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Rhinitis Medicamentosa


Presentation

  • A re-presented with a permanently blocked nose. Working on radio and TV, he was using two bottles of Otrivine per day for almost four years “so that I can breathe at night and sound normal on air”.[imj.ie]
  • . … Read More Non allergic rhinitis Presented by Wat Mitthamsiri, MD. December27, 2013 Read More Rhinitis, commonly known as a runny nose, is the medical term describing irritation and inflammation of some internal areas of the nose.[answer-me-up.com]
  • She presented to me with bilateral nose congestion, blockage, running nose, headache & post nasal discharge since last 7 years on & off. On nose examination, bilateral turbinates hypertrophy with congestion seen.[youtube.com]
  • Sympathetic stimulation causes activation of alpha 1 and alpha 2 receptors present in the walls of the capacitance vessels which leads to decreased blood flow and constriction of venous sinusoids causing nasal decongestion.[drtbalu.blogspot.com]
Mucosal Edema
  • Both groups showed a significant reduction in mucosal edema and nasal secretions. Patients treated with HA Spray-sol reduced or even eliminated (11/25 patients) the use of topical decongestant within 10 days of treatment with HA.[otolaryngology.conferenceseries.com]
  • Both groups showed a signifi cant reduction in mucosal edema and nasal secretions. Patients treated with HA Spray-sol reduced or even eliminated (11/25 patients) the use of topical decongestant within 10 days of treatment with HA.[omicsonline.org]
Asymptomatic
  • If deprived of the medication, RM patients (who are otherwise healthy and asymptomatic) often describe a feeling of anxiety, panic, suffocation, and claustrophobia.[nasalspray.com]
Italian
  • Ontology: Rhinitis medicamentosa (C0149980) Concepts Disease or Syndrome ( T047 ) SnomedCT 95239003 Dutch medicamenteuze rhinitis, rhinitis medicamentosa French Rhinite médicamenteuse German Rhinitis medicamentosa, Rhinitis, von Medikamenten verursacht Italian[fpnotebook.com]
Nightmare
  • The prospect of things such as surgical anesthesia, a camping trip to an isolated location or an ocean cruise (where they have no easy and immediate access to the nasal sprays) is a nightmare.[doctormigraine.com]
Camping
  • The prospect of things such as surgical anesthesia, a camping trip to an isolated location or an ocean cruise (where they have no easy and immediate access to the nasal sprays) is a nightmare.[doctormigraine.com]
Blister
  • Nasendoscopy showed hyperaemic nasal mucosa with “blistering”, a finding most commonly seen allergic rhinitis. He refused standard anti-allergy therapies: “none of that has ever worked”.[imj.ie]
Claustrophobia
  • If deprived of the medication, RM patients (who are otherwise healthy and asymptomatic) often describe a feeling of anxiety, panic, suffocation, and claustrophobia.[nasalspray.com]
Fear
  • You shouldn’t skip nasal decongestants as a possible treatment for rhinitis out of fear of developing rhinitis medicamentosa. If you’re otherwise able to use these medications, try them. Just be aware that they’re for short-term use only.[healthline.com]

Treatment

  • Rhinitis medicamentosa: a review of causes and treatment. Treatments in Respiratory Medicine, 4 (1), pp. 21-9. Graf P. Rhinitis Medicamentosa: a Review of Causes and Treatment. Treat Respir Med. 2005;4(1):21-9. PubMed PMID: 15725047.[unboundmedicine.com]
  • Results: The fluticasone group had a significantly increased histamine sensitivity after treatment, unlike the placebo group who had an unchanged or slightly decreased histamine sensitivity after treatment.[karger.com]
  • The most commonly reported treatment option was topical nasal steroids, although overall there was limited evidence on which to base treatment recommendation.[journals.sagepub.com]
  • This is the primary reason why the treatment of RM often fails.[nasalspray.com]
  • Treatment involves gradual weaning of topical decongestant, sometimes augmented by other anti-inflammatory or decongestant medications 1. Ultraviolet light phototherapy is a recognised treatment for allergic rhinitis 2.[imj.ie]

Prognosis

  • Prognosis Prognosis of rhinitis medicamentosa is favorable if underlying factors that led to overuse of intranasal decongestants are addressed and treated or have resolved, and patients adhere to recommendations to limit intranasal decongestants to short-term[emedicine.medscape.com]
  • […] turbinate steroid injections, oral adenosine and mast cell stabilizing agents; however, these recommendations are based on limited case reports. [2] Differential Diagnosis Allergic rhinitis Non-allergic rhinitis CPAP-related rhinitis Rhinosinusitis Prognosis[statpearls.com]
  • Also Read: What is Vasomotor Rhinitis, Know its Causes, Symptoms, Risk Factors, Complications, Diagnosis Treatment of Vasomotor Rhinitis & its Prognosis, Prevention and Recovery Period How Safe & Effective is Capsaicin in Treating Non-Allergic Rhinitis[epainassist.com]

