From the Guidelines
A persistent runny nose lasting for months is most commonly caused by chronic rhinitis, allergic rhinitis, or chronic sinusitis, and treatment should begin with identifying and avoiding triggers when possible, as recommended by the clinical practice guideline: allergic rhinitis 1. The possible causes of a persistent runny nose include:
- Allergic causes such as environmental allergens like pollen, dust mites, pet dander, or mold
- Non-allergic causes such as vasomotor rhinitis, medication side effects (particularly from blood pressure medications), structural issues like deviated septum, or chronic sinusitis
- Other conditions like sinusitis, which can be classified into acute, subacute, chronic, and recurrent, as defined in the diagnosis and management of sinusitis: a practice parameter update 1 Treatment options include:
- Over-the-counter antihistamines like loratadine (10mg daily), cetirizine (10mg daily), or fexofenadine (180mg daily) for allergic rhinitis
- Nasal corticosteroid sprays such as fluticasone (1-2 sprays per nostril daily) or mometasone (2 sprays per nostril daily) for both allergic and non-allergic rhinitis
- Saline nasal irrigation using a neti pot or squeeze bottle twice daily to clear mucus and irritants
- Prescription medications like montelukast (10mg daily) or ipratropium bromide nasal spray (2 sprays per nostril 2-3 times daily) for severe cases
- Evaluation by an ENT specialist to rule out structural issues, nasal polyps, or chronic sinusitis that might require surgical intervention, as suggested by the clinical practice guideline: allergic rhinitis 1 It is essential to note that persistent symptoms should never be ignored, as they occasionally indicate more serious underlying conditions, and clinicians should assess patients with a clinical diagnosis of AR for associated conditions such as asthma, atopic dermatitis, sleep-disordered breathing, conjunctivitis, rhinosinusitis, and otitis media, as recommended by the clinical practice guideline: allergic rhinitis 1.
From the FDA Drug Label
Other adverse events that occurred in ≤3% but ≥1% of patients and that were more common with fluticasone propionate (with uncertain relationship to treatment) included: blood in nasal mucus, runny nose, abdominal pain, diarrhea, fever, flu-like symptoms, aches and pains, dizziness, bronchitis
The possible causes of a persistent runny nose lasting months may include:
- Allergic rhinitis: as fluticasone propionate is used to treat this condition
- Side effects of medication: such as fluticasone propionate, which has been reported to cause runny nose in some patients
- Other underlying conditions: such as infections, anatomical issues, or other diseases that may cause runny nose 2
From the Research
Possible Causes of Persistent Runny Nose
- Viral infections, such as the common cold, can cause a runny nose that lasts up to 10 days 3
- Allergic rhinitis, which can be seasonal or perennial, is a common cause of persistent runny nose, with symptoms including nasal obstruction, rhinorrhea, sneezing, and nasal itch 3, 4
- Non-allergic rhinitis, which can be caused by irritants, temperature and humidity changes, or non-specific nasal hyperreactivity, can also lead to a persistent runny nose 3
- Chronic sinusitis, which can be caused by allergic and non-allergic rhinitis or anatomical defects in the nose, is another possible cause of a persistent runny nose 5, 6
- Nasal polyps, which can be caused by sinusitis, allergic rhinitis, or non-allergic rhinitis, can also contribute to a persistent runny nose 6
Treatment Options for Persistent Runny Nose
- Avoidance of allergens and irritants, such as pollen, dust, and mold, can help alleviate symptoms of allergic rhinitis and non-allergic rhinitis 3, 7
- Medical treatment, including antihistamines, nasal corticosteroids, and decongestants, can help control symptoms of allergic rhinitis and non-allergic rhinitis 3, 4, 7
- Immunotherapy, such as allergy vaccines or tablets with allergens, can be effective in treating allergic rhinitis 3, 7
- Surgery may be necessary in some cases of persistent sinusitis or nasal polyps that are refractory to pharmacotherapy 6, 7
- Nasal hygiene, including nasal saline washes, can help promote drainage and reduce symptoms of sinusitis and allergic rhinitis 5