Presentation
A re-presented with a permanently blocked nose. Working on radio and TV, he was using two bottles of Otrivine® per day for almost four years “so that I can breathe at night and sound normal on air”. [imj.ie]
She presented to me with bilateral nose congestion, blockage, running nose, headache & post nasal discharge since last 7 years on & off. On nose examination, bilateral turbinates hypertrophy with congestion seen. [youtube.com]
… Read More Non allergic rhinitis Presented by Wat Mitthamsiri, MD. December27, 2013 Read More Rhinitis, commonly known as a runny nose, is the medical term describing irritation and inflammation of some internal areas of the nose. [answer-me-up.com]
Sympathetic stimulation causes activation of alpha 1 and alpha 2 receptors present in the walls of the capacitance vessels which leads to decreased blood flow and constriction of venous sinusoids causing nasal decongestion. [drtbalu.blogspot.com]
Entire Body System
- Swelling
Topical corticosteroids such as budesonide and fluticasone propionate should be used to alleviate rebound swelling of the nasal mucosa. Where possible, avoiding exposure to BKC is recommended. [unboundmedicine.com]
The swelling of the nasal passages caused by rebound congestion may eventually result in permanent turbinate hyperplasia which may block nasal breathing until surgically removed. [morebooks.de]
After a certain period of time the effect of the nasal sprays wear off and the nasal mucosa swells even more than before. [chordate.com]
Clinical examination will reveal nasal mucosa swelling, erythematous and granular appearances. [statpearls.com]
Respiratoric
- Nasal Irritation
Nasal congestion • Intranasal corticosteroids (INS) – Local side effects: Rare and can be avoided with proper administration technique • Nasal irritation • Bleeding • Nasal septal perforation D V Wallace, et al., The diagnosis and management of rhinitis [slideshare.net]
Cardiovascular
- Hypertension
All should be avoided in patients receiving monoamine oxidase inhibitors because of the risk of provoking a hypertensive crisis. Links: rhinitis [gpnotebook.co.uk]
For patients with hypertension, when no other contraindications such as allergy to product ingredients are present, pharmacists may direct them to the nasal decongestant propylhexedrine marketed as Benzedrex (B.F. [pharmacytimes.com]
It may even exacerbate or complicate hypertension in certain individuals. Chronic use of these decongestants may also lead to nasal septum perforation or a nose deformity requiring surgical intervention. [rhinitismedicamentosa.net]
Nasal decongestant sprays should not be used if the patient has heart disease, diabetes mellitus, hypertension, thyroid disease, or trouble urinating due to an enlarged prostate gland. [uspharmacist.com]
These include aspirin, ibuprofen (Advil, Motrin IB, others), and high blood pressure (hypertension) medications, such as beta blockers. [mayoclinic.org]
- Heart Disease
hypertension, and ischemic heart disease, as well as interact with several other medications. [pharmacytimes.com]
Nasal decongestant sprays should not be used if the patient has heart disease, diabetes mellitus, hypertension, thyroid disease, or trouble urinating due to an enlarged prostate gland. [uspharmacist.com]
- Tachycardia
Both have short half-lives and peak concentrations and occur at 0.5 to 2.0 hours after oral administration. 2 Common adverse effects associated with oral decongestants include anxiety, insomnia, nervousness, palpitations, restlessness, and tachycardia [pharmacytimes.com]
As safety outcomes, lying and standing blood pressure and heart rate were measured at half-hourly intervals for the first 2 hours and hourly thereafter until either 4 hours had elapsed or no postural drop in blood pressure (or reflex tachycardia) was [atsjournals.org]
Neurologic
- Insomnia
Both have short half-lives and peak concentrations and occur at 0.5 to 2.0 hours after oral administration. 2 Common adverse effects associated with oral decongestants include anxiety, insomnia, nervousness, palpitations, restlessness, and tachycardia [pharmacytimes.com]
Nasal congestion • Oral decongestants – Pseudoephedrine (restricted prescription) – Phenylephrine (less effective) – Effective at relieving nasal congestion – Side effects: • • • • • Insomnia Loss of appetite Irritability Palpitations Elevated BP D V [slideshare.net]
Treatment
Rhinitis medicamentosa: a review of causes and treatment. Treatments in Respiratory Medicine, 4 (1), pp. 21-9. Graf P. Rhinitis Medicamentosa: a Review of Causes and Treatment. Treat Respir Med. 2005;4(1):21-9. PubMed PMID: 15725047. [unboundmedicine.com]
Results: The fluticasone group had a significantly increased histamine sensitivity after treatment, unlike the placebo group who had an unchanged or slightly decreased histamine sensitivity after treatment. [karger.com]
The most commonly reported treatment option was topical nasal steroids, although overall there was limited evidence on which to base treatment recommendation. [journals.sagepub.com]
