From the Guidelines
Vasomotor rhinitis (VMR) is a chronic nasal condition characterized by symptoms like runny nose, nasal congestion, and postnasal drip that occur without an allergic cause, affecting approximately 5-10% of the population 1.
Definition and Diagnosis
VMR happens when blood vessels in the nose expand and contract inappropriately in response to triggers such as temperature changes, spicy foods, strong odors, alcohol, hormonal changes, or emotional stress. Unlike allergic rhinitis, it doesn't involve an immune response to allergens. Diagnosis of VMR is made by a combination of careful history taking and exclusion, with negative or irrelevant skin test responses ruling out IgE-mediated rhinitis, and a history of symptoms triggered by environmental irritants suggesting a diagnosis of VMR 1.
Treatment and Management
Treatment typically includes:
- Avoiding known triggers
- Using saline nasal sprays for moisture
- Medications like intranasal anticholinergics (ipratropium bromide 0.03% nasal spray, 2 sprays per nostril 2-3 times daily) to reduce nasal secretions, as suggested by the diagnosis and management of rhinitis: an updated practice parameter 1
- Intranasal corticosteroids (fluticasone propionate 50mcg, 1-2 sprays per nostril daily) to help reduce inflammation, which is a common approach in managing nonallergic rhinitis syndromes, including vasomotor rhinitis 1 For severe cases, surgical options might be considered to reduce nerve sensitivity in the nasal passages. The condition results from an imbalance in the autonomic nervous system controlling nasal blood vessels and glands, leading to exaggerated responses to normal environmental stimuli.
Key Considerations
It is essential to note that VMR can be associated with other conditions, such as sinusitis, and a thorough examination, including nasal endoscopy and rhinomanometry, may be necessary to rule out other causes of symptoms 1. Additionally, patients with VMR may also respond to triggers that typically cause allergic rhinitis, making diagnosis and management more complex 1.
From the FDA Drug Label
Vasomotor Rhinitis 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.
Vasomotor Rhinitis (VMR) is a condition characterized by a symptom complex comprised of:
- Rhinorrhea
- Post nasal drip
- Nasal congestion
- Sneezing in patients with negative skin tests to indoor and outdoor aeroallergens, negative nasal smears for eosinophils, and negative sinus X-rays 2.
From the Research
Definition and Characteristics of Vasomotor Rhinitis (VMR)
- Vasomotor rhinitis is a common disorder that affects millions of Americans, resulting in significant morbidity 3.
- It is characterized by a combination of symptoms, including nasal obstruction and rhinorrhea, and is a diagnosis of exclusion reached after taking a careful history, performing a physical examination, and, in select cases, testing the patient with known allergens 4.
- The pathophysiology of VMR is unknown, but it is a chronic non-IgE-mediated condition that is similar to allergic rhinitis, but persists for over nine months each year 5.
Symptoms and Diagnosis of VMR
- Symptoms of VMR can closely resemble those of allergic rhinitis and can be difficult to differentiate from those resulting from allergy 3.
- A careful history, physical examination, and diagnostic testing help clinicians arrive at a definitive diagnosis 3.
- The lack of straightforward diagnostic criteria is limiting, and research for better treatment options requires the definition of homogeneous populations characterized by well-defined inclusion and exclusion criteria 6.
Treatment of VMR
- Therapy should be based on the presenting symptoms of VMR, and combination therapy with topical corticosteroids and azelastine is useful 3.
- Azelastine nasal spray has been shown to be highly efficacious in the treatment of all the symptoms of VMR, and has potent anti-inflammatory effects 5, 7.
- Topical anticholinergic agents can be useful in patients whose predominant symptom is rhinorrhea 3.