Specialist article: Nose
Allergy and nasal breathingWhat the nose does during hay fever
Your nose runs, then it is blocked, and your mouth takes over? Here you will learn what happens in the nose with hay fever and allergic rhinitis, why it works as a filter and laboratory, what studies show about mouth breathing and allergy, and why, in our view, healthy nasal breathing brings benefits. It is a pattern of breathing, swallowing and head balance.
Does this sound familiar?
First your nose runs, then it is blocked?
What applies to you?
Tap whatever applies to you.
If several of these apply, it is worth looking at two things. The allergy itself belongs in medical hands. How you breathe helps determine how much pollen gets deeper into the airways. And this pattern can be trained.
What the nose filtersHow the mouth takes overThe key points at a glance
- Hay fever is an allergic rhinitis. The nasal mucosa reacts to harmless substances such as pollen, swells and blocks the nose. The allergy itself requires medical treatment.
- The nose filters, warms and humidifies the air we breathe and enriches it with nitric oxide. Mouth breathing bypasses this route, was associated with more asthma in studies and is therefore, in our view, harmful.
- In our view, healthy nasal breathing brings benefits with allergies. It is a pattern of breathing, swallowing and head balance, does not replace allergy treatment and creates the conditions for the nose to be able to fulfil its protective tasks.
Video
Allergies and hay fever: what breathing has to do with them
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Fundamentals
What happens in the nose during hay fever
An allergy is a misjudgement by the immune system. It considers a harmless substance dangerous and fights it off.
Pollen, house dust mites or animal hair are not actually a threat. In an allergy, however, the immune system forms IgE antibodies against them. When the substance comes into contact with the mucosa again, immune cells release messenger substances such as histamine, and the mucosa swells and produces mucus. In the nose this is called allergic rhinitis. If pollen is the trigger, it is called hay fever.
What you feel as a blocked nose is swollen mucosa. The nasal turbinates carry a network of blood vessels that fills up considerably during an allergic reaction. The passage becomes narrow. How this alternates between left and right over the course of the day is described in the article on the nasal septum.
That is why the nose runs first and then becomes blocked. Both come from the same mucosa.
of adults in Germany had, according to a survey by the Robert Koch Institute, been diagnosed by a doctor with allergic rhinitis at some point, often with the eyes also affected1
were suffering from at least one allergic condition at the time of the same survey1
had antibodies in their blood against common airborne allergens, examined in 7,025 adults2
So around a third of adults are sensitised, but only some of them are noticeably allergic. In our view, whether antibodies turn into symptoms also depends on how much allergen reaches the mucosa. This is where the nose comes in.
Symptoms
Allergic rhinitis: symptoms and triggers
Hay fever does not only show up in the nose. The symptoms range from the eyes to the bronchi.
Sneezing
Often in bouts, especially in the morning and after time spent outdoors.
Runny nose
Clear, watery discharge runs from the nose.
Blocked nose
The mucosa swells, on one side or on both. The air switches to the mouth.
Itching
The nose, palate or ears itch and tingle.
Eyes
Red, watery or itchy eyes are often part of it.
Cough and tight chest
A sign that the reaction is reaching the lower airways. This should be checked by a doctor.
Pollen is released at different times depending on the plant. Hazel and alder often start as early as late winter, birch follows in spring, grasses in summer and herbs such as mugwort in late summer.
House dust mites, animal hair and mould spores, on the other hand, are present all year round; this is referred to as perennial allergic rhinitis. If the swelling persists for a long time, the openings of the sinuses can also become narrow; more on this in the article on sinusitis.
Nasal function
The nose as a filter
Before a pollen grain reaches the bronchi, it has to get past the nose. That is what the nose is built for.
At the entrance of the nose, the nasal hairs catch larger particles. Behind them, the nasal turbinates guide the air in narrow, winding channels past a large area of mucosa. In the process, the air is warmed and humidified, and particles come into contact with the moist surface.
