Allergic vs Non-Allergic Rhinitis: Why Your Allergy Tests Might Be Negative

You have been sneezing, congested, or reaching for tissues for weeks — maybe months — and it certainly feels like an allergy. But then your allergy test comes back negative. What does that actually mean?

In many cases, persistent nasal symptoms are caused by non-allergic rhinitis rather than by a classical immune response to an allergen. In other cases, the test may simply have not covered the right allergen, or the timing may not have been ideal. Understanding the distinction between allergic rhinitis vs non-allergic rhinitis is essential for working out what is driving your symptoms — and what to do next.

This guide is written for UK readers and draws on NHS guidance, Allergy UK factsheets, and BSACI clinical resources. It is intended as general health information and is not a substitute for professional medical advice. If you experience sudden facial swelling, breathing difficulty, or collapse alongside nasal symptoms, call 999 immediately.

Quick Reality-Check: What Rhinitis Is (and What It Isn't)

Rhinitis simply means inflammation of the nasal lining — the thin, moist tissue (mucosa) that lines the inside of your nose. When this tissue becomes inflamed, it swells, produces more mucus than usual, and becomes more sensitive to stimuli. The result is the cluster of symptoms most people recognise: a blocked or runny nose, sneezing, postnasal drip, and sometimes reduced sense of smell (NHS, 2024).

Rhinitis is not a diagnosis in itself — it is a description of what is happening in the nose. The important clinical question is always why it is happening. Broadly, rhinitis falls into two categories:

• Allergic rhinitis — driven by an IgE-mediated immune response to a specific allergen (pollen, dust mite, pet dander, mould). This is what most people mean when they say "hay fever," although hay fever technically refers to seasonal allergic rhinitis only.
• Non-allergic rhinitis — similar symptoms, but not driven by an IgE-mediated allergy. This category includes vasomotor rhinitis, medication-related rhinitis, hormonal rhinitis, and structural causes.

According to Allergy UK, non-allergic rhinitis may affect as many as one in four adults with persistent nasal symptoms, and in some studies the prevalence is even higher (Allergy UK, 2025). It is significantly underdiagnosed because patients and clinicians alike often assume that chronic nasal symptoms must be allergic in origin.

Allergic Rhinitis in the UK: Typical Triggers and Patterns

Allergic rhinitis is common. The NHS estimates that around one in five people in the UK is affected at some point in their life (NHS, 2024). When the immune system encounters an airborne protein it has become sensitised to, it produces specific IgE antibodies. These antibodies trigger mast cells in the nasal lining to release histamine and other inflammatory chemicals, causing the characteristic symptoms of sneezing, itching, congestion, and watery discharge.

Seasonal vs Year-Round Symptoms

One of the most useful distinctions in clinical practice is whether symptoms are seasonal or perennial (year-round):

• Seasonal allergic rhinitis follows a predictable calendar pattern. In the UK, tree pollens (especially birch and London plane) tend to peak from March to May, grass pollens dominate from late May through July, and weed pollens (such as mugwort and nettle) are most relevant from late summer into early autumn. If your symptoms reliably worsen during a specific window each year, a seasonal trigger is likely (Allergy UK, 2025).
• Perennial allergic rhinitis produces symptoms throughout the year, often without a clear seasonal peak. This pattern is more commonly associated with indoor allergens such as house dust mite, pet dander, and indoor moulds. Symptoms may fluctuate with changes in exposure — for example, worsening after vacuuming, during damp weather, or when spending more time indoors in winter.

Common Triggers: Pollen, Dust Mite, Pets, Mould

The allergens most commonly implicated in UK rhinitis include:

• Grass pollen — Timothy grass is the most clinically relevant species in UK testing panels.
• Tree pollen — silver birch is the dominant allergenic tree in the UK; London plane tree pollen is particularly relevant in urban areas.
• House dust mite — Dermatophagoides pteronyssinus is the most common species in UK homes. Dust mite allergy rhinitis is a leading cause of perennial symptoms and is often underestimated because the allergen is invisible.
• Cat and dog dander — proteins in skin flakes, saliva, and urine can trigger symptoms even without direct animal contact, as dander is easily transferred on clothing.
• Mould spores — Alternaria, Cladosporium, and Aspergillus are the most commonly tested moulds in the UK. Exposure may be seasonal (outdoor moulds) or perennial (indoor damp environments).

