Exercise is effective in improving nasal congestion


Vasomotor rhinitisIndicationsVasomotor rhinitis is a chronic, non-allergic and non-infectious cold that manifests itself in a runny or blocked nose. The symptoms are caused or made worse by various triggers, such as strong odors, smoke, dust, changes in temperature and pressure. Azelastine, glucocorticoid and ipratropium bromide nasal sprays are mainly recommended for drug treatment. Saltwater rinses can also relieve the discomfort.

Synonymous: vasomotor rhinopathy, hyperreflective rhinopathy, idiopathic rhinitis, vasomotor rhinitis, vasomotor rhinitis

Symptoms

Vasomotor rhinitis manifests itself as a chronic watery, runny and / or blocked nose. The symptoms are similar to hay fever, but occur year-round and without involvement of the eyes. Both diseases can also occur together. Other possible symptoms are the urge to sneeze, itch, headache, frequent swallowing and coughing.

Causes and Triggers

Vasomotor rhinitis is a non-allergic and non-infectious rhinitis. The exact causes are unknown. The most common of several hypotheses is based on an imbalance of the autonomic nervous system and an increased sensitivity of the mucous membrane ("nasal hyperreactivity"). The symptoms are triggered or worsened by certain factors. This includes:

  • Odors such as perfume, fresh paint, chemical irritants and solvents
  • Smoke, dust, wind
  • Emotions, stress, fatigue
  • alcohol
  • Hot and hot spices, e.g. cayenne pepper, pepper
  • Changes in temperature and pressure, humidity
  • Bright light
  • Dry air, e.g. air conditioning

The condition is therefore also referred to as "hyperreflective rhinopathy", which is technically more correct. Other triggers such as drugs (rhinitis medicamentosa) or hormones (pregnancy rhinitis) do not belong to vasomotor rhinitis.

diagnosis

So far there is no specific test. The diagnosis is made during medical treatment based on the patient's history, physical examination, laboratory methods (allergy test) and by excluding other causes. Possible differential diagnoses include other rhinitis such as allergic diseases (hay fever, year-round allergic rhinitis), nasal polyps, and infectious causes such as a cold and acute sinusitis.

Non-drug treatment

The triggers should be identified and avoided if possible. Sport and sauna visits should have a positive effect. In severe cases, surgery may be indicated.

Medication

Azelastine nasal sprays:

  • should be effective against all symptoms. They have been clinically studied and are approved in the United States for this indication. Azelastine is long-acting and only needs to be used twice a day. Oral antihistamines, however, are not recommended.

Glucocorticoid nasal sprays:

  • with active ingredients such as budesonide, mometasone, beclomethasone or triamcinolone acetonide are used for nasal congestion and some are approved for this indication. The drugs must be used regularly in order to develop their full effect.

Ipratropium bromide nasal sprays:

  • mainly help against a runny nose and are approved for this indication.

Mast cell stabilizer nasal sprays:

  • with cromoglicic acid can help against sneezing and nasal congestion. Frequent and regular use 4-6 times a day is a disadvantage.

Decongestant nasal sprays:

  • With oxymetazoline and other active ingredients, the nasal mucous membrane swells and inhibits secretion. If used for longer than 5-7 days, they can lead to rhinitis medicamentosa and, in our opinion, should not be used in this indication. Oral sympathomimetics, for example with phenylephrine or pseudoephedrine, should also not be used or should only be used with caution due to the possible side effects.

Moisturizing nasal sprays:

  • Salt water rinses and sprays are recommended as an additional measure and appear to be beneficial.

Capsaicin nasal sprays and botulinum toxin are also mentioned in the literature, and alternative remedies can also be tried.

literature
  • Agency for Healthcare Research and Quality (AHRQ)
  • Banov C.H., Lieberman P. Vasomotor Rhinitis Study Groups. Efficacy of azelastine nasal spray in the treatment of vasomotor (perennial nonallergic) rhinitis. Ann Allergy Asthma Immunol, 2001, 86 (1), 28-35 Pubmed
  • Garay R. Mechanisms of vasomotor rhinitis. Allergy, 2004, 59, Suppl 76, 4-9 Pubmed
  • Gehanno P., Deschamps E., Garay E., Baehre M., Garay R.P. Vasomotor rhinitis: clinical efficacy of azelastine nasal spray in comparison with placebo. ORL J Otorhinolaryngol Relat Spec, 2001, 63 (2), 76-81 Pubmed
  • Graf P., Enerdal J., Hallén H. Ten days' use of oxymetazoline nasal spray with or without benzalkonium chloride in patients with vasomotor rhinitis. Arch Otolaryngol Head Neck Surg, 1999, 125 (10), 1128-32 Pubmed
  • Kaliner M.A. The treatment of vasomotor nonallergic rhinitis. Clin Allergy Immunol. 2007, 19, 351-62 Pubmed
  • Lal D., Corey J.P. Vasomotor rhinitis update. Curr Opin Otolaryngol Head Neck Surg, 2004, 12 (3), 243-7 Pubmed
  • Medicine textbooks
  • Mastin T.T. Therapy choices beyond antihistamines. Vasomotor rhinitis, Adv Nurse Pract, 2001, 9 (11), 50-4 Pubmed
  • Pattanaik D., Lieberman P. Vasomotor rhinitis. Curr Allergy Asthma Rep, 2010, 10 (2), 84-91 Pubmed
  • Wheeler P.W., Wheeler S.F. Vasomotor rhinitis. Am Fam Physician, 2005, 72 (6), 1057-62 Pubmed
  • Winter M.W. Vasomotor rhinopathy. Current status of therapy. ENT practice today, 2006, 24, 121-133
author

Conflicts of Interest: None / Independent. The author has no relationships with the manufacturers and is not involved in the sale of the products mentioned.


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