There they get stuck in the mucus. Tiny cilia continuously push this mucus towards the throat, where it is swallowed without being noticed. In this way, the nose continuously cleans itself.
How much the very front part of this filter alone contributes was examined by a research group from Ankara in 233 people with hay fever. They compared the density of nasal hair with who also had asthma3.
of people with few or no nasal hairs also had asthma in addition to hay fever3
was the figure among those with a lot of nasal hair, in the same study3
The study shows an association, not proof. But it is consistent with the anatomy. The better the nose filters, the less allergen reaches the deeper airways, provided the air actually flows through the nose.
Like a porch in front of the front door
A porch holds back dirt and cold before they get into the home. Anyone who constantly comes in through the patio door brings the dirt in anyway. That is how we see the nose. It is the intended entrance for the air we breathe, and the mouth a side entrance for great exertion. In our view, healthy nasal breathing is an important part of the recipe with which the body shields itself against germs and allergens.
Nitric oxide
More than a filter: the nose’s laboratory
The nose does not just clean the air. It also adds something to it.
Nitric oxide, NO for short, is continuously produced in the paranasal sinuses. In 1995, a research group at the Karolinska Institute in Stockholm found very high concentrations in the air of the sinuses, produced by their mucosa. NO has an antibacterial effect, and the researchers see this as a contribution to defence against germs4. With nasal breathing, it travels with the airflow into the lungs. A year later, the same group examined whether this is measurable5.
The nose is a filter, air conditioner and laboratory all at once.It cleans, warms and humidifies the air we breathe and enriches it with nitric oxide. With mouth breathing, this conditioning does not take place.
higher was the oxygen value measured through the skin in 6 out of 8 healthy people during nasal breathing, compared with mouth breathing5
was the rise in blood oxygen in 6 long-term ventilated patients when air from their own nose was fed in5
The studies are small and do not concern allergy, but they show that the nose is more than an air channel. In our understanding, mouth breathing is therefore harmful. Cool, dry and unfiltered air hits the throat and bronchi directly, germs and allergens get deeper, and the NO of the sinuses is missing. The deeper mucous membranes have to do defence work that the nose otherwise takes off them. In our view, this makes you more susceptible to infections and keeps irritation going for longer.
Mouth breathing
Blocked nose with allergies: how the mouth takes over
Allergy and mouth breathing are linked in both directions. That is what makes the connection so persistent.
One direction is obvious. If your nose is blocked, you breathe through your mouth. In a study of children aged three to nine in a small Brazilian town, allergic rhinitis was the most common cause of mouth breathing, found in 81.4% of mouth breathers. In many children, several causes came together, such as enlarged adenoids6.
The allergen hits the mucosa
Pollen or dust mite particles land in the nose.
The mucosa swells
The nose becomes narrow, especially at night and when lying down.
The mouth steps in
The air takes the easier route and bypasses the nose’s filter.
More allergen reaches the airways
Unfiltered, cool and dry air hits the throat and bronchi.
The pattern becomes ingrained
The nose is used less, and mouth breathing often persists beyond the season.
The other direction is less well known. In the Japanese Nagahama Study, 9,804 adults were asked about mouth breathing and pre-existing conditions, in addition to blood tests and lung function tests7. There, mouth breathing was associated with asthma, even when the researchers adjusted for hay fever.
of respondents said they breathe through their mouth7
was the statistical chance of asthma with mouth breathing alone, compared with people without mouth breathing and without allergic rhinitis (odds ratio 1.85)7
was it when mouth breathing and allergic rhinitis occurred together (odds ratio 4.09)7
In people without asthma, mouth breathing was also associated with more frequent sensitisation to house dust mites, more eosinophilic immune cells in the blood and weaker lung function7. The authors suggest that the mouth bypasses the protective function of the nose and lets more allergen into the airways.
