TREATMENT OF NONSPECIFIC HYPER-REFLECTORY RHINOPATHY (VASOMOTORIC RHINITIS) WITH CAPSAICIN

Apart from adrenergic and cholinergic neurones, peptidergic neurones a re involved in the autonomic control of nasal mucosa. Their transmitte r substances are peptides, so-called ''neuropeptides''. It is assumed that they are released from peptidergic neurones in the nasal mucosa a fter irritation of receptors by unspecific stimuli, and are responsibl e for the symptoms of hyperreactive rhinopathy. Repeated topical appli cation of Capsaicin (8-methyl-N-vanillyl-6-nonenamide) leads to a sele ctive degeneration of peptidergic neurones and desensitisation of its receptors in the nasal mucosa. 123 patients who were suffering from hy perreactive rhinopathy were treated in a prospective study by repeated topical applications of capsaicin solutions in increasing concentrati ons. A symptom score demonstrated an improvement of the predominating symptoms (nasal congestion, hypersecretion, sneezing) by 62% to 72%. A reduction of unpleasant side effects following application (epiphora, itching, sneezing, mucosal oedema) indicating a desensitising effect could be documented by a symptom score and by active anterior rhinoman ometry. Immunohistochemical investigations of nasal mucosa biopsies re vealed no reduction of peptidergic neurones within the nasal mucosa, s o that a blockage of receptors seems to be responsible for the positiv e effects. The treatment of hyperreactive rhinopathy with capsaicin or related substances seems to be a promising new way in the treatment o f hyperreactive rhinopathy. Further investigations have to prove the s ite of effect and mechanism of activity of the substance, such as the best modality of application.