Correlation between Objective Nasal Mucosal Swelling and Estimated Stuffiness during Long-Term Use of Vasoconstrictors

Gräf, Peter; Juto, Jan-Erik

doi:10.1159/000276687

Cited by 11 publications

(6 citation statements)

References 10 publications

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“…29 They can be combined with oral decongestants, and the combination can improve nasal airflow in the short term (on the basis of data from trials lasting 2 to 6 weeks), at the cost of some side effects. 30,31 Topical nasal decongestants are more effective than oral agents, but there are reports of rebound congestion (rhinitis medicamentosa) or reduced effectiveness beginning as early as 3 days after treatment, 32 and only short-term use is recommended. In one study, adding an intranasal glucocorticoid reversed the reduced effectiveness of a topical decongestant.…”

Section: Strategies and Evidencementioning

confidence: 99%

Allergic Rhinitis

2015

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A 35-year-old woman has a history of nasal congestion on most days of the year, dating back to her late teens. She has chronic nasal drainage, which is clear and thick. Her congestion is worst in the late summer and early fall and again in the early spring; at these times, she also has sneezing, nasal itching, and cough. Five years ago, she had an episode of shortness of breath with wheezing on a day when her nasal symptoms were severe, but this episode resolved spontaneously and has not recurred. Her eyes do not bother her. Over-the-counter oral antihistamines help her symptoms a little, as do nasal decongestants, which she uses occasionally. Her 6-year-old son has similar symptoms. How should this case be managed?

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Section: Strategies and Evidencementioning

confidence: 99%

Allergic Rhinitis

2015

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“…Statistical analysis was performed by Microsoft-EXCEL and IBM-SPSS-statistics (25) software-package (Armonk, NY-IBMcorp). Data In control group, they were respectively 15/51 (29.4%), 24/51 (47.1%) and 12/51 (23.5%).…”

Section: Discussionmentioning

confidence: 99%

Predisposing factors of rhinitis medicamentosa: what can influence drug discontinuation?

Corso¹,

Mastrapasqua²,

Tricarico³

et al. 2020

Rhin

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Background: the primary end point of our study was to define risk factors and identify the underlying conditions that may have led to the abuse of vasoconstrictors in rhinitis medicamentosa. Moreover, we analysed factors that may influence the vasoconstrictors discontinuation.Methodology: this was a prospective case-control observational study. Cases and controls were evaluated at the baseline in order define factors that may have influenced onset of rhinitis medicamentosa. They were re-evaluated at 3 months to verify symptoms control and drug discontinuation. Finally, they underwent a phone call questionnaire after 12 months regarding drug discontinuation. A potential bias of our study is that evaluating discontinuation we included subjects treated differently according to the main diagnosis.Results: patients with rhinitis medicamentosa were more frequently smokers than controls, they had higher mean HAMA scores and positive psychiatric diseases history. Additionally, we frequently detected a local inflammation at nasal cytology in patients with rhinitis medicamentosa. A significant improvement in all nasal symptoms scores was observed in cases and controls but 29.4% of cases did not discontinue the vasoconstrictors. Two major factors negatively influenced discontinuation: positive nasal cytology and pathological HAMA score. Conclusion:we observed that positive local inflammation, anxiety and smoking habit correlate positively with vasoconstrictors abuse. In addition, we demonstrated that anxiety and local inflammation were the most important factors impairing drug discontinuation.

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“…In literature, the (over)use of oxymetazoline HCl is often described to be related to RM (e.g. Graf and Juto, 1994a, b, 1995). Opinions vary as to how long topical decongestants can safely be used without risking the development of RM (Graf et al ., 1999), as the recommended usage of topical decongestants varies globally (Morris et al ., 1997).…”

Section: Discussionmentioning

confidence: 99%

“…From most OTC‐formulations only minimal effects are observed in vivo , but long‐term use may result in RM. This is the case, for example, when formulations with oxymetazoline are used for longer than 10 days (Graf and Juto, 1994a, b, 1995).…”

Section: Introductionmentioning

confidence: 99%

New aspects of the Slug Mucosal Irritation assay: predicting nasal stinging, itching and burning sensations

Lenoir

Adriaens

Remon

2010

J of Applied Toxicology

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Short AbstractThe objective of this study was to evaluate the mucosal tolerance of several marketed nasal formulations using the slug Arion lusitanicus. None of the tested formulations resulted in tissue damage, however a clear effect on the mucus production of the slugs was observed, either due to the active ingredient, presence of benzalkonium chloride as a preservative or hyperosmolality of the formulation. The new 1-day protocol of the Slug Mucosal Irritation assay is a good tool to predict nasal clinical discomfort. AbstractToday, stinging, itching and/or burning (SIB) sensations cannot be detected by animal tests or in vitro models. In the past, the Slug Mucosal Irritation (SMI) assay demonstrated a relation between an increased mucus production in slugs and an elevated incidence of SIB sensations in humans. A new 1-day SMI-test procedure was developed focusing on the prediction of these short term sensations.The objective of this study was to verify whether this new procedure is capable predicting mucosal tolerance of several marketed nasal formulations using the slug Arion lusitanicus. Irritation and tissue damage were quantified with a 5-day repeated exposure study by means of the mucus produced and proteins and enzymes released. On the other hand, the new protocol predicted SIB sensations by means of the mucus production. The effects of 6 liquid nasal formulations were tested with both protocols, while 5 physiologic saline solutions were only tested with the new protocol to optimize it. None of the tested liquid nasal formulations resulted in tissue damage, however the exposure to the different formulations had a clear effect on the mucus production of the slugs and moderate discomfort was observed in some cases.These effects were due to the active ingredient, the presence of benzalkonium chloride as a preservative or the hyperosmolality of the formulation. For the most part 2 results agreed with clinical data found in literature. It was concluded that the SMI assay and the new 1-day protocol in particular is a good tool to predict nasal clinical discomfort.

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Correlation between Objective Nasal Mucosal Swelling and Estimated Stuffiness during Long-Term Use of Vasoconstrictors

Cited by 11 publications

References 10 publications

Allergic Rhinitis

Allergic Rhinitis

Predisposing factors of rhinitis medicamentosa: what can influence drug discontinuation?

New aspects of the Slug Mucosal Irritation assay: predicting nasal stinging, itching and burning sensations

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