From the Guidelines
Vasomotor rhinitis should be treated with intranasal corticosteroids as the first-line medication option, as they reduce inflammation and nasal hyperreactivity, according to the most recent and highest quality study 1.
Diagnosis and Treatment
Vasomotor rhinitis is a chronic nasal condition characterized by symptoms like nasal congestion, runny nose, and postnasal drip without an allergic cause. The diagnosis of vasomotor rhinitis is based on the presence of these symptoms, which are intensified by changes in temperature or relative humidity, alcohol, and odors such as bleach, perfume, or solvents 1.
Treatment Options
Treatment typically begins with avoiding triggers such as temperature changes, alcohol, spicy foods, and strong odors.
- First-line medication options include:
- Intranasal corticosteroids like fluticasone (2 sprays per nostril daily) or mometasone, which reduce inflammation and nasal hyperreactivity 1.
- Antihistamines may help with runny nose symptoms, with options including azelastine nasal spray (1-2 sprays per nostril twice daily) or oral medications like loratadine (10mg daily) 1.
- For persistent symptoms, ipratropium bromide nasal spray (0.03%, 2 sprays per nostril 2-3 times daily) specifically targets excessive nasal secretions 1.
- Nasal saline irrigation using a neti pot or squeeze bottle with sterile saline solution can provide symptomatic relief by clearing irritants and thinning mucus.
Pathophysiology
Vasomotor rhinitis occurs when nasal blood vessels and glands overreact to non-allergic stimuli due to autonomic nervous system dysfunction, causing nasal tissue swelling and increased secretions without the immune system involvement seen in allergic rhinitis 1.
Additional Considerations
In severe cases unresponsive to medications, surgical options might be considered. It is essential to note that nonsedating oral antihistamines have not been shown to be effective in nonallergic rhinitis, and oral and intranasal decongestants may be considered in patients with nonallergic rhinitis and nasal congestion, with similar precautions as discussed 1.
From the FDA Drug Label
Two hundred sixteen patients with vasomotor rhinitis received Astelin® Nasal Spray two sprays per nostril twice a day in two U. S. placebo controlled trials. These patients had vasomotor rhinitis for at least one year, negative skin tests to indoor and outdoor aeroallergens, negative nasal smears for eosinophils, and negative sinus X-rays, Astelin® Nasal Spray significantly improved a symptom complex comprised of rhinorrhea, post nasal drip, nasal congestion, and sneezing. For patients age 12 and older with nonallergic vasomotor rhinitis the dosage is two sprays per nostril twice daily.
The diagnosis of Vasomotor (non-allergic) rhinitis is based on:
- A history of symptoms for at least one year
- Negative skin tests to indoor and outdoor aeroallergens
- Negative nasal smears for eosinophils
- Negative sinus X-rays
The treatment for Vasomotor (non-allergic) rhinitis is:
From the Research
Diagnosis of Vasomotor Rhinitis
- The diagnosis of vasomotor rhinitis is one of exclusion, and it is based on a careful history, physical examination, and diagnostic testing to rule out other conditions such as allergic rhinitis 3.
- Symptoms of vasomotor rhinitis include clear rhinorrhea, nasal congestion, sneezing, and postnasal drip, which can be triggered by various factors such as exercise, stress, heat, cold, and environmental irritants 4, 3.
- Diagnostic testing such as skin prick tests and nasal cytology examinations can help to exclude allergic rhinitis and other conditions 3, 5.
Treatment of Vasomotor Rhinitis
- Treatment of vasomotor rhinitis usually involves avoidance of inciting agents and pharmacological therapy 4.
- Topical anticholinergic agents such as ipratropium bromide can be effective in treating rhinorrhea symptoms 4, 6.
- Azelastine nasal spray has been shown to be effective in reducing symptoms of vasomotor rhinitis, including rhinorrhea, sneezing, postnasal drip, and nasal congestion 3, 5.
- Olopatadine 0.6% nasal spray has also been shown to be effective in reducing symptoms of vasomotor rhinitis and protecting against hyperosmolar challenge 7.
- Combination therapy with topical corticosteroids and azelastine may also be useful in treating vasomotor rhinitis 3.