A survey study shows associations, not a cause. But if you follow the work of the nose, the conclusion suggests itself that mouth breathing in allergy is not only a consequence. It is common and can even be a trigger and amplifier, because it bypasses the defences of the nose. As with a bicycle chain, one link engages the next. Unfiltered air irritates the mucous membrane, the swelling keeps the mouth open, and with every season the pattern becomes more ingrained.
Self-test: close your lips and breathe calmly through your nose for one minute. How do you feel?
Nose and bronchi
From the nose to the bronchi: the change of level
The nose and bronchi are two sections of the same airway. What begins at the top can spread downwards.
When hay fever turns into allergic asthma, this is called a change of level. The allergy moves one floor down, from the nose into the bronchi. Behind this is the idea of a shared airway, known as “one airway”.
A European long-term study followed 6,461 adults aged between 20 and 44 who had no asthma at the start, over almost nine years8.
of people with allergic rhinitis developed asthma during this period; among people without allergy and without rhinitis it was 1.1 %8
was the risk of new asthma with allergic rhinitis, after adjusting for age, sex, weight, smoking and other factors8
The role the airway plays is shown by an older experiment with young people with asthma. When they were allowed to breathe naturally during treadmill training, most opened their mouths. When they had to breathe through the nose, the narrowing of the bronchi afterwards was almost completely absent. With pure mouth breathing it was more pronounced9.
Coughing, wheezing or shortness of breath with hay fever should be clarified by a doctor. Training nasal breathing can be combined with asthma treatment.
The triad
Nasal breathing is a pattern
A clear nose alone is not enough. What matters is whether the body chooses it as its airway, even when nobody is paying attention.
In our view, nasal breathing depends on three basic functions that support one another: breathing, swallowing and head balance. After every swallow, the tongue rests against the palate and the lips lie loosely together. This tongue reference position seals the oral cavity, and the air takes the route through the nose.
When the head is balanced above the body, the space in the throat stays open. If it moves forward, in our view the mouth opens more easily. Because you swallow many hundreds to thousands of times a day, this interplay is constantly readjusted.
The allergy itself begins in the immune system. Whether the nose is used as a filter, however, is decided by the breathing pattern. If mouth breathing is not due to an acutely blocked nose, in our view its cause usually lies in the pattern, that is, in the basic functions. This triadic functional circuit stands at the beginning of many causal chains.
Then there is the tissue. What is integrated into a function is used and keeps its tension. What is not used becomes slack. A nose through which little breathing has taken place for years loses the stimulus of the airflow, and its mucous membrane tends more to swell. If nasal breathing becomes the rule again in everyday life, it gets this stimulus back. Users tell us that their hay fever complaints have decreased considerably since they started breathing through the nose. This is individual experience and not a promise.
The allergy is a matter of the immune system. Nasal breathing is a matter of pattern.One belongs in medical hands. The other can be trained, and the two are not mutually exclusive.
Children
Allergy in children: pay attention to breathing
In children, the face and jaws are still growing. How they breathe therefore affects more than just the nose.
Children with allergies often breathe through their mouth, often at night and unnoticed. In the Brazilian study of three- to nine-year-olds, these were the most common signs of mouth breathing6. You can find more about night-time breathing noises in the article on snoring and sleep apnoea.
Sleeping with the mouth open
The most common sign, in 86 % of mouth breathers.
Snoring
In 79 % of mouth breathers.
Itchy nose
In 77 %, typical of allergic rhinitis.
Damp pillow
Saliva on the pillow in 62 %.
Restless sleep
Sleep problems or restless sleep in 62 %.
Irritable during the day
Irritability during the day in 43 %.
An older study from North America compared 30 allergic mouth breathers with 15 non-allergic nasal breathers, all aged six to twelve. On X-ray, the mouth breathers had on average longer faces, a narrower upper jaw and more often a crossbite10. Such a study cannot show which came first, and the groups are small.
Your child’s allergy should be treated by a paediatrician. For children there is a separate exercise plan with the FaceFormer ZERO made of softer material; find out more under FaceFormer for children.
