Rhinorrhea – Causes, Symptoms and Treatment

What is Rhinorrhea?

Rhinorrhea (also spelled rhinorrhoea) is the medical term for a runny nose, meaning an increased flow of fluid from the nasal passages. The discharge can range from thin and clear to thick and discolored, depending on the underlying cause. Rhinorrhea is one of the most common symptoms worldwide, affecting people of all ages.

Causes

Rhinorrhea can be triggered by a wide range of factors. The most common causes fall into the following categories:

Infections

• Common cold: Viral infections, most often caused by rhinoviruses, are the leading cause of acute rhinorrhea.
• Influenza: Flu viruses can also produce nasal discharge.
• Sinusitis: Inflammation of the sinuses is frequently accompanied by rhinorrhea.

Allergies

• Allergic rhinitis (e.g., hay fever): Allergic reactions to pollen, dust mites, or pet dander cause watery nasal discharge.

Non-allergic Causes

• Cold air or sudden temperature changes
• Spicy or strongly seasoned foods (gustatory rhinorrhea)
• Hormonal changes (e.g., during pregnancy)
• Certain medications (e.g., ACE inhibitors, beta-blockers)
• Nasal polyps or structural abnormalities
• Irritants such as smoke, dust, or chemical fumes

Rare and Serious Causes

• Cerebrospinal fluid (CSF) leak: In rare cases, clear nasal discharge may indicate a leak of cerebrospinal fluid, for example following head trauma or surgery.

Symptoms and Presentation

The primary symptom is the nasal discharge itself. Associated symptoms may include:

• Sneezing
• Nasal congestion (blocked nose)
• Itching in the nose or throat
• Facial pressure or pain (in sinusitis)
• Headache
• General feeling of illness (in infectious cases)

The color and consistency of the discharge can provide clues about the cause: clear, watery discharge is more typical of allergies or viral infections, while yellow-green discharge may suggest a bacterial infection or sinusitis.

Diagnosis

Rhinorrhea is primarily diagnosed through a clinical assessment, including a medical history and physical examination. The healthcare provider will consider:

• Duration and type of nasal discharge
• Associated symptoms such as fever, cough, or itching
• Known allergies or previous medical conditions

If an allergic cause is suspected, allergy testing (skin prick test, specific IgE blood test) may be performed. For chronic or one-sided nasal discharge, nasal endoscopy or imaging (CT scan of the sinuses) is recommended to rule out structural changes or a CSF leak.

Treatment

Treatment depends on the underlying cause:

Symptomatic Treatment

• Decongestant nasal sprays (e.g., xylometazoline): Provide short-term relief of nasal congestion -- should not be used for more than 7 days to avoid a rebound effect.
• Saline nasal rinses: Help cleanse the nasal lining and promote drainage of secretions.
• Antihistamines: Effective for allergic rhinorrhea by reducing the allergic response.

Causal Treatment

• Antibiotics: Only indicated for confirmed bacterial infections (e.g., bacterial sinusitis).
• Intranasal corticosteroids: Highly effective for long-term management of allergic rhinitis.
• Allergen immunotherapy (desensitization): A long-term treatment option for allergies.
• Surgical intervention: May be necessary for nasal polyps, deviated septum, or repair of a CSF fistula.

General Measures

• Staying well hydrated
• Avoiding known allergens (in allergic rhinorrhea)
• Steam inhalation to soothe the nasal mucosa

When to See a Doctor

In most cases, rhinorrhea is harmless and resolves on its own. However, medical attention is recommended if:

• Nasal discharge persists for more than 10 days
• High fever and severe headache are present
• One-sided, clear discharge occurs after a head injury (possible CSF leak)
• There is blood in the nasal discharge
• Visual disturbances or facial swelling develop

References

1. Fokkens WJ et al. - European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS 2020). Rhinology, 2020.
2. Bousquet J et al. - Allergic Rhinitis and its Impact on Asthma (ARIA) 2019 Update. Journal of Allergy and Clinical Immunology, 2019.
3. World Health Organization (WHO) - Acute Respiratory Infections. WHO, Geneva, 2021.