Definition:
- Non-allergic, non-infectious rhinitis, also called irritant rhinitis or idiopathic non-allergic rhinitis.
- “Vaso” refers to blood vessels; “motor” refers to nerves innervating nasal tissue and blood vessels.
- Affects up to 10% of the population.
Features of Vasomotor Rhinitis:
- Symptoms:
- Intermittent episodes of sneezing, watery nasal drainage (rhinorrhea), nasal congestion.
- Hypersensitive response to stimuli (e.g., dry atmosphere, air pollutants, spicy foods, alcohol, strong emotions, medications).
- Exaggerated nasal response to low concentrations of irritants (pollens, dust, mold, animal dander).
- Types of Patients:
- “Runners”: Predominant wet rhinorrhea.
- “Dry Subjects”: Predominant nasal congestion and blockage with minimal rhinorrhea.
Triggers:
- Environmental changes (temperature, barometric pressure).
- Perfumes, strong odors, smoke.
- Inorganic dust, air pollution.
- Spicy foods, alcohol.
- Medications (e.g., some blood pressure tablets).
- Emotional or physical stress.
- Sexual arousal.
Diagnosis:
- Based on patient history and nasal/throat examination.
- Allergy testing to rule out allergic causes.
- CT scan may be required to exclude chronic sinusitis or nasal polyps.
Key Features:
- No history of allergies.
- No infection causing symptoms.
- Variable presentation.
- Often affects older individuals.
- Seasonal pattern possible.
- Symptoms: Rhinorrhea, frontal headaches, congested turbinates, usually no itching (pruritus).
- Eating (especially spicy foods) can worsen symptoms.
Other Non-Allergic Rhinitis Causes:
- Nonallergic rhinitis with eosinophilia syndrome (NARES).
- Occupational rhinitis.
- Hormonal rhinitis.
- Drug-induced rhinitis.
- Rhinitis medicamentosa.
- Gustatory rhinitis.
Conditions Confused with Non-Allergic Rhinitis:
- Nasal polyps.
- Previous trauma to the nose.
- Structural abnormalities (e.g., deviated nasal septum).
Treatment:
Non-drug, Non-surgical:
- Normal saline nasal douches.
Drug Therapy:
- Antihistamines:
- Variable response; useful in mixed vasomotor and allergic rhinitis.
- Anticholinergic Agents:
- Atrovent (Ipratropium bromide) nasal spray for runny nose.
- Nasal Steroids:
- Help with congestion, runny nose, and sneezing.
- Examples: Fluticasone, budesonide.
- Side effects: Mucosal swelling, redness, burning, drying, nosebleeds, nasopharyngeal thrush.
- Decongestants:
- For nasal congestion.
- Examples: Pseudoephedrine (Sudafed) tablets, oxymetazoline (Drixine) nasal spray, xylometazoline (Otrivine) nasal spray.
- Side effects: Nervousness, insomnia, irritability, difficulty urinating in elderly males.
- Risk of rhinitis medicamentosa with prolonged use of nasal sprays.
Surgery:
- Rarely considered if drug therapy is ineffective.
- Procedures:
- Cryosurgery: Affects mucosa and submucosa; may cause post-operative congestion.
- Vidian neurectomy: Disrupts sympathetic and parasympathetic fibers, reducing rhinorrhea.
- Other surgical options: Cauterization, submucosal resection of the conchal bone, partial/total inferior turbinate resection.
Key Takeaways:
- Vasomotor rhinitis is a non-allergic response to irritants.
- Diagnosis involves excluding allergic rhinitis and other causes.
- Management includes avoiding triggers, nasal irrigation, and medications (antihistamines, anticholinergics, nasal steroids, decongestants).
- Surgery is a last resort for refractory cases.