The hay fever and allergic rhinitis section of our website provides further background on seasonal triggers and the tests most commonly used to identify them.

Non-Allergic Rhinitis: The Most Common Reasons Tests Come Back Negative

If your allergy tests are negative but you still have persistent nasal symptoms, there is a good chance that non-allergic rhinitis is responsible. This is not a single condition — it is an umbrella term covering several distinct mechanisms, none of which involve the classical IgE antibody pathway (BSACI, 2023).

Irritant / Vasomotor Rhinitis (Temperature, Smoke, Strong Smells)

Vasomotor rhinitis — sometimes called idiopathic rhinitis — is the most common subtype of non-allergic rhinitis. The nasal lining overreacts to non-specific irritants rather than to a particular allergen protein. Common triggers include:

• Changes in temperature or humidity (e.g., moving from cold outdoor air to a warm room)
• Strong odours, perfumes, or cleaning products
• Tobacco smoke or air pollution
• Spicy food (gustatory rhinitis)
• Dry air from central heating or air conditioning

Vasomotor rhinitis symptoms typically include watery nasal discharge, congestion, and postnasal drip — but not usually itching or sneezing, which tend to be more prominent in allergic rhinitis. This subtle difference can sometimes help distinguish the two, although overlap is common (NHS, 2024).

Medication-Related Rhinitis (Overuse of Nasal Decongestants)

Rhinitis medicamentosa is a well-recognised form of rebound congestion caused by prolonged use of topical nasal decongestant sprays (such as oxymetazoline or xylometazoline). These sprays are effective for short-term relief — the NHS recommends using them for no more than seven consecutive days — but extended use can cause the nasal lining to become dependent on the medication, leading to worsening congestion when the spray wears off (NHS, 2024).

Other medications associated with rhinitis as a side effect include certain antihypertensives (e.g., ACE inhibitors), beta-blockers, aspirin, and oral contraceptives. If you suspect a medication may be contributing to your symptoms, discuss this with your prescribing clinician before making any changes.

Hormonal Rhinitis, Pregnancy and Thyroid Considerations

Hormonal changes — particularly those associated with pregnancy, the menstrual cycle, puberty, and thyroid dysfunction — may contribute to nasal congestion and rhinitis-like symptoms. Pregnancy rhinitis, for example, is estimated to affect around one in five pregnant women, typically during the second and third trimesters, and usually resolves after delivery (NHS, 2024).

If your rhinitis symptoms coincide with a known hormonal change or if you have an underactive thyroid, it is worth mentioning this to your GP. These causes are managed differently from both allergic and vasomotor rhinitis and may require input from an endocrinologist or obstetrician as appropriate.

Structural Causes (Deviated Septum, Polyps) — When ENT Assessment Matters

Not all nasal obstruction is caused by inflammation. Structural abnormalities — such as a deviated nasal septum, nasal polyps, or enlarged turbinates — can produce persistent one-sided or bilateral congestion that mimics rhinitis. Nasal polyps in particular are associated with chronic rhinosinusitis and may co-occur with aspirin sensitivity and asthma (a combination sometimes called Samter's triad).

If your congestion is predominantly one-sided, does not respond to standard treatments, or is accompanied by facial pain, loss of smell, or recurrent sinus infections, referral to an ENT (ear, nose, and throat) specialist may be appropriate. This is a clinical decision best made in discussion with your GP.

Why Allergy Tests Can Be Negative Even When Symptoms Feel ‘Allergic’

Receiving a negative allergy test but symptoms that persist is one of the most common frustrations reported by people with chronic rhinitis. Several factors may explain this apparent contradiction.

