RHINITIS MEDICAMENTOSA - ASPECTS OF PATHOPHYSIOLOGY AND TREATMENT

With modern vasoconstrictors, such as oxy-and xylometazoline, the risk of developing rhinitis medicamentosa (RM) has been considered to be s mall or even nonexistent. However, recent studies have shown that over use of these drugs may result in rebound congestion, nasal hyperreacti vity, tolerance, and histologic changes of the nasal mucosa. Using rhi nostereometry, it has also been shown that the long-term use of the pr eservative benzalkonium chloride (BKC) in oxymetazoline nasal spray ac centuates the severity of rhinitis medicamentosa in healthy volunteers . A nasal decongestant spray composed of a combination of vasoactive s ubstances and BKC has a long-term adverse effect on the nasal mucosa. BKC alone induces mucosal swelling after 30 days use of the nasal spra y in healthy subjects, unlike placebo. According to the author, rhinit is medicamentosa can be defined as a condition of nasal hyperreactivit y, mucosal swelling, and tolerance that is induced, or aggravated, by the overuse of topical vasoconstrictors with or without a preservative . An adequate treatment of these patients consists of a combination of vasoconstrictor withdrawal and a topical corticosteroid to alleviate the withdrawal process. The underlying nasal disorder must then be tre ated. Patients with rhinitis medicamentosa who overuse topical deconge stants and are able to stop using such drugs should be careful about t aking these drugs again, even for a few days. They must be informed ab out the rapid onset of rebound congestion upon repeated use in order t o avoid the return of the vicious circle of nose-drop abuse.