That's a very common question in an allergy clinic. We often see patients, often in their 70s, who report having profuse rhinorrhea (runny nose) when they eat specific foods. Very often these are hot foods such as hot soup or spicy foods, for example, Thai food, or it could be any food. Some patients even report symptoms with pasta sauce. The symptoms of rhinorrhea with food consumption are called gustatory rhinitis.
Diagnostic Challenges
Testing Limitations
Most of the patients we see would like to be tested for foods with a skin test or a blood test. However, the test is rarely helpful because the symptoms are triggered through activation of the nerves in the nose.
Treatment Options
Primary Medication
The main treatment for this condition is an anticholinergic medication called ipratropium. Ipratropium is very helpful, and it can be used in a large dosage range. For some patients, one spray can help. Other patients may need 2 sprays up to 4 to 6 times a day. Ipratropium comes in 2 dosages, 0.03% and 0.06%. So there's quite a leeway in terms of how it can be used, from a very low dose to a very high dose.
Side Effects and Monitoring
The issue with ipratropium is that it is anticholinergic. For some patients, it can increase the intraocular pressure. For patients who have to use ipratropium at high dosages for a long time, we recommend monitoring of intraocular pressure with their optometrist or ophthalmologist. Overall, for symptoms of gustatory rhinitis, ipratropium as needed is very effective.
Misconceptions About Allergy Testing
Ineffectiveness of Food Allergy Tests
Skin testing for food allergies is rarely helpful in patients with gustatory rhinitis. Skin testing for inhalant allergies may be helpful, as when you look at all patients with rhinitis, approximately 40% to 50% of them do have allergic rhinitis. Some patients have mixed rhinitis, which is allergic and non-allergic rhinitis occurring at the same time.
Impact on Quality of Life
Social and Professional Implications
Treating gustatory rhinitis can be life-changing for many patients because they're embarrassed to go to a professional dinner or even to a family gathering, such as a Thanksgiving dinner. You can imagine, you appear at a professional business dinner and your nose starts to run, so you have to use multiple tissues. People around you look at you like you are sick, and it can really impede social interaction.
Preventive Measures
One way to prevent this is to use 2 sprays of ipratropium about 15 to 30 minutes before the dinner and as needed after that. This is able to control the symptoms for most patients, and they are able to enjoy the dinner setting despite the gustatory rhinitis. We have a way to control gustatory rhinitis in a very effective and safe way.
Published: 12-14-2024