Symptoms
Vasomotor rhinitis manifests as a chronic watery-running and/or stuffy nose. Symptoms resemble hay fever but occur year-round and without eye involvement. Both diseases can also occur together. Other possible symptoms include sneezing, itching, headache, frequent swallowing and coughing.
Causes and triggers
Vasomotor rhinitis is one of the nonallergic and noninfectious rhinitides. The exact causes are unknown. The most common among several hypotheses assumes an imbalance of the autonomic nervous system and increased sensitivity of the mucosa (“nasal hyperreactivity”). Symptoms are triggered or worsened by certain factors. These include:
- Odors, e.g., perfume, fresh paint, chemical irritants, and solvents.
- Smoke, dust, wind
- Emotions, stress, fatigue
- Alcohol
- Hot and hot spices, e.g. cayenne pepper, pepper.
- Temperature and pressure changes, humidity
- Bright light
- Dry air, e.g. air conditioning
The condition is therefore also called “hyperreflective rhinopathy”, which is technically more correct. Other triggers such as drugs (rhinitis medicamentosa) or hormones (pregnancy rhinitis) do not belong to vasomotor rhinitis.
Diagnosis
To date, no specific test exists. Diagnosis is made by medical treatment based on patient history, physical examination, laboratory methods (allergy testing), and exclusion of other causes. Possible differential diagnoses include other rhinitis such as allergic diseases (hay fever, perennial allergic rhinitis), nasal polyps, and infectious causes such as a cold and acute sinusitis.
Nonpharmacologic treatment
Triggers should be identified and avoided if possible. Sports and sauna visits should have a beneficial effect. In severe cases, surgery may be indicated.
Drug treatment
Azelastine nasal sprays:
- Are reported to be effective against all symptoms. They have been clinically studied and are approved for this indication in the United States. Azelastine is long-acting and only needs to be used twice daily. Oral antihistamines, on the other hand, are not recommended.
Glucocorticoid nasal sprays:
- With active ingredients such as budesonide, mometasone, beclomethasone or triamcinolone acetonide are used for a blocked nose and are partly approved in this indication. The drugs must be applied regularly to develop their full effect.
Ipratropium bromide nasal sprays:
- Mainly help against a runny nose and are approved for this indication.
Mast cell stabilizer nasal sprays:
- With cromoglicic acid can help against the sneezing and stuffy nose. Disadvantage is the frequent and regular use 4-6 times a day.
Decongestant nasal sprays:
- With oxymetazoline and other active ingredients decongest the nasal mucosa and inhibit secretion. They can lead to rhinitis medicamentosa if used for longer than 5-7 days and, in our opinion, should not be used in this indication. Oral sympathomimetics for example with phenylephrine or pseudoephedrine should also not be used or only with restraint because of the possible side effects.
Humidifying nasal sprays:
- Salt water rinses and sprays are recommended as an additional measure and seem to have a beneficial effect.
The literature further mentions capsaicin nasal sprays and botulinum toxin and finally alternative remedies can be tried.
