Vasomotor rhinitis

Generality

Vasomotor rhinitis, or non-allergic rhinitis, is a particular form of rhinitis, which occurs due to excessive dilation of the blood vessels of the nasal mucosa. This vasodilation involves an accumulation of blood and fluids in the cavities of the nose, an accumulation that is a cause of irritation and inflammation of the nasal mucosa.

Several factors seem to favor the aforementioned vasodilation process; among these, the most important are: environmental factors (changes in temperature, high humidity, etc.), hormonal imbalances, some pharmacological substances (NSAIDs, beta-blockers, ACE inhibitors, etc.), intense physical exercise, etc.

For a correct diagnosis are essential: physical examination, medical history and allergy tests.

The treatment of vasomotor rhinitis involves, first of all, the elimination from the daily life of everything that can favor the dilation of the blood vessels of the nasal mucosa.

Medical meaning

Rhinitis is the medical term for any irritative and inflammatory process affecting the nasal mucosa.

Highly vascularized, the nasal mucosa is the mucus-secreting epithelium that covers and makes the nasal cavities moist.

The classic symptoms of rhinitis are: stuffy nose, runny nose, repeated sneezing, postnasal drip (or drain) and nasal voice.

Main functions of the nasal mucosa:

Heats and humidifies the air that enters the nose;
It traps harmful (or in any case foreign) substances that could be found in the air that enters the nose;
It supports the sense of smell, as it has connections with the first cranial nerve (or olfactory nerve).

What is vasomotor rhinitis?

Vasomotor rhinitis, or non-allergic rhinitis, is the irritative and inflammatory process affecting the nasal mucosa, which is certainly not due to either an allergy (allergic rhinitis) or to an infectious disease (infectious rhinitis).

Causes

At present, the precise causes of vasomotor rhinitis are unclear.

According to the most accredited medical theories, to initiate the inflammatory process that characterizes non-allergic rhinitis would be an excessive dilation of the blood vessels of the nasal mucosa and the consequent accumulation, in the nasal cavities covered by the latter, of huge quantities of blood and fluids .

On the basis of various scientific studies, some of the main factors that would seem to be able to favor, in circumstances that are still difficult to understand, the aforementioned process of vasodilation are:

High temperature, sudden changes in temperature, high humidity, exposure to toxic fumes (eg cigarette smoke), spicy foods, foods that are too hot, stress, alcohol, intense aromas, etc. All these factors are labeled with the term environmental factors;
Hormonal imbalances, which characterize particular moments in the life of a human being, such as pregnancy (exclusively for women) or puberty;
Hormonal therapies or hormonal contraceptives;
Special pharmacological substances, including: some NSAIDs (eg: ibuprofen or aspirin), beta-blockers, ACE inhibitors (or angiotensin-converting enzyme inhibitors), nasal decongestants in the form of sprays (in these situations, we talk about medicated rhinitis), drugs for the treatment of erectile dysfunction and some tranquilizers (eg: benzodiazepines);
The presence of damage to the turbinates or the absence of the latter, due for example to surgery removal surgery. The turbinates are specific areas of the nasal cavities, consisting of tissues that have the task of humidifying the inside of the nose and preventing the entry into the body of bacterial agents and other potentially dangerous microorganisms.
Vasomotor rhinitis, which depends on damage to the turbinates or their absence, is also called atrophic rhinitis ;
Intense physical exercise;
Strong emotions;
Sexual arousal.

It is important to point out that, in some cases, vasomotor rhinitis appears without the occurrence of any of the above circumstances; in other words, it appears for inexplicable reasons. In these situations, the doctors describe the inflammatory condition as an idiopathic disorder ( idiopathic vasomotor rhinitis ).

Meaning of idiopathic

The term idiopathic, associated with the name of a pathology, indicates that the latter has arisen for unknown or unidentifiable reasons.

Epidemiology

Interesting statistical studies conducted in the United States have shown that vasomotor rhinitis affects about 17 million inhabitants and affects the twenties with a particular predilection.

MIXED RHINITIS: WHAT IS IT?

