryan31337

    Ryan31337 Senior Member (Voting Rights)

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    Yes I'd agree with that. My autonomic function clearly deteriorates with over-exertion, poor sleep, infection and most other stressors. Objectively its quite clear from 24/7 tracking of heart rate ranges (postural & sleeping), blood pressure and heart rate variability, along with a slew of more subjective issues. I have autonomic small fibre neuropathy confirmed by sympathetic microneurography, so would imagine it all ties in.
     

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