What is vasomotor rhinitis

Vasomotor rhinitis also called non-allergic rhinitis, which is the term used for rhinitis that has no known cause. Rhinitis is a condition that typically involves nasal obstruction or congestion, runny nose or post-nasal drip, itchy nose, and/or sneezing. Vasomotor rhinitis has no known cause and is not related to allergy.

Vasomotor rhinitis symptoms

Vasomotor rhinitis symptoms can be long-lasting. Or they can come and go. Symptoms of vasomotor rhinitis may include:

• Nasal blockage or congestion
• Sneezing
• Runny nose
• Drainage down the back of the throat from the nose and sinuses. This drainage is called post-nasal drip or postnasal drainage
• Itchy nose
• Cough

Vasomotor rhinitis doesn’t usually cause itchy nose, eyes or throat — symptoms associated with allergies such as hay fever.

Vasomotor rhinitis may occur before a case of sinusitis or with sinusitis, a condition where infection or inflammation affects the sinuses. If you have facial pressure, decreased sense of smell, or a greenish-yellow nasal drainage, you may also have sinusitis. A qualified ENT (ear, nose, and throat) specialist, or otolaryngologist, can provide a thorough evaluation and appropriate treatment for your nasal/sinus condition.

What causes vasomotor rhinitis?

The exact cause of vasomotor rhinitis is unknown. Experts do know that vasomotor rhinitis occurs when blood vessels in your nose expand and fill the nasal lining with blood and fluid. There are several possible causes, including the nerve endings in the nose being hyperresponsive, similar to the way the lungs react in asthma.

Whatever the trigger, the result is the same — swollen nasal membranes, congestion or excessive mucus.

Some of the causes of vasomotor rhinitis include:

• Infection with a virus (viral or post-viral rhinitis).
• Dry air.
• Polluted air, such as from fumes, smoke, odours, and perfumes.
• Eating and drinking (sometimes specific foods, sometimes all food/drink consumption) such as spicy food and consumption of alcohol, especially red wine
• Certain medications (various over-the-counter and prescription preparations), such as aspirin, ibuprofen, and hormones.
• Hormone changes in the body (such as rhinitis of pregnancy).
• Alcohol use.
• Aging.
• Weather or temperature changes
• Inflammation or irritation in the nose unrelated to allergy
• Nasal symptoms of other medical conditions

There are many things known to trigger vasomotor rhinitis — some resulting in short-lived symptoms while others cause chronic problems. vasomotor rhinitis triggers include:

• Environmental or occupational irritants. Dust, smog, secondhand smoke or strong odors, such as perfumes, can trigger nonallergic rhinitis. Chemical fumes, such as those you might be exposed to in certain occupations, also may be to blame.
• Weather changes. Temperature or humidity changes can trigger the membranes inside your nose to swell and cause a runny or stuffy nose.
• Infections. A common cause of nonallergic rhinitis is a viral infection — a cold or the flu, for example.
• Foods and beverages. Nonallergic rhinitis may occur when you eat, especially when eating hot or spicy foods. Drinking alcoholic beverages also may cause the membranes inside your nose to swell, leading to nasal congestion.
• Certain medications. Some medications can cause nonallergic rhinitis. These include aspirin, ibuprofen (Advil, Motrin IB, others), and high blood pressure (hypertension) medications, such as beta blockers.
• Nonallergic rhinitis can also be triggered in some people by sedatives, antidepressants, oral contraceptives or drugs used to treat erectile dysfunction.
• Overuse of decongestant nasal sprays can cause a type of nonallergic rhinitis called rhinitis medicamentosa.
• Hormone changes. Hormonal changes due to pregnancy, menstruation, oral contraceptive use or other hormonal condition such as hypothyroidism may cause nonallergic rhinitis.
• Sleeping on your back, sleep apnea and acid reflux. Lying on your back at night while you sleep can cause nonallergic rhinitis, as can obstructive sleep apnea or acid reflux.