Mismatch Between History and Test Panel (Wrong Allergens, Wrong Season)

A specific IgE blood test only measures antibodies to the allergens included in the panel. If the allergen responsible for your symptoms was not included — for example, if you were tested for grass pollen but your real trigger is London plane tree — the result will be negative even though an allergy may exist.

This is why a detailed symptom history is essential before selecting a test panel. Timing matters too: if you are tested during winter but your symptoms are worst in May, the clinical picture and the test selection should be guided by that seasonal pattern rather than by what is convenient.

Timing and Antihistamines: Why Testing Strategy Matters

One advantage of IgE blood testing over skin prick testing is that blood test results are not affected by antihistamine use. You do not need to stop your regular antihistamines before a rhinitis blood test IgE appointment. However, the overall testing strategy still matters — choosing the right panel based on your exposure history is more important than the format of the test.

Timing of testing relative to allergen exposure is less critical for blood tests than for skin prick tests, but IgE levels to seasonal allergens may be at their highest during or shortly after the relevant pollen season. This is worth bearing in mind when interpreting borderline results.

Total IgE vs Specific IgE: What Each Can and Cannot Tell You

It is worth understanding the difference between two types of IgE measurement:

• Total IgE measures the overall level of immunoglobulin E in your blood. It can be elevated in allergic conditions, but also in parasitic infections, some autoimmune conditions, and certain immunodeficiency syndromes. A normal total IgE does not rule out specific allergies, and an elevated total IgE does not confirm them.
• Specific IgE measures IgE antibodies directed against a particular allergen protein — for example, Timothy grass (g6) or house dust mite (d1). A raised specific IgE indicates sensitisation to that allergen. However, sensitisation does not automatically mean clinical allergy — some people have detectable IgE without experiencing symptoms on exposure. Results should always be interpreted alongside clinical history by a qualified professional (BSACI, 2023).

Local Allergic Rhinitis: What Clinicians Mean and Why It Is Debated

Local allergic rhinitis (LAR) is a concept that has gained attention in the allergy literature over the past decade. In LAR, the nasal mucosa itself is thought to produce IgE antibodies locally — meaning that an allergic process is occurring in the nose, but IgE levels in the bloodstream remain normal. This would explain why some patients with allergy-like symptoms consistently test negative on both blood tests and standard skin prick tests.

Diagnosis of LAR typically requires nasal provocation testing — applying a small amount of allergen directly to the nasal lining and measuring the response — which is not widely available outside specialist allergy centres. The concept remains an area of active research and clinical debate. If your symptoms are strongly suggestive of allergy but all standard tests are negative, a discussion with an allergy specialist may be appropriate (BSACI, 2023).

A Practical UK Diagnostic Pathway (History First, Tests Second)

The most effective approach to rhinitis is one that starts with a detailed understanding of your symptoms before any laboratory tests are ordered. This principle is emphasised in BSACI and NICE guidance: a careful history is the foundation of allergy assessment.

Symptom Diary + Exposure Mapping

Before you book a test, consider keeping a structured symptom diary for at least two to four weeks. Record:

• Which symptoms are present (congestion, sneezing, itch, watery eyes, postnasal drip)
• The time of day symptoms are worst
• Whether symptoms are seasonal, perennial, or episodic
• Known environmental exposures (pets at home, damp/mould, workplace irritants)
• Any pattern related to specific locations (better on holiday, worse at work, etc.)
• Medications currently being used, including nasal sprays and antihistamines

This information is valuable both for selecting the right test panel and for helping your clinician interpret the results.

When an IgE Blood Test Is Useful

IgE blood testing is most valuable when your history suggests a possible allergic trigger — for example:

• Symptoms that follow a seasonal pattern consistent with pollen exposure
• Year-round symptoms that worsen in dusty environments, around pets, or in damp homes
• Rhinitis accompanied by other atopic features (eczema, asthma, food allergy)
• A need to identify or rule out specific sensitisations to guide avoidance strategies

In these situations, a targeted specific IgE panel — covering the allergens most consistent with your history — provides the most useful information. The Allergic Rhinitis/Asthma Profile and UK Aero Allergen panel are examples of panels designed to cover the most common airborne allergens relevant to UK patients.