Etiology

  • Etiology The cause of this condition is primarily by the prolonged use (more than 7 to 10 days) of topical nasal decongestant. However, intranasal cocaine use has also been reported to cause a similar condition.[statpearls.com]
  • Classification Allergic rhinitis Definition : acute or chronic rhinitis caused by exposure to an inhaled allergen Etiology Type I hypersensitivity reaction Genetic predisposition to atopy Clinical features Recurrent episodes of sneezing, nasal congestion[amboss.com]
  • Etiology R A Sittipane, et al., Nonallergic Rhinitis, Am J Rhinol Allergy 27, S48–S51, 2013 33.[slideshare.net]
  • Few studies have explored etiologic causes, although it is recognized that sensory neuropeptides and cholinergic effecter discharges are involved in gustatory and senile rhinitis.[waojournal.biomedcentral.com]
  • […] an increased nasal discharge. 4 ,5 If nasal decongestant sprays are used too often and/or for an extended period of time, they can cause nasal congestion to worsen, a well-documented rebound condition known as rhinitis medicamentosa. 6-9 A possible etiology[uspharmacist.com]

Epidemiology

  • However, this is arguably open to debate as there is no evidence of worsening congestion in those who use intranasal corticosteroids containing BKC. [6] [7] [8] Epidemiology It occurs most commonly in young and middle-aged adults with a similar rate in[statpearls.com]
  • Epidemiology: Thailand, adult C Bunnag, et al., Epidemiology of rhinitis in Thais, Asia Pac J Allergy Immunol. 2000;18:1-7. 20.[slideshare.net]
  • […] damage to human nasal epithelia or aggravation of rhinitis medicamentosa associated with intranasal products that contain BKC [11, 12, 13, 14, 15], intranasal products with BKC are generally safe and well tolerated for short-term and long-term use. [10] Epidemiology[emedicine.medscape.com]
  • Settipane RA, Charnock DR: Epidemiology of rhinitis: allergic and nonallergic. Clin Allergy Immunol. 2007, 19: 23-34. 4. Settipane RA: Rhinitis: a dose of epidemiological reality. Allergy Asthma Proc. 2003, 24: 147-154. 5.[waojournal.biomedcentral.com]
Sex distribution
Age distribution

Pathophysiology

  • Synonyms: Rebound rhinitis / chemical rhinitis Pathophysiology: The nasal mucous membrane is rich in resistance blood vessels draining into capacitance venous sinusoids.[drtbalu.blogspot.com]
  • The pathophysiology of the condition is unclear; however, vasodilatation and intravascular edema have both been implicated.[unboundmedicine.com]
  • Other ingredients (such as Naphazoline) and combination formulations make up the remaining 2% What Is The Pathophysiology Of Rhinitis Medicamentosa? The pathophysiology of RM is not completely understood.[nasalspray.com]
  • Maps Rhinitis medicamentosa Pathophysiology The pathophysiology of RM is unclear, although several mechanisms involving norepinephrine signaling have been proposed.[yourprayinfo.blogspot.com]

Prevention

  • Preventing Rhinitis Medicamentosa Rhinitis medicamentosa is a condition that cannot be preventable. However, patients diagnosed with this condition must avoid the triggers in case they are known about it.[epainassist.com]
  • While allergies are the most frequent cause of […] Read More Exercise Induced Rhinitis – can we prevent it? July 11, 2017 Often when exercising, some people get a runny nose.[rhinitismedicamentosa.net]
  • The first thing you can do to prevent rhinitis medicamentosa is to carefully read the label on your decongestant. It should spell out how often and how long the medication can be used.[healthline.com]
  • Patients should be warned that repeated short term use, of an intranasal decongestant even after a year of discontinuation can cause recurrence of RM. [16] Enhancing Healthcare Team Outcomes Rhinitis medicamentosia is a preventable condition, and therefore[statpearls.com]
  • Education is an important part of treatment and prevention of rhinitis medicamentosa. Doctors need to educate patients about the consequences of using otc nasal decongestant for a period that exceeds 5 to 7 days.[rhinitismedicamentosa.net]

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