What Your Itchy Nose Is Trying to Tell You

An itchy nose, medically termed nasal pruritus, can often be a simple nuisance caused by allergies or dry air, but it might also indicate a more serious condition like nasal polyps or a sinus infection. Understanding the cause is key to effective treatment, so it’s important to consult a healthcare professional if over-the-counter remedies aren’t working.

Why Is My Nose So Itchy?

Pruritus is itching anywhere on the body. It happens when the immune system releases histamine, which triggers inflammation—your body’s natural response to disease, injury, or infection.

Histamine binds to histamine type 1 rececptors (H1R) on sensory nerves. This causes nerves to rapidly fire, creating the sensation of an itch.

H1 receptors are found throughout the body, including the skin and nasal passages. Histamine release can be triggered by allergens, infections, extreme temperature changes, medications, or direct skin irritation.

Allergic Rhinitis

Allergic rhinitis, or hay fever, is mostly caused by pollen from trees and grass. Mold spores, pet dander, dust mites, and cockroach droppings, along with other airborne allergens, can also trigger it.

Allergic rhinitis affects between 20% and 30% of adults in the United States and a larger percentage of children. The symptoms may be seasonal (limited to “pollen season”) or perennial (occurring year-round).

Symptoms of allergic rhinitis include:

• Nasal itchiness
• Nasal congestion
• Sneezing
• Runny nose
• Coughing
• Watery eyes
• Post-nasal drip
• Difficulty breathing
• Fatigue

Over-the-counter (OTC) antihistamines such as Zyrtec (cetirizine), Allegra (fexofenadine), and Clarinex (desloratadine) are the main form of treatment for allergic rhinitis. There are also antihistamine nasal sprays that can treat nasal symptoms directly.

Environmental Irritants

Environmental irritants are those in the environment that can irritate the skin, eyes, or respiratory tract. These include aerosolized irritants such as:

• Smoke
• Cigarettes
• Exhaust fumes
• Air pollution, including ozone
• Fumes from cleaning products, solvents, paint, or varnishes
• Industrial pollutants
• Cold, dry air or hot, humid air

Breathing in these irritants can cause the rapid onset of inflammation in the respiratory tract, leading to symptoms like:

• Nasal itchiness
• Headaches
• Dizziness
• Coughing
• Vocal hoarseness
• Eye redness end tearing
• Difficulty breathing
• Nausea or vomiting

The response can differ, with some people being more sensitive to them than others.

Certain pollutants, like ozone, directly stimulate the release of histamine. They do so by causing immune cells in your skin, called mast cells, to break open and release histamine into surrounding tissues, including those of the nasal passages.

The best way to deal with environmental irritants is to remove yourself from the source of the exposure or to wear the appropriate face mask, such as an N95 mask or a full-facial respiratory mask.

Sinusitis

Sinusitis describes the inflammation of the sinuses, most often due to an infection. Also known as acute rhinosinusitis, the condition is most often linked to viral infections such as:

• Adenoviruses
• Rhinoviruses
• Coronaviruses, including COVID-19
• Influenza viruses
• Parainfluenza viruses
• Respiratory syncytial virus (RSV)

Bacteria can also sometimes cause sinus infections, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

Fungal sinusitis is more commonly attributed to immunosuppressive diseases, like HIV, that allow normally occurring fungi to overgrow and establish an infection.

Symptoms of sinusitis include:

• Headache
• Sinus pain and pressure
• Nasal itchiness
• Thick nasal discharge
• Nasal congestion
• Fatigue
• Cough
• Loss of smell
• Post-nasal drip
• Upper teeth pain
• Earache

Most viral infections are allowed to run their course; treatment is mainly focused on managing symptoms. Bacterial or fungal infections may be treated, respectively, with oral or intravenous (IV) antibiotics or antifungal drugs.

Food Allergies

All allergies are characterized by the inappropriate release of histamine. With a food allergy, you may start to feel itching of the mouth, nose, eyes, or skin within minutes to two hours of eating an allergenic food.

In the United States, the eight most common food allergens are:

• Eggs
• Fish
• Shellfish
• Tree nuts
• Peanuts
• Milk
• Wheat
• Soybeans

With a food allergy, your body is overreacting to a specific food protein that most immune systems regard as harmless. If your immune system is hypersensitive to that protein, it can cause allergy symptoms like:

• Nasal itchiness
• Sneezing
• Nasal congestion
• Stomach
• Nausea or vomiting
• Diarrhea

Food allergies can often be effectively treated with oral antihistamines.

Nasal Polyps

Nasal polyps are soft, benign (non-cancerous) growths that develop inside the sinus or nasal passages. They are often teardrop-shaped and grow in clusters. While small polyps may not be problematic, large polyps can block airways and lead to sinus inflammation (referred to as chronic sinusitis).

