Warm and Red Nose

[freeme3]

I have been experiencing a warm, red and swollen nose from time to time.  At first my nose would only turn red and warm after coming inside from cooler weather to a warm environment.  Now it is happening randomly during the day and night (especially when I lie down to go to sleep).

I have very bad seasonal allergies and right now hayfever is in full bloom where I live and I am assuming that this is allergies but am not sure. (I do get allergy shots every 2 weeks). This past weekend I went to the emergency room because my nose was hurting so much.  The ER doctor looked up my nose and said that it is very, very swollen and that my turbinates are almost touching.  I asked him why my nose turns red when I change temperatures and he said that it is likely a vasomotor response.  He prescribed me a 10 course of steroids.

1. Can allergies make the outside of your nose turn red and cause it to be swollen?  Why does it happen randomly throughout the day?  I asked the ER doctor if it could possibly be rosacea and he said no.  I am just trying to understand what is happening.

2. When my nose is not warm or red, it seems that it is very cold. There does not seem to be a "normal temperature" going on with my nose. It is almost like my nose is having trouble regulating its temperature and is very sensitive to everything.  Also, it seems that when I exert myself or get warm, my nose turns red.  I guess that could be a normal reaction though?  I asked this question in the, "Allergy community" and another doctor responded saying that my cold nose could be Raynaud's but what about the warmness and redness that occurs?  Is that Raynaud's as well?  my hands and feet do get cold from time to time and sometimes my feet will turn a dark red or purple color when I am nervous or cold.

3. I am experiencing a lot of anxiety over my red nose and am wondering if that is actually worsening the red flushed nose?  
4. I also have dermographic urticaria. Could this all be related?

Thank you!

[freeme3]

Hello Dr. Kumar,

Thank you for responding to my message.  My nose has been bothering me again, it is just very sore.  It feels very swollen inside, lots of pressure.  I suppose this is typical with allergies?  Normally my nose does not hurt, just my sinuses will bother me.  My nose will hurt worse when I lie down and I feel a lot of pressure inside of it and cannot breathe.  What can I do to help this?  I am having a difficult time breathing because of this.  My nose is also very red and dry inside.

Thank you

[Naveen Kumar, MD]

Dear freeme3

The burning sensation inside your nose could be due to the drying of nasal mucosa secondary to either allergic rhinitis or exposure to cold/hot temperature. After a brief exposure to extremes of temperature one can have dryness in nose along with irritation of the nerve endings which may be perceived as burning sensation.  

You are quite right about the possible cause of nasal congestion on lying down. When one lies down, blood supply to the face does increase and it can lead to nasal congestion. Another possible cause could be dust on the pillow cover, which can lead to nasal stuffiness particularly in individuals having allergy related problems.

Please, do not worry about the transient blushing of nose, as it is natural to notice such redness during anxiety and allergic episodes. You need to just keep a watch for any pimple like eruptions following blushing as it could be Acne Rosacea.

About your query on whether it is possible to have non-allergenic rhinitis and allergenic rhinitis at the same time, I would say it is very unlikely to have both at the same time. The best differentiating feature is that non-allergic rhinitis does not respond well to an antihistaminic.

Hope that this information helps and hope that you will get better soon.

Best Regards
Dr. Naveen Kumar N.

[freeme3]

Dear Dr. Kumar,

Thank you for your response, it is helpful.  My nose will often be painful inside like it is burning.  Do you know what would be causing the pain?  It is not all of the time, just occasional.  It will feel dry and swollen inside. It especially burns if I am outside breathing in cool air.  Sometimes it will turn red and get stuffy when I lie down to go to sleep;  I suppose that is from the blood rushing to my face because I am lying down?

So I should not be worried about the transient redness of my nose?  It seems to worsen if I am thinking or anxious about it.  I can often make myself blush just by looking in the mirror and feeling anxiety about it.  

Also, it is possible to have non-allergenic rhinitis and allergenic rhinitis at the same time?

Thank you again for your help!

Sincerely,
Freeme3

[Naveen Kumar, MD]

Dear freeme3,

Nasal blushing or Red nose can occur because of an allergy,  after alcohol consumption, skin irritation, prolonged exposure to cold temperatures, infection,  or rhinophyma (large, bulbous reddened nose due to unknown cause), etc. I will try to answer your queries one by one.

1. Can allergies make the outside of your nose turn red and cause it to be swollen? Why does it happen randomly throughout the day?

Answer: Yes, Allergic Rhinitis/ Hay fever in some individuals can cause swelling and redness of the nose because of the vasomotor stimulation and retention of the blood in the capillaries. When it happens depends on the factors stimulating the vasomotor reflex such as change of temperature, stress, dust, etc.

2. Is that Raynaud's as well? my hands and feet do get cold from time to time and sometimes my feet will turn a dark red or purple color when I am nervous or cold.

Answer: The possibility of Raynaud's phenomenon cannot be ruled out, but to confirm this you will have to undergo few tests such as vascular ultrasound and a cold stimulation test.

3. I am experiencing a lot of anxiety over my red nose and am wondering if that is actually worsening the red flushed nose?

Answer: As I have mentioned above, even emotional upset can cause blushing of the nose but it is usually transient and disappears once the stimulation is gone.

4. I also have dermographic urticaria. Could this all be related?

Answer: Dermographism is also an allergic condition and nasal allergy too is a part of it. Yes, all of these conditions are inter-related.

To sum it up, the blushing and intermittent swelling of your nose could be mainly due to allergy. Rosacea is a condition associated with intermittent facial flushing or blushing, sometimes with burning sensation, red bumps, and small cysts. Rosacea evolves in various stages with inflammation of the skin over the forehead, cheeks, nose, and chin. Your symptoms do not appear to be because of Rosacea. Rhinophyma is ruled out as you report that there is retention of fluid and increased thickness of the skin.

I would suggest you to consult a good ENT specialist for a thorough examination and appropriate management.

Hope that this information helps and hope that you will get better soon.

Thank you for using MedHelp's "Ask an Expert" Service, where we feature some of world's renowned medical experts in their fields. Millions have benefitted from our service to get personalized advice for them and for their loved ones.

Best Regards.
Dr. Naveen Kumar N