Treatment
What helps with allergies: medicine and your own contribution
The allergy itself is treated by a doctor. Your breathing pattern is the part you have in your own hands.
It starts with a diagnosis by skin or blood test. After that, three approaches come into question, often combined: reducing contact with the allergen, relieving symptoms with medication, for example antihistamines or cortisone-containing nasal sprays, and, for suitable allergies, hyposensitisation, also known as specific immunotherapy. It targets the immune system itself and runs over several years.
after the end of three to four years of hyposensitisation against grass pollen, symptoms in a randomised study remained as low as in those who continued treatment11
with 747 participants were analysed in a Cochrane review of nasal irrigation with saline solution. The irrigations possibly relieved symptoms considerably; the quality of the evidence was low12
These treatments have their firm place. They do not address the airway you choose, and this also applies to decongestant sprays and procedures on the nose. Once the nose is clear again, the mouth often stays open nevertheless, because the pattern has become ingrained. This is where the training comes in, as a complement, not as a replacement.
Decongestant nasal spray
It provides air by constricting the blood vessels of the mucous membrane and is intended for a few days. Used for weeks, the mucous membrane gets used to it and swells more without the spray, the so-called rhinitis medicamentosa13. In our view, constant use attacks precisely the mucous membrane whose filtering work you need. No spray changes how you breathe.
Procedure on the nose
A reduction of the turbinates creates space, but in our view it usually treats the symptom, the narrow nose, and not the pattern behind it. Then there are risks. If too much mucous membrane is removed, empty nose syndrome can develop. The nose is then wide and nevertheless feels blocked, dry and crusty, because the tissue that warms, humidifies and senses the airflow is missing.
Medical allergy treatment
- Identifies what you are allergic to
- Dampens the reaction with medication
- Can modulate the immune system (hyposensitisation)
- In the hands of your medical practice
Training the basic functions
- Addresses the breathing pattern, not the allergy
- Practises breathing, swallowing and head balance in one sequence
- Creates the conditions for the nose to be able to filter
- In your own hands
The two approaches do not replace each other. They work at different points and can be combined. More on this under FaceFormer and other treatments.
Putting this into context also means looking at what is missing. There is no study on FaceFormer training for allergies. The individual building blocks are supported by evidence: the filter function, NO and the link between mouth breathing and asthma. The absence of a study does not mean that the link does not exist. It means that it has not been tested. Studies on the method are presented on the studies page.
If you take antihistamines, cortisone nasal spray or asthma medication on medical advice, above all the reliever inhaler, do not stop them on your own. If you have needed a decongestant spray for some time, discuss coming off it with your practice. The training can be combined with any of these treatments.
Training
Training nasal breathing: creating the conditions
The resolution to breathe through your nose often only lasts until the next flight of stairs. A breathing pattern is a stored sequence, and it changes through precise, frequent repetition. That is why in FaceFormer training you practise lip closure, tongue reference position, swallowing, nasal breathing and head balance in one sequence, with the FaceFormer resting in the oral vestibule. You start with the basic exercise.
From around week 3, the pull exercise is added. You press the lip wedge together with your lips for six seconds while gently pulling it forward with your thumb and index finger. Your lips hold against the pull, your head stays upright, and you breathe through your nose the whole time.
Then you briefly bite down with your back teeth and swallow once. In this way, the exercise combines mouth closure, nasal breathing and swallowing.
- From day 1
Basic exercise
Three times a day for a few minutes with the FaceFormer ZERO.
- From around week 3
Pull exercise and night
The pull exercise is added. At night you wear the FaceFormer ZERO as soon as you have mastered the basic exercise.
- After a few weeks
Switching to the ONE
During the day, you train with the FaceFormer ONE. It is the same size and shape as the ZERO, just made of firmer material.
- From around week 6
Breathing exercise
The breathing exercise combines the training with calm nasal breathing and breathing pauses.
- Over 6 to 12 months
The pattern runs by itself
This is the time frame the exercise manual allows for; after that, maintenance training is enough.
