Can Allergic Rhinitis Cause Dizziness?
Yes, allergic rhinitis can cause dizziness, though this is not a typical or primary symptom of the condition. 1
Understanding the Relationship
Allergic reactions may result in central symptoms of dizziness, including nonspecific chronic imbalance, and in some cases may be associated with Meniere's disease or autoimmune inner ear disease. 1 However, it's critical to recognize that dizziness is not listed among the cardinal symptoms of allergic rhinitis in major clinical practice guidelines.
Cardinal Symptoms of Allergic Rhinitis (What to Expect)
The typical presentation includes: 2
- Nasal congestion (present in 94.23% of patients) 3
- Rhinorrhea/runny nose (present in 90.38% of patients) 3
- Sneezing
- Nasal and ocular itching
- Postnasal drip
- Frequent throat clearing
Atypical Symptoms That Should Raise Concern
If a patient presents with dizziness as a prominent complaint alongside rhinitis symptoms, consider alternative or complicating diagnoses. 2 Less typical symptoms such as severe headache, unilateral rhinorrhea, unilateral nasal blockage, epistaxis, or anosmia suggest alternative diagnoses and warrant further investigation for more concerning conditions like cerebrospinal fluid rhinorrhea, sinonasal tumors, or chronic rhinosinusitis. 2
Clinical Approach When Dizziness Is Present
First: Rule Out Medication-Induced Dizziness
First-generation antihistamines are a common culprit for dizziness in patients being treated for allergic rhinitis. 4 These medications cause:
- Significant sedation and performance impairment that patients may not subjectively perceive 4
- Psychomotor effects including ataxia and agitated psychosis (especially in children) 4
- Increased fall risk in older adults leading to fractures and subdural hematomas 4
Switch to second-generation antihistamines (cetirizine, fexofenadine, desloratadine, loratadine) or intranasal antihistamines (azelastine, olopatadine) to eliminate medication-related dizziness. 3, 4
Second: Consider Allergically-Induced Vestibular Involvement
When dizziness persists despite appropriate medication management, consider: 1
- Nonspecific chronic imbalance from allergic mechanisms
- Meniere's disease with allergic triggers
- Autoimmune inner ear disease (requires high-dose, long-term steroids, biologics, or immunomodulators)
Third: Evaluate for Complications and Comorbidities
Poorly controlled allergic rhinitis contributes to: 5
- Sleep loss and secondary daytime fatigue (which can manifest as lightheadedness or imbalance)
- Eustachian tube dysfunction with ear plugging, muffled sounds, and pain 3
- Chronic sinusitis (which may cause pressure-related dizziness)
Treatment Approach for Allergically-Related Dizziness
Most standard allergic rhinitis pharmacotherapies have limited benefit in treating allergically-induced dizziness, with important exceptions: 1
Effective Treatments:
- Allergy immunotherapy (the only disease-modifying intervention) 6, 1
- Elimination diet for diagnosed food allergies 1
- Short-term steroids for acute exacerbations 1
Avoid:
- First-generation antihistamines (except for their vestibular suppressant properties in acute vertigo, but this is counterproductive if they're causing the dizziness) 1
- Long-term reliance on oral decongestants (pseudoephedrine can cause palpitations and irritability that may be confused with dizziness) 4
Critical Pitfall to Avoid
Never assume dizziness is a normal part of allergic rhinitis without investigating further. The presence of dizziness should prompt evaluation for:
- Medication side effects (especially first-generation antihistamines) 4
- Complications like sinusitis or eustachian tube dysfunction 3, 5
- Alternative diagnoses including vestibular disorders, autoimmune conditions, or structural abnormalities 2, 1
- Sleep deprivation and fatigue from poorly controlled rhinitis symptoms 5
If dizziness is the primary complaint with minimal nasal symptoms, allergic rhinitis is unlikely to be the primary diagnosis and warrants comprehensive vestibular and neurologic evaluation. 2