From the Guidelines
Rhinitis medicamentosa should be treated by discontinuing the use of topical decongestants and administering intranasal corticosteroids to control symptoms, as recommended by the most recent guidelines 1. The diagnosis of rhinitis medicamentosa is characterized by rebound nasal congestion resulting from overuse of topical decongestant nasal sprays, typically including oxymetazoline (Afrin) or phenylephrine-containing products.
Key Points to Consider
- The pathophysiology of this condition is not fully understood, but it is believed to be related to the prolonged use of topical decongestants, which causes vasoconstriction followed by a rebound vasodilation when the medication wears off, creating a cycle of dependency as patients use more spray to relieve worsening congestion 1.
- Treatment involves suspending the use of topical decongestants and administering intranasal corticosteroids to control symptoms while allowing the rebound effects of the nasal decongestant spray to resolve 1.
- A short course of oral corticosteroids may be needed to control the patient's symptoms while the effects of the nasal decongestant spray dissipate 1.
- Prevention involves limiting use of topical decongestants to no more than 3-5 consecutive days, as recommended by the package insert for oxymetazoline nasal spray 1.
Management and Prevention
- Intranasal corticosteroids, such as fluticasone or mometasone furoate, can help manage symptoms during the withdrawal period 1.
- Saline nasal irrigation can also help clear mucus and reduce congestion.
- Oral antihistamines or short-term oral decongestants may provide additional relief, but their use should be limited to avoid exacerbating the condition.
- Once the rhinitis medicamentosa is treated, the patient should be evaluated for an underlying condition, such as allergic rhinitis 1.
From the Research
Diagnosis of Rhinitis Medicamentosa (Rebound Rhinitis)
- Rhinitis medicamentosa (RM) is a condition induced by overuse of nasal decongestants, characterized by nasal congestion, swelling, thickening, loss of elasticity, and loss of sensitivity to the decongestant 2, 3.
- Histological changes consistent with RM include nasociliary loss, squamous cell metaplasia, epithelial edema, epithelial cell denudation, goblet cell hyperplasia, increased expression of the epidermal growth factor receptor, and inflammatory cell infiltration 2, 3.
- There is no precise diagnosis standard for RM, making it difficult for objective diagnosis 3.
- Diagnosis requires careful questioning during consultation to establish the condition, as patients may be unaware of it 4.
Treatment of Rhinitis Medicamentosa (Rebound Rhinitis)
- Stopping the nasal decongestant is the first-line treatment for RM 2, 3, 5, 4, 6.
- Intranasal glucocorticosteroids, such as budesonide and fluticasone propionate, should be used to alleviate rebound swelling of the nasal mucosa and speed recovery 2, 5, 4.
- Treatment of the underlying nasal disease is necessary after withdrawal of topical decongestants 5, 4.
- Patients should be informed about the rapid onset of rebound congestion upon repeated use of topical decongestants to avoid the return of the vicious circle of nose-drop abuse 5.