If your nose is only partly blocked, continue training as usual as long as enough air still flows through your nose. If it is completely blocked during the pollen season or the mucous membrane is acutely inflamed, take a short break and resume as soon as your nose lets enough air through. The free FaceFormer app guides you through the basic exercises, and all modules are available on the exercise pages.
Everyday life
Hay fever season: nasal breathing in everyday life
Lips closed, nose open
Lips resting lightly together, the tip of your tongue at its reference point behind the upper front teeth. This way the air takes the route through your nose.
Rinse your nose
Saline solution rinses out pollen and secretions and can be combined with medication.
Keep pollen outside
Do not take off your outdoor clothes in the bedroom, and wash your hair in the evening. This means less pollen ends up on your pillow.
Build up gradually when exercising
First breathe through your nose while walking and build up from there. If you have exercise-induced asthma, keep your emergency inhaler with you.
Pay attention to your mouth at night
If you wake up with a dry mouth, you are probably breathing through your mouth at night. Taping your mouth shut is not a solution; you can read why in the article on mouth taping.
Questions
Frequently asked
What is the difference between hay fever and allergic rhinitis?
Allergic rhinitis is the umbrella term for a runny or blocked nose caused by an allergy. Hay fever is the form triggered by pollen, which is why it occurs in certain months. If you react to house dust mites, animal hair or moulds, it is called perennial allergic rhinitis.
Why is the nose blocked during an allergy?
During an allergic reaction the nasal mucosa swells, especially at the nasal turbinates, where there is a dense network of blood vessels. On top of that comes mucus. When lying down and at night, the nose often becomes narrower. The air then switches to the mouth.
Does healthy nasal breathing bring benefits with allergies?
In our view, yes, even if it does not end the allergy, because that arises in the immune system. The nose filters pollen and dust before they reach the bronchi, and in studies mouth breathing was associated with more asthma and more frequent sensitisation to house dust mites. Users tell us that their complaints have decreased considerably, and some experience a season almost without complaints. This is individual experience and not a promise; there is no study on the training in allergies.
Can I train with the FaceFormer if I have hay fever?
Yes, as long as enough air still flows through your nose, even if it is not completely clear. If it is completely blocked during the acute phase or the mucosa is inflamed, take a short break and start again as soon as your nose lets enough air through. The training can be combined with allergy medication and hyposensitisation.
Should I stop using my nasal spray if I am training nasal breathing?
Do not stop prescribed remedies such as cortisone nasal spray, antihistamines or asthma medication on your own; discuss changes with your practice. Decongestant sprays are a different matter. They are intended for a few days; used for weeks, the mucous membrane gets used to them and swells more without the spray. It is best to plan coming off them with your practice. The training addresses the breathing pattern and can be combined with both.
Do nasal rinses help with hay fever?
A Cochrane review of 14 studies found indications that rinsing with saline solution can relieve symptoms of allergic rhinitis. However, the quality of the evidence was low, and there were no data beyond three months.
Is my child breathing through the mouth because of the allergy?
That is quite possible. In a study of children aged three to nine, allergic rhinitis was the most common cause of mouth breathing, often together with enlarged adenoids. Have the allergy treated by a paediatrician and also keep an eye on your child’s breathing.
Does the training help with histamine intolerance?
Histamine intolerance is not an allergy. According to the common explanation, the body breaks down histamine from food less effectively, whereas in allergic rhinitis the immune system itself releases histamine. A connection with the breathing pattern has not been demonstrated. The training targets the basic functions of breathing, swallowing and head balance, not histamine breakdown. If you suspect it, have it clarified by a doctor.
Does the FaceFormer also help with asthma or COPD?
The FaceFormer is not a remedy for a particular diagnosis, but the training device for the basic functions of breathing, swallowing and head balance. There is no study on the training in asthma or COPD. The article on Asthma and nasal breathing classifies in detail the finding that mouth breathing was associated with more asthma in studies.
