From the Guidelines
Vasomotor rhinitis is a chronic nasal condition characterized by symptoms like nasal congestion, runny nose, and postnasal drip without an allergic cause, and treatment typically begins with intranasal corticosteroids such as fluticasone (Flonase) 1-2 sprays per nostril daily or mometasone (Nasonex) 2 sprays per nostril daily, as recommended by the most recent guidelines 1.
Diagnosis and Treatment
The diagnosis of vasomotor rhinitis is based on the presence of chronic nasal symptoms without an allergic cause, and the treatment options include:
- Intranasal corticosteroids, which are the most effective medications for treating allergic rhinitis and are also effective in nonallergic rhinitis, including vasomotor rhinitis 1
- Antihistamines like azelastine nasal spray 1-2 sprays twice daily, which can help manage symptoms, particularly rhinorrhea 1
- Ipratropium bromide nasal spray (0.03% or 0.06%) 2 sprays 2-3 times daily, which effectively reduces watery discharge by blocking acetylcholine receptors 1
- Lifestyle modifications, such as avoiding triggers like temperature changes, spicy foods, and strong odors, using saline nasal irrigation daily, and maintaining adequate hydration and room humidity 1
Pathophysiology
Vasomotor rhinitis is thought to occur due to autonomic nervous system dysfunction, causing blood vessels in the nasal passages to dilate abnormally, leading to excessive mucus production and nasal congestion without the immune-mediated inflammation seen in allergic rhinitis 1.
Management
The management of vasomotor rhinitis involves a combination of medication and lifestyle modifications, and if symptoms persist despite these measures, consulting a healthcare provider for additional options like anticholinergic medications or surgical interventions may be considered 1.
From the FDA Drug Label
Astelin® Nasal Spray significantly improved a symptom complex comprised of rhinorrhea, post nasal drip, nasal congestion, and sneezing. The diagnosis of Vasomotor (non-allergic) rhinitis is based on symptoms such as rhinorrhea, post nasal drip, nasal congestion, and sneezing, with negative skin tests to indoor and outdoor aeroallergens, negative nasal smears for eosinophils, and negative sinus X-rays. The treatment for Vasomotor (non-allergic) rhinitis is Azelastine Nasal Spray, two sprays per nostril twice a day, which has been shown to significantly improve symptoms 2.
- Key symptoms improved by treatment include:
- Rhinorrhea
- Post nasal drip
- Nasal congestion
- Sneezing
From the Research
Diagnosis of Vasomotor Rhinitis
- Vasomotor rhinitis is a common disorder that is seen routinely in allergy practice, affecting millions of Americans and resulting in significant morbidity 3.
- The pathophysiology of this complex heterogeneous disorder is unknown, but symptoms and signs 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, with a lack of concomitant allergic disease determined by negative skin prick test for relevant allergens and/or negative allergen-specific antibody tests 4.
Treatment of Vasomotor Rhinitis
- The mainstay of treatment for nonallergic rhinitis, which includes vasomotor rhinitis, are intranasal corticosteroids, although they may not be effective in treating all symptoms of vasomotor rhinitis 4, 5.
- Topical antihistamines, such as azelastine, have been found to be efficacious in treating vasomotor rhinitis, with studies demonstrating a decrease in nasal obstruction and mucosal edema 6, 7.
- Topical anticholinergics, such as ipratropium bromide, are effective in treating rhinorrhea symptoms 4.
- Combination therapy with topical corticosteroids and azelastine is useful, and adjunct therapy includes decongestants and nasal saline 4, 3.
- Investigational therapies, such as capsaicin, silver nitrate, and acupuncture, have been discussed, but further studies are required to investigate their efficacy 4.