Dealing with nonallergic rhinitis (NAR)

[Esperanto]

For more than 50 years, I have suffered from "hay fever"-like symptoms that are, however, related to changes in weather/air pressure. So not just in spring, but throughout the year. Recently, I noticed that the symptoms are suddenly becoming more frequent. Normally, the attacks last 2 to 4 days.  But now I have a kind of permanent runny nose alternating with extremely intense attacks. Strange, but perhaps PD also makes its unasked-for contribution here. From experience in my relatively short PD career of 2 years, I know that once again this may not be a coincidence.... 

HU peers of were initially hard to find. This turned out to be mainly due to my poor English. But using sneezing, runny nose, stuffy impacted nose, stuffed nose, snotty nose, postnatal drip, I came across numerous posts with similar symptoms. Also, I got more guidance in finding the scientific names Rhinorrhea and more specifically Vasomotor (nonallergic) rhinitis. The relationship with PD was thus quickly found.

Case-control studies have reported a higher prevalence of rhinorrhea in patients with PD compared to healthy controls. Of interest, 76% of patients with PD reported rhinorrhea exacerbation while eating. Further studies have corroborated a 5-fold increased prevalence of rhinorrhea in patients with PD compared to controls and also an association with lightheadedness among rhinorrhea-affected. Here is a fairly recent survey of available reliable data.

ncbi.nlm.nih.gov/pmc/articl...

Take home points:

→ Of 451 patients with PD and 233 controls, the pooled prevalence of rhinorrhea in patients with PD was 45.0% (95% CI 33.94–56.40), which was significantly greater than that in controls (p < 0.001).

→ Prevalence of self-reported olfactory dysfunction was greater in patients with PD; however, a pooled analysis of studies using objective scores showed no difference. The mean age of patients with PD was greater than that of controls (p = 0.002).

→ Treatment options for rhinorrhea include anticholinergic sprays, antihistamines, topical steroid nasal sprays, vidian neurectomy, cryotherapy, and radiofrequency ablation.

→ Future studies should explore the pathophysiologic basis for rhinorrhea in patients with PD and the relationship between rhinorrhea and disease severity and duration, as well as determine whether treatment-specific outcomes differ in patients with PD.

So nonallergic rhinitis, like the allergic form, does indeed appear to be much more common in PD, but I did not come across any follow-up research. A pity, because surely there seems to be more to be gained from this “relationship”.

Because the symptoms at the moment largely nullify the effect of my C/L medication, I am asking for your help again, as I did before (with great success!) for my B6 deficiency and sleep deprivation. Would love to hear your experiences and tips for dealing with the rhinorrhea "runny nose" perils!

🍀

[Kevin51]

The fungi Malassezia is commonly detected on human skin and is usually present in PwPs as it likes our overactive sebaceous glands (hence the "woman who can smell PD"). Some PwPs say that sugars stimulate Malassezia and speculate that to be the reason behind the rhinorrhea getting worse while eating.

[Esperanto in reply to Kevin51]

The festive month of December with its many sweets will certainly not contribute positively to this. 🙂 Thal had a link 6 months ago about sugar addiction in PD. 

scienceofparkinsons.com/202...

Perhaps a healthy resolution for 2023 !

[perilousseas]

My father (93 years old) has had Parkinson's for 20 years or so and a chronically runny nose. He started with high dose thiamine treatment in November of this year (a B-1 patch twice per week), and his nose has stopped its constant running. There also seems to be less mucus building up in his mouth, and he hasn't had any "mucus attacks" for a few weeks. Not sure if any of this is due to the high dose thiamine, but thought I'd mention it.

[PDsux_10 in reply to perilousseas]

Hi, Where does your dad source his B 1 patch and what is the dosage of each patch please?Thank you kindly

Mel

[perilousseas in reply to PDsux_10]

I started out buying just five patches at usanaturalpatches.com/. I did call the company and asked them if any customers were using them for Parkinson's disease, and the man on the phone said yes. He even told me I'd get a discount by entering the code "helppd" in the appropriate box at checkout. They offer a pack of five patches for $9.95 plus shipping. You can also buy 25- and 50-patch packs. I started with five patches to make sure Dad wouldn't have a bad reaction to them, and he had no problem. I went back to the site later and ordered the 25-patch pack. They shipped them out promptly.

