Vasomotor rhinitis is a chronic inflammatory disease of the inner lining in the nose.
Patients with non-allergic rhinitis may present with the following features:
Patients with vasomotor rhinitis classically present with watery rhinorrhea and sneezing. The mucous membrane becomes edematous and the color may vary from a bright red to purple. Vasomotor rhinitis is characterized by several periods of exacerbation and remission. Unlike bacterial and certain viral causes of rhinitis, cases with vasomotor rhinitis do not develop purulent exudate. The absence of distinguished allergens differentiates vasomotor rhinitis from the allergic rhinitis.
The symptoms of vasomotor rhinitis may be aggravated by cigarette smoke, perfumes, paint fumes, spicy foods, emotional stress, alcohol, bright lights, temperature, and barometric pressure changes . It is unusual to be diagnosed with vasomotor rhinitis prior to adulthood. Patients with vasomotor rhinitis may have symptoms all year, which can be influenced and/or worsened by changes in weather. Generally, symptoms develop not until adulthood.
There are no specific diagnostic tests available for vasomotor rhinitis. Also, there are no established criteria for a minimum level of diagnostic workup necessary for diagnosing vasomotor rhinitis . Diagnosis is mostly based on clinical clues, such as clear discharge which differs from the purulent discharge seen in infective rhinitis.
Certain tests that may be of value such as CT scan and allergy testing, that if are reported as normal in a patient with symptoms of rhinitis and/or sinusitis, is highly suggestive of non-allergic rhinitis.
The standard first line medical treatment for vasomotor rhinitis is topical anti-histamines. There is no single agent that is effective in all cases for the control of symptoms. According to existing evidence base, a step-wise application of multiple agents should be advised for achieving symptom control.
In cases where the standard therapy fails, the other options that may be considered include oral decongestants, topical decongestants, and local silver nitrate application by an expert such as an otolaryngologist . However, there is no strong evidence that demonstrates clear benefit from these treatment options. Patients with severe symptoms that cannot be controlled by medical therapy options and are causing significant impairment of routine activity may be considered for sphenopalatine block .
Submucosal injection of botulinum toxin type A is a novel treatment option for severe vasomotor rhinitis that is presently being studied in dog models  .
The standard treatment options for vasomotor rhinitis are as follows:
A step-wise application of various treatment options should be employed based upon the symptoms of the patient. If the predominant symptom is rhinorrhea, the first line of treatment is with a topical anti-cholinergic agent  . Topical corticosteroids may be used as a first line in cases presenting with nasal congestion as a primary concern . Topical anti-histamine is the best initial therapy for patients with nasal congestion, rhinorrhea, sneezing and post-nasal drip   . If the response is inadequate to the first line agents, the medications may be changed or added as necessary.
Exercise may be a useful adjunct as it reduces airway resistance and enhances natural decongestion of the nasal cavity through I-adrenergic mediated mechanisms . However, the decongestion mediated by exercise is for only a short period of time, but can be repeated given the several benefits from it.
In the pediatric age group, it is preferable to consider a trial of non-pharmacological and preventive measures prior to the initiation of any medications for the treatment of vasomotor rhinitis. During pregnancy, the symptoms of vasomotor rhinitis may be treated with intranasal saline instillation .
If the drug therapy fails to suppress the symptoms of rhinitis, surgery may be considered in very rare circumstances. The procedures that can be performed include the following:
In cases presenting with chronic rhinitis, where the nasal mucosa has underwent chronic hypertrophic changes, the following procedures may be considered:
In the treatment of vasomotor rhinitis, endoscopic sinus surgery is preferred over the open procedure (Transantral approach) owing to lower morbidity, better tolerability, and safety. It was observed that the symptoms of vasomotor rhinitis such as nasal congestion and rhinorrhea remained suppressed for several years after the procedure.
There is no cure available for non-allergic rhinitis; however, the symptoms can be controlled using prescription or over-the-counter medications. The prognosis of patients diagnosed with vasomotor rhinitis depends upon the severity of symptoms. The correction of the underlying condition, for instance a deviated nasal septum, remains the mainstay for permanent control of symptoms and improvement in prognosis.