Nasal polyps are common and mostly affect people in their 30s and 40s. Infections, allergies, or any condition that causes long-term sinus inflammation can lead to nasal polyps. Polyps are also closely linked to asthma and aspirin sensitivity.

Symptoms of nasal polyps include:

• Nasal itchiness
• Runny nose
• Headache
• Nasal congestion
• Sinus pain and pressure
• Sneezing
• Cough
• Loss of smell and taste
• Post-nasal drip
• Upper teeth pain
• Snoring

The first-line treatment of nasal polyps is a corticosteroid nasal spray. If the topical drug is unable to shrink the polyp, oral corticosteroids may be used. A surgery called a polypectomy offers a permanent solution by removing the abnormal growth.

CPAP Machines

Sleep apnea is a condition in which breathing repeatedly stops during sleep, either due to airway obstruction (obstructive sleep apnea) or the disruption of the part of the brain that regulates breathing (central sleep apnea).

A continuous positive airway pressure (CPAP) machine is a device used to keep airways open in people with sleep apnea. It does so by pushing air at a continuous pressure flow into in the nose, mouth, or both.

Nasal pruritus occurs when the constant air pressure from the CPAP machine causes nasal tissues to dry out and become inflamed. There may also be skin irritation from the mask itself, especially if it is ill-fitting.

Other side effects of a CPAP machine include:

• Runny nose
• Nasal congestion
• Facial pain
• Skin irritation
• Eye pain or irritation
• Bloating

These symptoms can be alleviated by connecting an external humidifier to the unit. (Most CPAPs today have built-in humidifiers.) You can also change to a full face mask or one that covers your nose and mouth to reduce nose irritation.

Nasal Tumors

Nasal and paranasal tumors are abnormal growths of tissues. They differ from polyps in that they are comprised of abnormal cells, while polyps are comprised of normal cells. Nasal tumors are those that develop in the main nasal passage, while paranasal tumors occur in the paranasal sinuses.

Nasal and paranasal tumors are generally non-cancerous but some can turn cancerous. The two most common types of nasal cancer are squamous cell carcinoma (SCC) and adenocarcinoma.

Symptoms of nasal tumors, both benign and cancerous, include:

• Nasal itchiness
• Sinus pressure and pain
• Blocked sinus (usually one-sided)
• Headaches
• Nosebleeds
• Ear pain and pressure

If the tumor is cancerous and starts to spread, it can cause double vision, eye bulging, facial swelling, jaw numbness, and trismus (lockjaw).

Surgery is the first line of treatment for benign tumors that affect breathing and all cancerous tumors irrespective of stage.

Radiation can be used after cancer surgery to clear any remaining cancer cells. Chemotherapy and targeted therapies may also be used.

Brain Tumors

As surprising as it may seem, nasal itching may be a tell-tale sign of a brain tumor. As far back as the 1970s, scientists in Europe noticed that roughly one in five people experienced sometimes intense and persistent pruritis localized to the nostrils.

Further investigation revealed that most tumors were localized to a specific part of the brain called the brainstem which regulates many vital functions, including respiration and sneezing.

Other recent studies have revealed that brain tumors in different parts of the brain trigger pruritus in different parts of the body, including the head and trunk.

While brainstem tumors are rare in exceptionally rare in adults, a typically cancerous type called brainstem glioma accounts for approximately 15% of all childhood brain tumors.

Symptoms of an advanced brainstem glioma may include:

• Double vision
• Weakness
• Unsteady gait
• Difficulty swallowing
• Difficulty speaking or writing
• Headache
• Drowsiness
• Nausea and vomiting

In some cases, intense localized itching (resistant to antihistamines and other medications) may be the sole symptom of a brainstem tumor in children.

Surgery is possible for only some types of brainstem tumors; radiation tends to be reserved for advanced cases due to the impact it may have on vital functions. Chemotherapy has limited use in all but high-grade (aggressive) cancers.

How Nasal Pruritus Is Diagnosed

Conditions that cause nasal itching are best diagnosed by a physician who specializes in disorders of the ear, nose, and throat, called an otolaryngologist. Other specialists may also be involved, such as an allergist who diagnoses and treats allergies.

The otolaryngologist will ask you about your symptoms and medical history before giving you a physical exam, which will involve looking into your ears, nose, and throat.

Medical imaging may be used to confirm a diagnosis, including the use of a computed tomography (CT) scan to help detect nasal polyps or tumors.

If an allergic condition is suspected, allergy testing with a skin prick test or RAST blood test may be used to confirm this and identify which substances cause the allergy.