This week you sneeze in long bursts every morning, with a box of tissues ready at the head of the bed. Next week your nose is almost quiet. The air conditioner is still set to 26 degrees, and the bedding is still washed every week. Some people go back to their home village on leave, where the house is far dustier with straw, and their nose calms down. Anyone who has lived with allergic rhinitis for years knows these ups and downs, yet few people understand why they happen.
How allergic rhinitis happens
In a person with allergies, the immune system has mistakenly identified certain harmless substances as harmful: house dust mites, pollen, mold, dog and cat hair. Each time the lining of the nose comes into contact with them, a chain of inflammatory reactions starts right there. The person sneezes, has an itchy nose, a clear runny nose and a blocked nose; some people get itchy eyes as well.
The ARIA guidelines, the international recommendations on allergic rhinitis, note that the condition affects about 10% to 40% of the population and affects quality of life, school and work (Brożek, 2017). The allergens and the immune reaction are real, and they remain the main focus of treatment. What changes is the level of the reaction. With the same amount of allergen, sometimes the nose copes, and sometimes it reacts violently.
How stress and sleep relate to the bad spells
In 2013, Patterson’s team asked 179 university employees to keep an online diary every day, in two rounds of 14 days each. Of these, 69 people had allergy symptoms, and this group rated their own stress higher than the others did. In both rounds, people who felt more stressed also had more allergy flares, and negative mood moved in the same direction. The amount of cortisol measured in saliva, however, was not related to the number of flares.
Among people with allergic rhinitis, about 65% have stress, 48% have poor-quality sleep, 36% have insomnia, and 59% sleep less than 7 hours a night. Their rates of insomnia, anxiety and depression are clearly higher than in people without the condition. These figures come from a meta-analysis of 49 studies by Safia and colleagues, published in 2024.
They show that these problems tend to go together, but not which one leads to which. A nose blocked all night makes sleep fitful; in our clinical practice, some people also tell us that just a few late nights leave their nose much worse the next morning. Even so, this does not make allergic rhinitis a psychological illness.
Long-lasting stress wears down many systems in the body, including the immune system, as our article how stress affects your health explains; ways to get your sleep back are in our article on sleep.
The body’s reaction threshold
The autonomic nervous system keeps moving the body back and forth between a state of alertness and a state of rest. In a healthy person this switch is fairly smooth: a gust of cold air brings a few sneezes, and that is it. In our understanding, someone who has been stressed for months and sleeping too little may be held in the alert state for a long time, and find it hard to lower the alarm level after the trigger has passed. At that point a whiff of perfume, a blast from the air conditioner or a little dust while clearing out a cupboard can sometimes be enough to make the nose react more strongly than it needs to.
Traditional medicine classes bouts of sneezing and clear runny nose as the condition called “sneezing with nasal discharge” (鼻鼽, bí qiú). It is usually linked to Lung qi (肺气 / 肺氣, fèi qì) and defensive qi (卫气 / 衛氣, wèi qì; the part of qi that helps the body hold off outside factors) not being firm enough, so people tend to have attacks when the weather turns or when they are worn out. At the clinic, besides avoiding allergens and using medication, we also pay attention to this reaction threshold.
Signs that you should see an ear, nose and throat or respiratory doctor early
Typical allergic rhinitis affects both sides, with clear mucus, and gets better and worse in spells. The following signs suggest a different problem, which needs an ear, nose and throat (ENT) doctor to look inside the nose with a scope, or a respiratory doctor to examine you:
- Repeated nosebleeds;
- A blocked nose on one side that lasts, and no longer comes and goes in spells as before;
- Cloudy, pus-like discharge with a bad smell from one side;
- Pain or heaviness in the face around the nose, with fever;
- Loss or reduction of your sense of smell that lasts;
- Wheezing, chest tightness or shortness of breath, especially at night or during exertion.
If you are severely short of breath, your lips turn blue, or you cannot finish a sentence, go to the emergency department right away.
What the clinic adds
The consultation starts from the story of your own nose’s ups and downs: when the bad spells fall, how you slept in the days before, how work was going, and whether your nose is calmer when you are away from home. The doctor does a clinical examination, the four examinations of traditional medicine (looking, listening, asking, taking the pulse) and a functional neurology examination, then uses Applied Kinesiology (AK). Muscle testing helps the doctor see where stress is having an effect, in the frontal lobe, the limbic system or the cingulate gyrus, and recheck right after each treatment step; the mechanism is described in our article why doctors use muscle testing. Muscle testing gives the doctor more information. When a nasal endoscopy or allergy tests are needed, the doctor will still ask you to have them done.
Depending on the examination, the doctor may combine acupuncture, an herbal decoction modified to suit your constitution, and advice on sleep and physical activity. On acupuncture, Feng and colleagues (2015) reviewed 13 randomized trials with 2,365 people with allergic rhinitis: the acupuncture groups had lower nasal symptom scores, needed less medication, had lower blood levels of IgE (the type of antibody tied to allergic reactions) and better quality of life than the control groups, with no serious adverse events requiring hospital admission linked to acupuncture. These data concern nasal symptoms and do not tell us whether acupuncture has any effect on stress. See also our article on acupuncture and moxibustion.
Frequently asked questions
I am using a nasal spray. Can I have acupuncture?
Yes. ARIA offers many medication options, including oral or nasal antihistamines and anti-inflammatory nasal sprays, used alone or in combination depending on the person (Brożek, 2017). When you start acupuncture or an herbal decoction, keep taking your medication regularly as prescribed, and do not stop it on your own; if your nose improves, cutting down the medication is something to discuss with the doctor who prescribed it.
Worth keeping
- Keep a diary for two weeks: each evening, score your blocked nose and sneezing from 0 to 10, note how many hours you slept and how stressed you were that day, then compare the bad weeks with the mild ones;
- Keep a steady bedtime, and try to get about 7 hours of sleep even in busy weeks;
- Wash your bedding every week, and cut down on carpets and stuffed toys in the bedroom;
- Wear a mask when sweeping the floor, clearing out cupboards or going through old things.
Once you have two weeks of diary in hand, especially if the bad weeks line up with stressful weeks rather than with the weather, bring it along with a list of the medications you are taking when you see Dr. Dinh Ngoc Duc (MD, MSc in Traditional Medicine).
References
- Brożek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision. J Allergy Clin Immunol. 2017;140(4):950-958. https://doi.org/10.1016/j.jaci.2017.03.050
- Patterson AM, Yildiz VO, Klatt MD, Malarkey WB. Perceived stress predicts allergy flares. Ann Allergy Asthma Immunol. 2013;112(4):317-321. https://doi.org/10.1016/j.anai.2013.07.013
- Safia A, Elhadi UA, Karam M, Merchavy S, Khater A. A meta-analysis of the prevalence and risk of mental health problems in allergic rhinitis patients. J Psychosom Res. 2024;184:111813. https://doi.org/10.1016/j.jpsychores.2024.111813
- Feng S, Han M, Fan Y, Yang G, Liao Z, Liao W, Li H. Acupuncture for the treatment of allergic rhinitis: a systematic review and meta-analysis. Am J Rhinol Allergy. 2015;29(1):57-62. https://doi.org/10.2500/ajra.2015.29.4116
