Rhinitis medicamentosa

Source: Wikipedia, the free encyclopedia.
Rhinitis medicamentosa
Other namesRebound congestion
SpecialtyOtorhinolaryngology
SymptomsNasal congestion
Usual onsetAfter 5–7 days of use of topical decongestant nasal sprays
CausesOveruse of decongestant nasal sprays and certain oral medications
PreventionLimiting use of decongestant nasal sprays and other potentially problematic medications
TreatmentCeasing use of offending medications

2-imidazolines) that constrict blood vessels in the lining of the nose, although evidence has been contradictory.[1]

Presentation

The characteristic presentation of RM involves

turbinate hypertrophy, which may block nasal breathing until surgically removed.[3]

Commercial introduction of oxymetazoline brand Afrin. The prolonged use of nasal vasoconstrictors causes rhinitis medicamentosa.

Pathophysiology

The

squamous cell metaplasia.[2]

Direct acting

beta-receptor stimulation to emerge.[5]

parasympathetic activity can result in increased secretions and nasal edema.[6][7] Evidence suggests that if oxymetazoline is used only nightly for allergic rhinitis (instead of more frequent dosage as may be directed on product label), it may be used longer than one week without high risk of rhinitis medicamentosa especially with use of intranasal steroid like fluticasone furoate.[8]

Treatment

The treatment of RM involves withdrawal of the offending nasal spray or oral medication. Both a "cold turkey" and a "weaning" approach can be used. Cold turkey is the most effective treatment method, as it directly removes the cause of the condition, yet the time period between the discontinuation of the drug and the relief of symptoms may be too long and uncomfortable for some individuals (particularly when trying to go to sleep when they are unable to breathe through their nose).

The use of

over-the-counter (OTC) saline nasal sprays may help open the nose without causing RM if the spray does not contain a decongestant.[8] Symptoms of congestion and runny nose can often be treated with corticosteroid nasal sprays under the supervision of a physician. For very severe cases, oral steroids or nasal surgery
may be necessary.

A study has shown that the anti-infective agent benzalkonium chloride, which is frequently added to topical nasal sprays as a preservative, aggravates the condition by further increasing the rebound swelling.[9]

See also

References

  1. PMID 23375990
    .
  2. ^
    PMID 16784007
    . Retrieved 29 April 2015.
  3. ^ Rhinitis Medicamentosa at eMedicine
  4. ISBN 978-1-118-68590-7
    .
  5. S2CID 43718145
    .
  6. PMID 2568728
    .
  7. PMID 6192384
    .
  8. ^
    PMID 21377716
    .
  9. S2CID 19989791
    .

Further reading

External links

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