At the salesman's suggestion, I ordered their product they call the "B1 Sport and Wellness Patch," though my recollection is that he said their patch products all have the same amount of thiamine: 75 mg. For my father's advanced age and 150 pound weight, I figured 75 mg. could be an appropriate dose, coming close to the 100 mg. injection dose so many patients received from Dr. Costantini. I put one patch on Dad twice a week and leave it on for eight hours. I believe they are working at that dose. If the amount needs to be adjusted, I'll try cutting a patch or applying them more often or less often, but I see improvement as it is, so we're sticking with the 75 mg. dose twice a week for now.

I had a good experience calling the company. Their phone number is on their website, and the man I spoke to was pleasant and friendly. Their website doesn't make any claims as to purity or the type of B1 they use, and I didn't ask. So all I really know is it seems to be helping my dad in a number of ways.

[PDsux_10 in reply to perilousseas]

Wow, Thank you so much for the info. I sure hope they ship to Australia. I am going to check it out. My husband takes 2000mg a day of solgar supplements. A patch I hope will work better 🤞 Happy New Year!Cheers

Mel

[chartist]

Stinging Nettle (SN) is useful for reducing symptoms of sinus issues. If there is a viral, fungal or bacterial overgrowth, the nasal spray, " XLEAR " has grapefruit seed extract (GSE) which is a potent antimicrobial and it also has the sugar alcohol , Xylitol, which has shown the ability to break down bacterial biofilms as does the GSE. Using at the maximum daily dose has shown benefit in different sinus problems and combined with SN should be a useful pair for many sinus issues. The XLEAR Nasal Spray has also shown the ability to reduce Covid-19 symptoms.

Here is a link to a typical SN product :

amazon.com/Stinging-Extract...

Here is a link to Xlear Nasal Spray :

amazon.com/XLEAR-Natural-Sa...

Here is information for Xlear and Covid-19 :

businesswire.com/news/home/...

Ultimately, you may have to alter the gut microbiome for long lasting effects. A basic treatment in this area would involve regular use of probiotics that are specific to sinus issues.

If there are polyps involved a proteolytic enzyme such as Serrapeptase or Nattokinase should be helpful to reduce the polyps as well as effectively fight congestion.

NAC acts as a mucolytic and a potent antioxidant

There are others, but these are popular and fairly straightforward.

Art

[HugoRipanykhazov]

I have been wondering if there are any specialists in this field? I have been experincing a runny nose for about 6 months now! I had ascribed it to some sort of allergy as it gets worse when I go into our kitchen or sometimes, living room.

But on a few days over this period. I have found it moving to second stage cold, when the running stops, the nose feels a bit more blocked/congested, and the mucous solidifies a bit

Then after a few days the running starts again.

(I'm not convinced it isnt an allergy)

[Esperanto in reply to HugoRipanykhazov]

Only as an expert by experience I can perhaps give you some tips. First of all, it is important to know if there is an allergic form. In that case, it is mainly a histamine problem, which probably also has a great influence on symptoms and the development of PD and even perhaps in its onset. I will pass on some more information about that later. In the non-allergic form, you can have problems from the same substances or conditions, but the difference is that they are mainly triggers, but not the (unknown) cause. However, through my recent search for further scientific research, I also came across the hypothesis that the two forms might occur simultaneously. With me, that might indeed be the case. To have any guidance you would have to do the allergy tests anyway. At the time, I only showed a mild allergy to cats, but I can still have enormous additional problems with pollen, house dust, cigarette smoke, perfume, pet dander, old books, wool, fine dust, etc. if there is already a runny nose.

So that may also be the case with you if the symptoms become more intense when entering the living room and kitchen. Also, in that situation, due to weakening of your immune system, you are more susceptible to a "normal" cold. Often that feels like a relief to have the runny nose turn into a stuffy nose…

[SilentEchoes]

"Vasomotor (nonallergic) rhinitis" wouldn't this be a part of a dysautonomia spectrum?

