Vasomotor rhinitis
From Wikipedia, the free encyclopedia
| ICD-10 | J30.0 |
|---|---|
| ICD-9 | 477.9 |
| DiseasesDB | 13772 |
| MedlinePlus | 001648 |
| eMedicine | ent/402 |
| MeSH | D012223 |
Vasomotor rhinitis is a form of rhinitis that is not related to allergic reactions, but which is characterized by many of the same symptoms, such as a chronic running nose with intermittent sneezing, rhinorrhea and blood-vessel congestion of the nasal mucus membranes. Vasomotor rhinitis is to be distinguished from sinus infection or other forms of allergy.
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[edit] Causes
Vasomotor rhinitis is also known as non-allergenic rhinitis, because it often has the same symptoms as allergies, but has different causes. Whereas allergenic rhinitis conditions (such as hayfever) are the result of the immune system overreacting to environmental irritants (pollen, etc), vasomotor rhinitis is believed to be caused by oversensitive or excessive blood vessels in the nasal membrane. These blood vessels (which are controlled in turn by the autonomic nervous system) contract or dilate in order to regulate mucus flow and congestion. But in the vasomotor rhinitis sufferer, oversensitive or excessive blood vessels causes an overreaction to such stimuli as changes in weather, temperature, or barometric pressure, chemical irritants such as smoke and aerosol sprays, psychological stress and emotional shocks, certain types of medications, and even spicy food. Thus, while a normal person's nose may run on a very cold day, a vasomotor rhinitis sufferer's nose may start running (or go completely dry) simply by walking into a slightly colder (or slightly warmer) room. While a normal person may tolerate a certain degree of cigarette smoke, the vasomotor rhinitis sufferer may experience significant discomfort from the same level of smoke. The pathology of vasomotor rhinitis is in fact not very well-understood and more research is needed.
Many patients can be subject to vasomotor rhinitis and allergic rhinitis simultaneously.
[edit] Symptoms
Recurring nasal inflammation, swelling of the nasal membrane or profuse watery nasal discharge might signal vasomotor rhinitis. Swelling of the nasal tissues can cause headaches. Some people start sneezing when walking from a cold air-conditioned room into warmer air.
[edit] Treatment
Vasomotor rhinitis cannot be cured completely but can be brought under a measure of control. Avoidance of the irritants is a common sense method of controlling vasomotor rhinitis (though many irritants, such as weather changes, cannot of course be controlled).
Currently in the United States, one medication exists for the effective management of vasomotor rhinitis: ipratropium bromide (Atrovent Nasal). Ipratropium bromide is an anticholinergic medication that blocks the sympathetic innervation of the vasculature of the nasal mucosa. Ipratropium bromide is available in 0.03% and 0.06% concentrations and can be used as a single spray to each side of the nose up to four times per day. Patients are typically advised to titrate frequency of use to comfort. Excessive use may result in an overly dry nose. An effective treatment modality is to use ipratropium bromide 30 minutes or more prior to contacting a known irritant (such as cold air).
Nasal corticosteroid sprays may be prescribed, and often work well when used regularly. These control inflammation of the nasal tissues.
Oral decongestants, such as pseudoephedrine-based pills, may provide benefit, but are associated with side-effects such as nervousness and jitteriness, insomnia, hypertension, and so on. (Pseudoephedrine is a sympathomimetic drug, which means that it simulates the effect of fight-or-flight chemicals, such as adrenaline, in the body.) A trial and error reduction of dosage may alleviate the side-effects while maintaining the effectiveness.
Decongestant nasal sprays (as opposed to oral decongestants) are not recommended. These may provide short term relief, but excessive use may result in "rebounding" -- the nasal blood vessels get even more hypersensitive. Overuse or addiction to decongestant nasal sprays is actually a cause of vasomotor rhinitis.
Antihistamines are designed for use in allergic rhinitis and, while considered safe, are rarely effective. Interestingly, azelastine, the only topical antihistamine spray currently available in the United States, has shown some benefit in non-allergic or vasomotor rhinitis.
Many patients find irrigation with nasal saline spray alleviates symptoms. Nasal saline spray dilutes irritants and mitigates their effects. (Stir one teaspoon of non-iodised salt into 500 millilitres of boiled or distilled water, and pour into nasal spray dispensers when cool).
For some patients, especially those with severe non-allergenic rhinitis which often produces large amounts of thick mucous, rinsing is the preferred treatment. The nasal passages and sinuses are flooded with liquid. The solution should be a pH balanced solution containing sodium chloride and sodium bicarbonate. Rinsing can also be used as part of the healing process after sinus or nasal surgery. For this rinse, boiled or distilled water is only necessary during recovery from surgery, as the entire contents of the bottle is used. That's assuming the water is safe to drink.
