Hormones can significantly influence the airways and nasal mucosa and thus the pathogenesis of rhinitis. Several observational studies suggest that sex hormones impact rhinitis. Late-onset menarche can offer some protection against the onset of allergic rhinitis. [1] In addition, during the peri-ovulatory stage of a normal menstrual cycle, as the levels of estrogen rise, there is an associated increase in nasal congestion. [2] Other studies have shown that during ovulation, the nasal mucosa become more reactive to histamine. [3] Higher estrogen levels are associated with more pronounced symptoms of rhinitis, but lower estrogen levels are associated with greater risk of nasal polyps. [4]
Studies in pregnant women provide even more evidence for the effects of sex hormones on rhinitis. The changes in sex hormones are thought to be the reason why approximately 20% of pregnant women have new onset rhinitis, [5] although there are some indications that higher levels of placental growth hormones could also be the reason. Admittedly, the exact mechanism is unknown.
There are multiple mechanisms by which sex hormones influence rhinitis. The nasal mucosa of humans has estrogen, progesterone, and androgen receptors. Estrogen exposure can lead to squamous metaplasia, interepithelial edema, glandular hyperplasia, deposition of fibrous tissue, and increased vascularity. [6] , [7] Both estrogen and progesterone can increase the H1 histamine receptor mRNA expression in the nasal epithelial cells. [8] Immediate hypersensitivity reactions and mast cell degranulation can be triggered by nasal mucosal exposure to estrogen or progesterone. [9] Eosinophilic adhesion to mucosal endothelial cells can also be regulated by estrogen with both estrogen and progesterone increasing degranulation.[10] Sex hormones can also regulate antibody production.
Lastly, there is also some small evidence that menopause is associated with more allergic rhinitis. [11]
Let’s move on to thyroid hormones. Basically, individuals with allergic rhinitis have a higher incidence of hypothyroidism. [12] Hypothyroidism can also lead to the risk of upper respiratory and sinonasal infections. Concomitant treatment for the hypothyroidism and the allergic rhinitis is more effective than just for one indication alone. [13]
While writing this blog, I am recalling a patient who had allergic rhinitis that came on gradually over a few years, first just seasonal, and then every day year-round. Her severe daily symptoms required seasonal and then year-round daily use of cetirizine, despite other natural attempts to address her condition. Suddenly, for no known reason, symptoms completely resolved and there was no need for cetirizine with no other known explanation except treatment for her subclinical hypothyroid with levothyroxine. Not a day since has she had any episodes of allergic rhinitis. Just sayin’………
References:
[1] Wei J, Gerlich J, Genuneit J, et al. Hormonal factors and incident asthma and allergic rhinitis during puberty in girls. Ann Allergy Asthma Immunol 2015;115:21-7 e2.
[2] Philpott C, El-Alami M, Murty G. The effect of the steroid sex hormones on the nasal airway during the normal menstrual cycle. Clin Otolaryngol Allied Sci 2004; 29:138-42.
[3] Haeggstrom A, Ostberg B, Stjerna P, Graf P, Hallen H. Nasal mucosal swelling and reactivity during a menstrual cycle. ORL J Otorhinolaryngol Relat Spec 2000;62:38-42.
[4] Espersen J, Weber U, Romer-Franz A, Lenarz T, Stolle SRO, Warnecke A. Leve lof sex hormones and their association with acetylsalicylic acid intolerance and nasal polyposis. PLoS One 2020; 15:e0243732.
[5] Ellegard E, Hellgren M, Toren K, Karlsson G. The incidence of pregnancy rhinitis. Gynecol Obstet Invest 2000;49:98-101.
[6] Helmi A, El Ghazzawi I, Mandour M, Shehata M. The effect of oestrogen on the nasal respiratory mucosa. An experimental histopathological and histochemical study. J Laryngol Otol 1975;89:1229-41.
[7] Toppozada H, Toppozada M, El-Ghazzawi I, Elwany S. The human respiratory nasal mucosa in females using contraceptive pills. An ultramicroscopic and histochemical study. J Laryngol Otol 1984; 98:43-51.
[8] Hamano N, Terada N, Maesako K, Ikeda T, Fukuda S, Wakita J, et al. Expression of histamine receptors in nasal epithelial cells and endothelial cells-the effects of sex hormones. Int Arch Allergy Immunol 1998;115:220-227.
[9] Pelikan Z. Possible immediate hypersensitivity reaction of the nasal mucosa to oral contraceptives. Ann Allergy 1978; 40:211-9.
[10] Hamano N, Terada N, Maesako K, Numata T, Konno A. Effect of sex hormones on eosinophilic inflammation in nasal mucosa. Allergy Asthma Proc 1998; 19:263-9.
[11] Richard G Chiu , Kamal Eldeirawi , Anthony I Dick , Sharmilee M Nyenhuis , Thasarat Sutabutr Vajaranant , Rachel Caskey , Victoria S Lee . Association of Menopause and Rhinitis Among Adult Women in the United States: Findings from the All of Us Research Program. Laryngoscope. 2025 Jan 24. doi: 10.1002/lary.32015. Online ahead of print.
[12] Degirmenci P, Kirmaz C, Oz D, Bilgir F, Ozmen B, Degirmenci M, et al. Allergic rhinitis and its relationship with autoimmune thyroid diseases. Am J Rhinol Allergy 2015; 29:257-61.
[13] Gamzatova A, Gadzhimirzaev G, Abusuev S, Gamzatova E. Treatment of allergic rhinitis associated with hypothyroidism. Vestn Otorinolaringol 2006;34-7.