More articles from the knowledge section
Where to go next
Sources
- Langen U, Schmitz R, Steppuhn H (2013). Häufigkeit allergischer Erkrankungen in Deutschland. Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 56(5-6):698-706. PMID 23703488. Source
- Haftenberger M, Laußmann D, Ellert U, Kalcklösch M, Langen U, Schlaud M, Schmitz R, Thamm M (2013). Prävalenz von Sensibilisierungen gegen Inhalations- und Nahrungsmittelallergene. Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 56(5-6):687-697. PMID 23703487. Source
- Ozturk AB, Damadoglu E, Karakaya G, Kalyoncu AF (2011). Does nasal hair (vibrissae) density affect the risk of developing asthma in patients with seasonal rhinitis? International Archives of Allergy and Immunology 156(1):75-80. PMID 21447962. Source
- Lundberg JO, Farkas-Szallasi T, Weitzberg E, Rinder J, Lidholm J, Änggård A, Hökfelt T, Lundberg JM, Alving K (1995). High nitric oxide production in human paranasal sinuses. Nature Medicine 1(4):370-373. PMID 7585069. Source
- Lundberg JO, Settergren G, Gelinder S, Lundberg JM, Alving K, Weitzberg E (1996). Inhalation of nasally derived nitric oxide modulates pulmonary function in humans. Acta Physiologica Scandinavica 158(4):343-347. PMID 8971255. Source
- Abreu RR, Rocha RL, Lamounier JA, Guerra AF (2008). Etiology, clinical manifestations and concurrent findings in mouth-breathing children. Jornal de Pediatria (Rio de Janeiro) 84(6):529-535. PMID 19060979. Source
- Izuhara Y, Matsumoto H, Nagasaki T et al., Nagahama Study Group (2016). Mouth breathing, another risk factor for asthma: the Nagahama Study. Allergy 71(7):1031-1036. PMID 26991116. Source
- Shaaban R, Zureik M, Soussan D et al. (2008). Rhinitis and onset of asthma: a longitudinal population-based study. The Lancet 372(9643):1049-1057. PMID 18805333. Source
- Shturman-Ellstein R, Zeballos RJ, Buckley JM, Souhrada JF (1978). The beneficial effect of nasal breathing on exercise-induced bronchoconstriction. American Review of Respiratory Disease 118(1):65-73. PMID 677559. Source
- Bresolin D, Shapiro PA, Shapiro GG, Chapko MK, Dassel S (1983). Mouth breathing in allergic children: its relationship to dentofacial development. American Journal of Orthodontics 83(4):334-340. PMID 6573147. Source
- Durham SR, Walker SM, Varga EM et al. (1999). Long-term clinical efficacy of grass-pollen immunotherapy. New England Journal of Medicine 341(7):468-475. PMID 10441602. Source
- Head K, Snidvongs K, Glew S, Scadding G, Schilder AG, Philpott C, Hopkins C (2018). Saline irrigation for allergic rhinitis. Cochrane Database of Systematic Reviews 6:CD012597. PMID 29932206. Source
- Zucker SM, Barton BM, McCoul ED (2019). Management of Rhinitis Medicamentosa: A Systematic Review. Otolaryngology Head and Neck Surgery 160(3):429-438. PMID 30325708. Source
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The free FaceFormer app guides you through the basic exercises, counts along and reminds you of your sessions. If you wish, a practice from the practitioner directory can support you.
FaceFormer ZERO + ONE
Both material hardnesses for getting started, day and night. The set for adults.
FaceFormer ZERO
The softer FaceFormer for getting started, for children and for the night.
FaceFormer ZERO Children’s Set
ZERO with hygiene box, plush bag and success book with stamp.
FaceFormer training aims to restore the physiological setting of the basic functions of breathing, swallowing and head balance, with lip closure and the tongue reference position, thereby creating the conditions under which symptoms can improve. It does not replace a medical assessment. You can find practitioners near you in the practitioner directory.
