There are two types of rhinitis: perennial; and seasonal (hayfever), a pollen sensitivity during late May to early August. Patients with rhinitis in early spring usually react to various wind-pollinated trees, weeds, shrubs or grasses.

Perennial rhinitis occurs all-year round and is like a cold that lasts forever.

Perennial rhinitis and sinusitis are frequent co-passengers, as the mucous membranes of the nasal passages and sinuses flow together. The continual allergic or fungal attack on these membranes often causes them to proliferate, leading to polyps, usually in the nasal passages. These polyps, in turn, make the problem worse by causing a physical obstruction in an already blocked nose. What doctors tell you The usual treatments for rhinitis are various drugs that only suppress the problem, such as antihistamines, which block the effects of histamine, a chemical released during an allergic reaction. Histamine is mainly responsible for the inflammation, sneezing and itching symptoms of rhinitis. Although antihistamines may be well tolerated, they commonly cause a dry mouth, nose and eyes, and drowsiness. The latest ‘second-generation’ drugs, such as Allegra and Clarityn, despite their claims, still come with a range of side-effects. Long-term use of topical steroid sprays, such as Beconase or Rhinocort, offers all the dangers of ordinary steroids.

The only conventional treatment of polyps is surgery, or a polypectomy. Although this can improve matters, it’s often only for a few months until the polyps recur because the underlying cause has not been addressed. Some of my patients have undergone as many as 10 polypectomies.

Perennial rhinitis has at least four main causes: * inhalant allergies, such as housedust, dust mites, moulds, animals and feathers * food allergies or intolerance * fungal/yeast problems * magnesium deficiency, which can worsen any or all of the above causes.

You will know you have this problem if you are worse: *in dusty environments or first thing in the morning * in August or September, especially on humid days before thunderstorms. In the hours before a thunderstorm, there is a marked increase in mould counts and a marked increase in hospital admissions for asthma * after sweeping up mould-ridden leaves or turning over a compost heap * in any damp, musty dwelling, indicating a reaction to indoor moulds. Another clue is if you are better in hot dry climates, such as the Algarve or Greek islands. Dust mites don’t survive in high heat and are extremely thirsty for water, and can’t live in desert-like environments. If you don’t improve in these situations, suspect a food sensitivity or a fungal/yeast problem.

You can also test for inhalant sensitivity with prick tests and radioallergosorbent test (RAST; a blood test measuring immunoglobulin E reactivity).

Foods play a large part in perennial rhinitis. Milk sensitivity is very common and frequently described as ‘mucus-forming’, but any food can be implicated. Suspect a food sensitivity if you have: * no history of inhalant sensitivity and a negative response to skin inhalant tests * a history of food cravings * abdominal distention after food, or puffy swelling of the ankles and fingers * occasional bouts of a rapid heartbeat or sweating for no apparent reason * weight problems and sudden, dramatic weight fluctuations from day to day.