From the Guidelines
Rhinitis medicamentosa is a condition characterized by rebound nasal congestion resulting from overuse of topical decongestant nasal sprays, typically developing after using these medications for more than 3-5 consecutive days. The most common culprits are oxymetazoline (Afrin) and phenylephrine-containing nasal sprays, as noted in the study by 1. When these medications are used repeatedly, they initially cause vasoconstriction of nasal blood vessels, providing temporary relief. However, with continued use, the nasal tissues become less responsive to the medication's effects, leading to a cycle of increasing usage and worsening congestion when the medication wears off, as described in the study by 1.
Key Characteristics of Rhinitis Medicamentosa
- Rebound nasal congestion resulting from overuse of topical decongestant nasal sprays
- Typically develops after using these medications for more than 3-5 consecutive days
- Common culprits include oxymetazoline (Afrin) and phenylephrine-containing nasal sprays
- Nasal tissues become less responsive to the medication's effects with continued use
Treatment and Prevention
- Treatment involves discontinuing the offending nasal spray, which often causes uncomfortable withdrawal symptoms for 1-2 weeks, as noted in the study by 1
- This process can be eased by gradually reducing the spray frequency or concentration, using saline nasal sprays for moisture, and temporarily using intranasal corticosteroids (like fluticasone) to reduce inflammation, as suggested in the study by 1
- Oral decongestants may provide temporary relief during withdrawal
- Prevention is best achieved by limiting decongestant nasal spray use to no more than 3 consecutive days and addressing underlying nasal conditions with appropriate treatments, as recommended in the study by 1
From the Research
Definition and Causes of Rhinitis Medicamentosa
- Rhinitis medicamentosa (RM) is a condition induced by overuse of nasal decongestants 2
- It is also known as rebound or chemical rhinitis 2
- The condition can be caused by the use of medications other than topical decongestants, such as oral beta-adrenoceptor antagonists, antipsychotics, oral contraceptives, and antihypertensives 2
- Topical vasoconstrictors, such as oxy- and xylometazoline, can also lead to RM, especially when used with preservatives like benzalkonium chloride (BKC) 3, 4
Symptoms and Pathophysiology
- Symptoms of RM include nasal congestion, stuffiness, and hyperreactivity 3, 4
- The pathophysiology of RM is unclear, but vasodilatation and intravascular edema have been implicated 4
- Histologic changes consistent with RM include nasociliary loss, squamous cell metaplasia, epithelial edema, epithelial cell denudation, goblet cell hyperplasia, and inflammatory cell infiltration 2
Treatment and Management
- Stopping the nasal decongestant is the first-line treatment for RM 2
- Topical corticosteroids, such as budesonide and fluticasone propionate, can be used to alleviate rebound swelling of the nasal mucosa 2, 4
- Avoiding exposure to BKC is recommended 4
- Patients with RM who overuse topical decongestants and are able to stop using such drugs should be careful about taking these drugs again, even for a few days, to avoid the return of the vicious circle of nose-drop abuse 3, 5
Diagnosis and Prevention
- Careful questioning is required during consultation to establish diagnosis 4
- Validated criteria need to be developed for better diagnosis of the condition 2
- Patients should be informed about the rapid onset of rebound congestion upon repeated use of nasal decongestants to prevent the return of RM 3, 5