When Non-Allergic Causes Are More Likely

Non-allergic rhinitis may be more likely when:

• Symptoms are triggered predominantly by temperature changes, strong smells, or irritants
• There is no clear seasonal pattern and no obvious allergen exposure
• Nasal congestion is the dominant symptom, with little sneezing or itching
• The patient has used topical nasal decongestants for more than seven days
• Symptoms started during pregnancy, around menopause, or with a new medication
• Previous allergy tests (blood or skin prick) have been consistently negative

If non-allergic rhinitis is suspected, management focuses on trigger avoidance and symptomatic treatment rather than allergen-specific strategies. A GP can guide this assessment.

What You Can Do Now (Safe Self-Care)

While investigation and professional guidance are important for persistent rhinitis, there are several evidence-based steps you can take in the meantime to help manage symptoms.

Saline Rinses and Trigger Reduction

Saline nasal irrigation — using a commercially available saline rinse bottle or neti pot with pre-made saline sachets — is supported by evidence for both allergic and non-allergic rhinitis. It helps to clear mucus, reduce inflammation, and remove irritant particles from the nasal passages (NHS, 2024). Use pre-made saline sachets or cooled boiled water with the correct salt concentration; never use unboiled tap water.

Practical trigger reduction strategies include:

• Using allergen-proof mattress and pillow covers if dust mite exposure is suspected
• Keeping windows closed during high-pollen days (check the Met Office pollen forecast)
• Showering and changing clothes after prolonged outdoor exposure during pollen season
• Reducing indoor humidity to below 50% to discourage mould and dust mite growth
• Avoiding known irritants such as cigarette smoke, strong perfumes, and aerosol sprays

Non-Sedating Antihistamines and Nasal Steroid Sprays (General Information)

Over-the-counter non-sedating antihistamines (such as cetirizine, loratadine, or fexofenadine) are widely available in UK pharmacies and may help with sneezing, itching, and watery discharge associated with allergic rhinitis. They are generally less effective for nasal congestion when used alone.

Intranasal corticosteroid sprays (such as fluticasone or mometasone) are available without prescription in the UK and are considered a first-line approach for moderate to severe rhinitis by NICE and BSACI. They reduce nasal inflammation and can improve congestion, sneezing, and discharge. Consistent daily use over several days is usually needed before the full benefit is noticed (NICE, 2024).

These are general options discussed in public health guidance. The most appropriate treatment for your situation should be discussed with your pharmacist, GP, or specialist.

When to Seek Urgent Help

How Nurse-Led Allergy Blood Testing Fits In

If your history suggests that allergic rhinitis may be contributing to your symptoms — or if you want to rule it out more thoroughly — a targeted IgE blood test can provide useful diagnostic information.

What the Appointment Involves (Venous Blood Draw)

At Allergy Clinic, blood tests are carried out by a registered nurse through a standard venous blood draw (venepuncture). The appointment is straightforward and typically takes around 15–20 minutes. The blood sample is sent to an accredited laboratory for analysis, and results are usually available within a few working days. Your results are delivered securely and can be shared with your GP, allergist, or other clinician for interpretation and clinical guidance.

Importantly, you do not need to stop taking antihistamines before a blood test — unlike skin prick testing, IgE blood results are not affected by antihistamine use.

Choosing the Right Panel Based on Your History

Selecting the most appropriate allergen panel is one of the most important steps in getting useful results. For rhinitis, the following options are commonly relevant:

• Rhinitis/Asthma panels — designed to cover the most common UK aeroallergens, including grass and tree pollens, dust mite, cat, dog, and several mould species.
• UK Aero Allergen panels — broader coverage of airborne allergens relevant to the UK climate and geography.
• Individual allergen testing — useful when your history points to a specific suspect (e.g., a particular animal or a workplace exposure) and you want to test for that allergen individually.

If you are unsure which panel is most appropriate, a brief review of your symptom diary and triggers — even in note form — can help narrow the selection. Our team can also provide general guidance on panel options at the time of booking.

Frequently Asked Questions

Can I have allergies if my IgE blood test is negative?