Risk factors for vasomotor rhinitis

Factors that may increase your risk of vasomotor rhinitis include:

• Exposure to irritants. If you’re exposed to smog, exhaust fumes or tobacco smoke — to name a few — you may be at increased risk of developing vasomotor rhinitis.
• Being older than age 20. Unlike allergic rhinitis, which usually occurs before age 20, often in childhood, vasomotor rhinitis occurs after age 20 in most people.
• Prolonged use of decongestant nasal drops or sprays. Using over-the-counter decongestant nasal drops or sprays (Afrin, Dristan, others) for more than a few days can actually cause more-severe nasal congestion when the decongestant wears off, often called rebound congestion.
• Being female. Due to hormonal changes, nasal congestion often gets worse during menstruation and pregnancy.
• Occupational exposure to fumes. In some cases vasomotor rhinitis is triggered by exposure to an airborne irritant in the workplace (occupational rhinitis). Some common triggers include construction materials, solvents, or other chemicals and fumes from decomposing organic material such as compost.
• Having certain health problems. A number of chronic health conditions can cause or worsen rhinitis, such as hypothyroidism and chronic fatigue syndrome.
• Stress. Emotional or physical stress may trigger vasomotor rhinitis in some people.

Vasomotor rhinitis prevention

There’s currently no surefire way to prevent vasomotor rhinitis. However, a new study suggested that children who ate oily fish or certain polyunsaturated fatty acids may be less likely to develop vasomotor and allergic rhinitis. The reduced risk was seen in children who consumed herring, mackerel or salmon at least once a week.

If you already have vasomotor rhinitis, you can take steps to reduce your symptoms and prevent flare-ups:

• Avoid your triggers. If you can identify things that cause or worsen your symptoms, avoiding them can make a big difference.
• Don’t overuse nasal decongestants. Using these medications for more than a few days at a time can actually worsen your symptoms.
• Get treatment that works. If treatment isn’t working, see your doctor. Your doctor can make changes that do a better job preventing or reducing your symptoms.

Vasomotor rhinitis complications

Complications from vasomotor rhinitis include:

• Nasal polyps. These are soft, noncancerous (benign) growths that develop on the lining of your nose or sinuses due to chronic inflammation. Small polyps may not cause problems, but larger ones can block the airflow through your nose, making it difficult to breathe.
• Sinusitis. Prolonged nasal congestion due to vasomotor rhinitis may increase your chances of developing sinusitis — an infection or inflammation of the membrane that lines the sinuses.
• Middle ear infections. Increased fluid and nasal congestion may lead to middle ear infections.
• Interrupted daily activities. vasomotor rhinitis can be disruptive. You may be less productive at work or school, and you may need to take time off because of symptom flares or doctor visits.

Vasomotor rhinitis diagnosis

Vasomotor rhinitis is diagnosed based on your symptoms and ruling out other causes, especially allergies. Your doctor will perform a physical examination and ask questions about your symptoms.

He or she may also recommend certain tests. There are no specific, definite tests used to diagnose vasomotor rhinitis. Your doctor is likely to conclude your symptoms are caused by vasomotor rhinitis if you have nasal congestion, a runny nose or postnasal drip, and tests for other conditions don’t reveal an underlying cause such as allergies or a sinus problem.

In some cases, your doctor may have you try a medication and see whether your symptoms improve.

Ruling out an allergic cause

In many cases, rhinitis is caused by an allergic reaction. The only way to be sure rhinitis isn’t caused by allergies is through allergy testing, which may involve skin or blood tests.

• Skin test. To find out whether your symptoms might be caused by a certain allergen, your skin is pricked and exposed to small amounts of common airborne allergens, such as dust mites, mold, pollen, cat and dog dander. If you’re allergic to a particular allergen, you’ll likely develop a raised bump (hive) at the test location on your skin. If you’re not allergic to any of the substances, your skin looks normal.
• Blood test. A blood test can measure your immune system’s response to common allergens by measuring the amount of certain antibodies in your bloodstream, known as immunoglobulin E (IgE) antibodies. A blood sample is sent to a medical laboratory, where it can be tested for evidence of sensitivity to specific allergens.