Sometimes, vasomotor rhinitis can occur in association with allergic rhinitis. The condition deriving from the association between vasomotor rhinitis and allergic rhinitis takes the specific name of " mixed rhinitis ".

Symptoms and Complications

In addition to causing a stuffy nose, runny nose, sneezing, retronasal discharge and nasal voice, vasomotor rhinitis is also responsible for:

Moderate irritation and a sense of discomfort in and around the nose;
Reduced sense of smell (anosmia);
Formation of one or more scabs inside the nasal cavities. These scabs can be responsible for a bad smell coming out of the nose and bleeding (if you try to remove them);
Snoring;
Halitosis.

COMPLICATIONS

If particularly severe or if not treated appropriately, vasomotor rhinitis can give rise to various complications, including: sleep disturbances, daytime sleepiness, irritability, concentration problems, nasal polyps, sinusitis and infections affecting the middle ear.

WHEN TO REFER TO THE DOCTOR?

An individual with all the typical symptoms of a vasomotor rhinitis should contact his or her doctor, when the above symptoms strongly condition the quality of life.

Diagnosis

From the point of view of symptoms, vasomotor rhinitis is very similar to allergic rhinitis and this makes the correct identification of both complicated.

In general, to diagnose a case of vasomotor rhinitis and not to confuse it with a case of allergic rhinitis, an accurate physical examination, a careful anamnesis and a series of allergy tests are necessary.

The use of the nasal swab is a further diagnostic solution, which doctors however take into consideration only when there is suspicion of an infectious rhinitis.

Knowing precisely the type of rhinitis in progress is essential for planning the most appropriate therapy.

OBJECTIVE AND ANAMNESIS EXAMINATION

Thanks to an accurate physical examination and a careful medical history, the doctors are able to understand if there is any particular circumstance, or some particular factor, at the origin of the symptoms that suggest a form of rhinitis.

ALLERGIC TESTS: HOW TO INTERPRET THEM?

Allergic tests include skin tests and blood tests.

A positive response to allergy tests is indicative of allergic rhinitis; a negative response, on the other hand, is indicative of vasomotor or infectious rhinitis.

Treatment

Generally, the treatment of vasomotor rhinitis involves:

A series of attentions aimed at avoiding direct contact with those factors that seem to favor the dilation of the blood vessels of the nasal mucosa and the consequent inflammatory process. This is possible, of course, in all those cases in which vasomotor rhinitis is not idiopathic;
Nasal washings with saline solutions. They serve to cleanse the nasal cavities from excess mucus and irritants. In addition to reducing the inflammatory state, they are a source of relief;
The use of nasal sprays based on corticosteroids. Corticosteroids are powerful anti-inflammatory drugs, which are medicines that reduce inflammation. Their prolonged use can lead to different side effects, therefore it is good to take them only after prescription;
The use of anticholinergic nasal sprays. They limit the production of mucus inside the nasal cavities, thus relieving the symptom known as a runny nose;
The use of decongestant nasal sprays. Reduce excessive dilation of blood vessels in the nasal mucosa.

WASHING WITH SALINE SOLUTION

Preparing saline solutions for washing the nose is quite simple and patients can also do it at home. It is enough, in fact, that I mix, in a solution of water, a teaspoon of salt and a teaspoon of baking soda and heat it all, taking care to use the preparation at body temperature.

To apply the solution, the main steps are three:

In front of a sink, stand up, make a goblet of one hand and pour a little of the saline solution;
"Pull up" the saline solution, aspirating it with one nostril at a time. If you cannot suck the solution with your nose, you can use a syringe;
Repeat the suction until a sense of well-being is felt. It may be that sometimes a small amount of saline is sufficient; it is therefore not necessary to consume all the preparation.

Prognosis

The prognosis in the case of vasomotor rhinitis depends on at least two factors: the severity of the symptoms and the attention that the patient puts to avoiding certain agents triggering the symptomatology (if there are any).

In most cases, careful and timely treatment leads to complete recovery; on the other hand, a late and perhaps non-continuous therapy is, quite frequently, associated with the onset of complications.