I have this problem too, doc tried to tell me it was viral. Preposterous! Clear, watery drip and no fever. No history of seasonal allergies either.

This was helpful for me, thanks.

SE

[Esperanto in reply to SilentEchoes]

The relationship may be possible because secondary dysautonomia is more common in PD. But too little is known about it to say for certain. A recent review of articles published shows that the mechanisms from which sinonasal symptoms arise are complex and involve psychological, physical, and biochemical factors. Autonomic nervus system dysfunction is likely to represent just one contributor among many factors that drive sinonasal symptoms. The conclusion is that more research is required to establish the direction of causality

ncbi.nlm.nih.gov/pmc/articl...

[SilentEchoes]

My research: The autonomic nervous system, which supplies the nasal mucosa, is under the control of the hypothalamus.The smoking gun.

n.neurology.org/content/90/...

[Esperanto]

The most common form of non-allergic rhinitis (NAR) is associated with (change of) weather conditions such as fog, rain, humid weather, strong temperature changes or cold air. Normally, the transition from summer to fall is a critical period as are winter conditions. Due to the long late summer, the reaction is even more intense than usual. The body seemed to get used to the very steady weather conditions of last summer. It is not clear why I also belong to the chosen ones from this ailment. It is bizarre that this is the case with all three my diseases, NAR, PD and my peripheral neuropathy (PN) and for no one a cure exists.

About the smoking gun of SilentEchoes that the disfunction of the hypothalamus here, as with PD, plays a role in the control of autonomic nervous system, is still too little known. Usually the NAR occurs much earlier than the PD diagnosis, with me even in my puberty, but the relationship is interesting and may explain why NAR is significantly more common in PWP.

[MarionP]

Sounds like If I read you correctly, maybe it's the obvious suggestion but relief via antihistamines is what you were sort of driving at. You just do have the side effect of when you have to use antihistamines long-term or chronically, just like me. That means basically rebound effects for you, perhaps... they are the bane of my existence because my atopic itchy skin is the symptom, and is also the symptom of the rebound If I missed a dose or dose lower than what my system has worked its way up to need, being chronically needing and it just means my whole life. That's the old addiction mechanism again, but it's in a scapable if you want to get any relief because I barely eat any sugars and yet I get the problem anyway, because that addiction model also makes you hyper sensitive to the original symptom you were using the medication to treat. It all goes in self-fulfilling and increasing circles, but that's the nature of the cycles, which are very very widespread in our nature (because that cycle is basically one of adaptation, and adaptation is the key to evolutionary survival that our bodies have mechanistically evolved). So you have some bad with good, which perhaps you can overcome as long as, like me, you at least can get an endless supply, and that's the key and problem both, isn't it, like it or not, how's the same as it is with nicotines and opioids and they now archaic group term for alkaloids (nowadays non alkaloids are also lumped in with alkaloids as alkaloids so it's not very helpful category anymore, just like "oxidation" and "redox" aren't helpful anymore).

[Esperanto]

Ultimately, finding the right balance between managing your symptoms and minimizing potential side effects can be a complex process. I personally have few issues with medication because I try to take them as little as possible., That is also the case with anti-histamine. This is possible because the weather-dependent nonallergic rhinitis (NAR) usually lasts only for a short period, ranging from a few instances of intense sneezing during a snowfall to about 4 days of severe "hay fever-like" symptoms. However, this autumn again, the symptoms lasted much longer and occurred constantly.

In your case, it's different because you have to continue taking medication to manage your symptoms, such as skin irritation, while I have long periods where I don't experience any symptoms. Since childhood, I've also had a very sensitive skin and I'm allergic to wool, which I should avoid even for NAR. However, the periods of intense itching have been increasing, causing a lot of discomfort in the various spots on my skin. I am somewhat concerned about the stories regarding PD's sensitivity to melanoma, but strangely, I never made the connection with my histamine levels, which actually seems quite obvious.