In some cases, rhinitis may be caused by both allergic and vasomotor causes.

Ruling out sinus problems

Your doctor will also want to be sure your symptoms aren’t caused by a sinus problem related to a deviated septum or nasal polyps. If your doctor suspects a sinus problem may be causing your symptoms, you may need an imaging test to view your sinuses.

• Nasal endoscopy. This test involves looking at the inside of your nasal passages. This is done with a thin, fiber-optic viewing instrument called an endoscope. Your doctor will pass the fiber-optic endoscope through your nostrils to examine your nasal passages and sinuses.
• Computerized tomography (CT) scan. This procedure is a computerized X-ray technique that produces images of your sinuses that are more detailed than those produced by conventional X-ray exams.

Vasomotor rhinitis treatment

Treating vasomotor rhinitis depends on the specific cause or diagnosis. If there is a specific trigger that can be avoided, this may be a successful treatment. For mild cases, home treatment and avoiding triggers may be enough.

Often, medications are used to control symptoms. Depending on the specific cause of the rhinitis symptoms, some of the medications that may be used include:

• Try to avoid things that trigger your symptoms.
• Intranasal saline spray or rinse. Use saline (saltwater) nasal washes to help keep your nasal passages open and wash out mucus and bacteria. You can buy saline nose drops at a grocery store or drugstore. Or you can make your own at home by adding 1 teaspoon of salt and 1 teaspoon of baking soda to 2 cups (500 ml) of distilled water. If you make your own, fill a bulb syringe with the solution, insert the tip into your nostril, and squeeze gently. Blow your nose.
• Antihistamines (oral or intranasal). Try a prescription antihistamine spray such as azelastine (Astelin, Astepro) and olopatadine hydrochloride (Patanase). While oral antihistamines don’t seem to help nonallergic rhinitis, nasal sprays containing an antihistamine may reduce symptoms of nonallergic rhinitis.
• Corticosteroids usually applied as an intranasal spray. If your symptoms aren’t easily controlled by decongestants or antihistamines, your doctor may suggest a nonprescription corticosteroid nasal spray, such as fluticasone (Flonase) or triamcinolone (Nasacort). Prescription-only corticosteroid nasal sprays are also available. Corticosteroid medications help prevent and treat inflammation associated with some types of nonallergic rhinitis. Possible side effects include nasal dryness, nosebleeds, headaches and throat dryness.
• Ipratropium bromide intranasal spray. The prescription drug ipratropium (Atrovent) is often used as an asthma inhaler medication. But it’s now available as a nasal spray and can be helpful if a runny, drippy nose is your main complaint. Side effects may include nosebleeds and drying of the inside of your nose.
  
• Decongestants. Available over-the-counter or by prescription, examples include pseudoephedrine-containing drugs (Sudafed) and phenylephrine (Afrin, Neo-Synephrine, others). These medications help narrow the blood vessels, reducing congestion in the nose. Possible side effects include high blood pressure, heart pounding (palpitations) and restlessness.

If your doctor recommends medicine to relieve symptoms, make sure to take it exactly as prescribed. For example, take a decongestant spray for no more than 3 or 4 days. Longer use can make symptoms worse. Call your doctor or nurse call line if you think you are having a problem with your medicine.

Over-the-counter oral antihistamines, such as diphenhydramine (Benadryl), cetirizine (Zyrtec), fexofenadine (Allegra) and loratadine (Claritin), typically don’t work nearly as well for nonallergic rhinitis as they do for allergic rhinitis.

For severe runny nose or nasal obstruction/congestion that does not respond to medications, your ENT specialist may consider additional office procedures or surgery appropriate to your situation.

Vasomotor rhinitis surgery

Surgical procedures may be an option to treat complicating problems, such as a deviated nasal septum or persistent nasal polyps.