The etiology of vasomotor rhinitis has not been fully understood, however there has been some association made with an imbalance in sympathetic and parasympathetic nervous systems, where the parasympathetic effects predominate and thus leading to symptomatic disease. The symptoms associated with vasomotor rhinitis are known to exacerbate in a dry atmosphere. Various environmental antigens may also act as triggers for inducing symptoms of vasomotor rhinitis like air pollution, pollen, perfume, and dust. In addition, several other triggers may also induce vasomotor rhinitis. These include the following:
It is interesting to note that individuals with non-allergic rhinitis remain asymptomatic when exposed to allergens that trigger allergic rhinitis, such as animal dander and pollen, unless they have co-existing allergic rhinitis.
Data obtained from the National Rhinitis Classification Task Force shows that almost 17 million people in the United States have non-allergic rhinitis. Non-allergic rhinitis is found in all age groups; however, it is more frequently diagnosed in adults. A study conducted in Norway reported that almost 25% of the total population suffered from the condition and close to half presented to the hospital seeking treatment for the same. Non-allergic rhinitis is rarely diagnosed in pediatric age group. The incidence has been increasing in the elderly population .
Nonallergic rhinitis is a distinct disease classification, separate from allergic rhinitis, which is characterized by an IgE-mediated response. The diagnosis of non-allergic rhinitis encompasses several individual classifications, including NARES, as well as vasomotor, occupational, hormonal, infectious, drug-induced, and gustatory conditions.
The mucus secretion and blood flow in the mucosal lining of the nasal cavity is controlled by the autonomic nervous system. The sympathetic nervous system controls the diameter of nasal resistance vessels. The glandular secretions and the capacitance vessels in the nasal mucosa are primarily influenced by the parasympathetic system. Increased parasympathetic activity or hypoactivity of the sympathetic system leads to engorgement of these vessels. This in-turn causes swelling of the nasal mucosa that presents as nasal congestion. Parasympathetic system overactivity also causes increased secretions from the nasal mucosa thus causing rhinorrhea. Hyperactive allergen receptors may also contribute to the pathophysiology of vasomotor rhinitis.
Cases diagnosed with vasomotor rhinitis are sub-divided as:
Autonomic stimulation by activities such as sexual intercourse and emotional exacerbation may also affect the vasomotor control in the nasal mucosa. Data from a small scale study revealed that individuals with vasomotor rhinitis also have a significant autonomic dysfunction (p<.005). Factors that possibly contributed to this conclusion were extraesophageal effects of gastroesophageal reflux disease and history of trauma to the nose .
All patients that have been diagnosed with vasomotor rhinitis should be advised to avoid all known allergens and environmental agents that may trigger exacerbation of symptoms, such as cigarette smoke, perfumes, auto emission fumes, light stimuli, hot or spicy foods, or changes in temperature.
The inflammation of mucosal lining in the nasal cavity is called as rhinitis. The inflamed mucosa may lead to different irritable symptoms such as nasal congestion, rhinorrhea, sneezing, pruritus, and post-nasal drip. Chronic non-allergic rhinitis is a diagnosis of exclusion. This is considered as a syndrome rather than a specific disease. Since there is no clear definition of the pathology that causes chronic non-allergic rhinitis, it therefore has been referred by several terms. The terms are as follows:
Patients with vasomotor rhinitis present with complaint of intermittent watery nasal discharge and/or congestion of the nasal cavity. Vasomotor rhinitis occurs due to an exaggerated inflammatory response to non-specific antigens, for instance, exposure to cold dry air and air pollution  . The inflammation leads to engorgement of mucosal vessels in the nasal cavity that in-turn lead to sneezing spells and rhinorrhea. Vasomotor rhinitis is considered as a subtype of non-allergic rhinitis.
The inflammation of the nasal passage is referred to as rhinitis. One of the several kinds of rhinitis is vasomotor rhinitis. You may experience symptoms such as stuffiness of the nose, runny nose and sneezing. You may also notice the mucosa or the insides of your nose change color anywhere from shades of red to purple. The exact cause of vasomotor rhinitis is not known, however, several irritants are known to exacerbate the symptoms. These may include pollen, dust, spicy food, pollution, perfumes, emotional stress, physical stress, and hormonal changes. The symptoms may also be exacerbated by certain prescription medications such as anti-depressants.
There is no cure for the condition. There are no specific tests that could be run to diagnose vasomotor rhinitis. The treatment is always aimed at relieving the symptoms of the patient. The most commonly prescribed initial treatment for most patients is topical anti-histamines. However, the initial treatment may vary according to the symptoms that you are experiencing.