Medication-induced rhinitis (MIR) is a form of non-allergic rhinitis, usually associated with the irrational use of topical vasoconstrictors, namely nasal decongestants.
CAUSES
Medication-induced rhinitis (MIR) is a form of non-allergic rhinitis, usually associated with the irrational use of topical vasoconstrictors, namely nasal decongestants.
Drug-induced rhinitis can be divided into two groups:
- Rhinitis specifically related to decongestants;
- Rhinitis associated with other medications such as certain antihypertensives, oral contraceptives, anti-inflammatory drugs, psychotropic drugs, etc.
In some patients, even a few days of using decongestant preparations can be enough to enter a vicious cycle. The mucosal edema reappears as the drug’s effect diminishes, necessitating repeated administration. As a result, the dosage and frequency of administrations increase, while the duration of the effect becomes shorter.
DIAGNOSIS is primarily based on a detailed medical history.
The causal medication for MIR and all relevant details regarding its administration are identified from the patient’s medical history. Physical examination of such patients often reveals swollen, hyperemic nasal turbinates.
WHAT IS THE REBOUND EFFECT?
Rebound is the phenomenon of the reappearance of symptoms when treatment is abruptly stopped. The initially treated symptoms often reoccur, and they can be even more pronounced. Similarly, in the case of MIR, abrupt discontinuation of the medication can lead to the appearance of nasal congestion that is much more bothersome than it was initially.
TREATMENT
The goal of treatment is to discontinue the use of the medication or drug at all costs.
For this purpose, I recommend the following:
- Gradually reduce the concentration of the medication;
- If you are using a 0.1% decongestant daily, switch to 0.05% after a period, then to 0.025%…;
- Switch to nasal spray instead of drops to monitor the administered dose more effectively;
- Gradually reduce the frequency of administrations and replace them with nasal hygiene using hypertonic saline solution;
- Consider initiating topical corticosteroid therapy – the dose and duration will be determined by an ENT specialist.
In some cases, a few doses of
systemic corticosteroids may be necessary.
If you started using decongestants due to an anatomical problem, surgical treatment may be required.
