VASOMOTOR RHINITIS
 
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VASOMOTOR RHINITIS

 

DEFINITION:

A disorder of the nasal mucosa characterized by persistent edema and hypersecretion of the nasal mucosa when exposed to specific irritants.

EPIDEMIOLOGY:

  • incidence: ?
  • age of onset:
    • any
  • risk factors:
    • exposure to irritant

PATHOGENESIS:

1. Background

  • exposure to an irritant -> triggers an imbalance of the auto-nomic nervous system control of the mucosal vasculature and mucous glands -> edema of the nasal mucosa -> nasal congestion
  • +/- obstruction with rhinorrhea
  • may also be called "nonVASOMOTOR RHINITIS"
  • not considered to be an inflammatory disorder with IgE-mediated hypersensitivity

2. Triggers

  • alcohol
  • bright lights
  • change in temperature or relative humidity
  • hot, spicy foods
  • odours

CLINICAL FEATURES:

1. Symptoms

1. Nasal Mucosal Manifestations

  • nasal congestion/obstruction
  • hypersecretion/rhinorrhea
  • sneezing and pruritis are rare
  • chronic cough

2. Other Muccous Membrane Manifestations

  • eyes, ears, and sinuses are rarely affected
  • no conjunctivitis

INVESTIGATIONS:

1. Nasal Secretion

  • no eosinophilia

2. Serum

  • no eosinophilia or elevated IgE

3. Allergy Tests

  • In Vivo - skin tests are all negative
  • In Vitro - Immunoassays - RAST, MAST, ELISA are all negative

4. Imaging Studies

1. Sinus Radiograms/CT

  • to rule out acute or chronic sinusitis

MANAGEMENT:

1. Avoidance

  • identify irritants and trial of avoidance therapy

2. Prophylactic Therapy

1. Atrovent Nasal Aerosol

  • first line of therapy:

1. Mechanism of Action

  • an anticholinergic agent which locally inhibits the parasympathetic receptors in the nose

2. Action

  • reduces the watery hypersecretion from the mucosal glands
  • side effects:
    • dry nose and mouth, nasal irritation, headaches, nasal crusting

3. Dose

  • 2 applications (40 ug) in each nostril bid increasing to tid & qid if necessary (maximal dose is 320 ug/d)
  • use in patients 12 years of age and older

2. Intranasal Corticosteroids

  • second line of therapy:

1. Flonase

  • fluticasone propionate suspension
  • 1 application (50 ug) in each nostril od
  • less than 1% oral bioavailability

2. Beconase

  • beclomethasone dipropionate suspension
  • 2 applications (100 ug) in each nostril bid

3. Rhinocort

  • budesonide powder
  • 2 applications (200 ug) in each nostril od
  • 11% oral bioavailability

3. Acute Therapy

1. Decongestants

  • 1. Sudafed (Pseudoephedrine HCl)
    • contraindications
      • do not use with MAO inhibitors
      • hypersensitivity to pressor amines
      • severe hypertension or coronary disease

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