It is possible. A negative specific IgE result makes a true IgE-mediated allergy to the tested allergens less likely, but it does not rule out every allergic mechanism. In rare cases, local allergic rhinitis may involve IgE production confined to the nasal lining that is not detectable in standard blood tests. A negative result may also occur if the wrong allergen panel was selected or if the test was taken outside the relevant exposure season. Your clinician can help interpret results in the context of your full history.

Is non-allergic rhinitis the same as sinusitis?

No. Rhinitis refers to inflammation of the nasal lining, while sinusitis refers to inflammation of the sinus cavities. The two conditions can coexist and share symptoms, but they involve different anatomical structures and may require different assessment. If you experience persistent facial pain, pressure, or a sensation of fullness around your cheeks and forehead, discuss this with your GP.

What is the difference between a cold and rhinitis?

A common cold is caused by a viral infection and typically resolves within 7–10 days. It often includes sore throat, mild fever, and general tiredness. Rhinitis — whether allergic or non-allergic — tends to be more persistent or recurrent, and usually lacks the systemic features of a viral illness. If nasal symptoms persist for more than two weeks without improvement, rhinitis is a more likely explanation than a lingering cold.

Do I need to stop antihistamines before a blood test?

No. Unlike skin prick testing, IgE blood tests are not affected by antihistamine use. You can continue taking your regular medications — including cetirizine, loratadine, or fexofenadine — before and on the day of your blood test. This is one of the practical advantages of blood-based allergy testing.

Which allergens are most relevant for rhinitis testing in London?

In London and the south-east of England, the most commonly relevant aeroallergens include house dust mite (D. pteronyssinus), grass pollen (Timothy grass), tree pollen (silver birch and London plane), cat and dog dander, and the moulds Alternaria and Cladosporium. London plane pollen is a notable urban allergen. The UK Aero Allergen profile is designed to cover the most relevant airborne triggers for UK-based patients.

What is local allergic rhinitis?

Local allergic rhinitis (LAR) is a concept in allergy medicine where IgE antibodies are produced within the nasal mucosa rather than systemically. Standard blood tests and skin prick tests may come back negative because the IgE is localised. Diagnosis typically requires specialist nasal provocation testing, which is not widely available. LAR remains an area of active research and clinical debate (BSACI, 2023).

Can non-allergic rhinitis be cured?

There is no guaranteed cure for non-allergic rhinitis, but symptoms can often be effectively managed. Trigger avoidance, saline nasal rinses, and nasal corticosteroid sprays may all help. If an underlying cause — such as medication overuse or a hormonal change — is identified, addressing that factor may improve symptoms significantly. Management should be discussed with your GP or specialist.

Considering an Allergy Blood Test?

If you are experiencing persistent nasal symptoms and would like to explore whether an allergic trigger may be involved, a targeted IgE blood test can provide a useful starting point. At Allergy Clinic, we offer nurse-led venepuncture with laboratory analysis for a range of aeroallergen panels and individual allergen tests.

Our service provides a diagnostic blood sample and a detailed laboratory report. We recommend taking your results to your GP, allergist, or immunologist for clinical interpretation and personalised guidance.

Browse available allergy tests and book an appointment →

Sources

• NHS — Non-allergic rhinitis, Allergic rhinitis, Hay fever. Available at: nhs.uk/conditions/non-allergic-rhinitis
• Allergy UK — Rhinitis factsheet, Allergen avoidance guidance. Available at: allergyuk.org
• British Society for Allergy and Clinical Immunology (BSACI) — Guidelines on the diagnosis and management of allergic and non-allergic rhinitis. Available at: bsaci.org
• NICE — Clinical Knowledge Summaries: Allergic rhinitis. Available at: nice.org.uk
• Anaphylaxis UK — Recognising and responding to anaphylaxis. Available at: anaphylaxis.org.uk
• Rondón, C. et al. — Local allergic rhinitis: concept, clinical manifestations, and diagnostic approach. Published in the Journal of Allergy and Clinical Immunology. Cited via BSACI clinical resources.