This is the primary reason why the treatment of RM often fails. [nasalspray.com]
Treatment involves gradual weaning of topical decongestant, sometimes augmented by other anti-inflammatory or decongestant medications 1. Ultraviolet light phototherapy is a recognised treatment for allergic rhinitis 2. [imj.ie]
Prognosis
[…] turbinate steroid injections, oral adenosine and mast cell stabilizing agents; however, these recommendations are based on limited case reports. [2] Differential Diagnosis Allergic rhinitis Non-allergic rhinitis CPAP-related rhinitis Rhinosinusitis Prognosis [statpearls.com]
Prognosis Prognosis of rhinitis medicamentosa is favorable if underlying factors that led to overuse of intranasal decongestants are addressed and treated or have resolved, and patients adhere to recommendations to limit intranasal decongestants to short-term [emedicine.medscape.com]
Also Read: What is Vasomotor Rhinitis, Know its Causes, Symptoms, Risk Factors, Complications, Diagnosis Treatment of Vasomotor Rhinitis & its Prognosis, Prevention and Recovery Period How Safe & Effective is Capsaicin in Treating Non-Allergic Rhinitis [epainassist.com]
Etiology
Classification Allergic rhinitis Definition : acute or chronic rhinitis caused by exposure to an inhaled allergen Etiology Type I hypersensitivity reaction Genetic predisposition to atopy Clinical features Recurrent episodes of sneezing, nasal congestion [amboss.com]
Etiology The cause of this condition is primarily by the prolonged use (more than 7 to 10 days) of topical nasal decongestant. However, intranasal cocaine use has also been reported to cause a similar condition. [statpearls.com]
Etiology R A Sittipane, et al., Nonallergic Rhinitis, Am J Rhinol Allergy 27, S48–S51, 2013 33. [slideshare.net]
Few studies have explored etiologic causes, although it is recognized that sensory neuropeptides and cholinergic effecter discharges are involved in gustatory and senile rhinitis. [waojournal.biomedcentral.com]
[…] an increased nasal discharge. 4 ,5 If nasal decongestant sprays are used too often and/or for an extended period of time, they can cause nasal congestion to worsen, a well-documented rebound condition known as rhinitis medicamentosa. 6-9 A possible etiology [uspharmacist.com]
Epidemiology
Epidemiology: Thailand, adult C Bunnag, et al., Epidemiology of rhinitis in Thais, Asia Pac J Allergy Immunol. 2000;18:1-7. 20. [slideshare.net]
However, this is arguably open to debate as there is no evidence of worsening congestion in those who use intranasal corticosteroids containing BKC. [6] [7] [8] Epidemiology It occurs most commonly in young and middle-aged adults with a similar rate in [statpearls.com]
Settipane RA, Charnock DR: Epidemiology of rhinitis: allergic and nonallergic. Clin Allergy Immunol. 2007, 19: 23-34. 4. Settipane RA: Rhinitis: a dose of epidemiological reality. Allergy Asthma Proc. 2003, 24: 147-154. 5. [waojournal.biomedcentral.com]
[…] damage to human nasal epithelia or aggravation of rhinitis medicamentosa associated with intranasal products that contain BKC [11, 12, 13, 14, 15], intranasal products with BKC are generally safe and well tolerated for short-term and long-term use. [10] Epidemiology [emedicine.medscape.com]
Pathophysiology
Synonyms: Rebound rhinitis / chemical rhinitis Pathophysiology: The nasal mucous membrane is rich in resistance blood vessels draining into capacitance venous sinusoids. [drtbalu.blogspot.com]
The pathophysiology of the condition is unclear; however, vasodilatation and intravascular edema have both been implicated. [unboundmedicine.com]
Other ingredients (such as Naphazoline) and combination formulations make up the remaining 2% What Is The Pathophysiology Of Rhinitis Medicamentosa? The pathophysiology of RM is not completely understood. [nasalspray.com]
Pathophysiology Several hypotheses have been postulated with rhinitis medicamentosa, although the exact pathophysiology is still unknown [2] [10] [11] : Hypothesis 1: Chronic vasoconstriction leads to ischemia of the nasal mucosa, which predisposes to [statpearls.com]
Prevention
Preventing Rhinitis Medicamentosa Rhinitis medicamentosa is a condition that cannot be preventable. However, patients diagnosed with this condition must avoid the triggers in case they are known about it. [epainassist.com]
In cases of atrophic rhinitis, routine nasal lavage and lubrication can prevent the formation of crusts and help to keep the nasal lining moist. Daily irrigation of the nasal passages is good preventive practice. [medicalnewstoday.com]
Your doctor can make changes that do a better job preventing or reducing your symptoms. Jan. 23, 2019 [mayoclinic.org]
Patients should not touch nasal mucosa while spraying these products to prevent contamination of the contents. [uspharmacist.com]
While allergies are the most frequent cause of […] Read More Exercise Induced Rhinitis – can we prevent it? July 11, 2017 Often when exercising, some people get a runny nose. [rhinitismedicamentosa.net]