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

Abstract

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.

The prevalence of non‐allergic rhinitis phenotypes in the general population: A cross‐sectional study

“…The second most common phenotype was RM (17% of NAR). Strictly speaking, RM is a subtype of DR, 1 though we have analyzed them separately due to the fact that RM is caused by a very specific medication that acts locally, has a different pathophysiological mechanism, 11 and is associated with psychiatric conditions, such as anxiety 44 or opioid use disorders. 45 Mehuys et al have also demonstrated an alarmingly high rates of ND (ab)use: about a half of individuals with persistent rhinitis purchasing over‐the‐counter medication for their nasal complaints were overusing ND, even though the majority was educated about the limit on duration of use.…”

“…The second most common phenotype was RM (17% of NAR). Strictly speaking, RM is a subtype of DR, 1 though we have analyzed them separately due to the fact that RM is caused by a very specific medication that acts locally, has a different pathophysiological mechanism, 11 and is associated with psychiatric conditions, such as anxiety 44 or opioid use disorders 45 46 .…”

Rhinology in review: from COVID-19 to biologicals

“…The most common NAR phenotypes are idiopathic and rhinitis medicamentosa, followed by occupational, smokers' ,hormonal, gustatory and rhinorrhoea of the elderly (62) . The high prevalence of rhinitis medicamentosa has also recently been shown to be correlated with the presence of local inflammation, anxiety and habitual smoking (68) .…”

Highlights of the treatment of allergic rhinitis according to Chinese guidelines

“…Used before INCs, topical decongestants can benefit allergic rhinitis patients with stuffy noses by expanding the distribution of subsequent INCs in the nasal cavity [38]. However, long-term frequent use of intranasal decongestants at improper concentrations may result in rhinitis medicamentosa, which is characterized by rebound nasal congestion and tachyphylaxis [39,40]. Therefore, intranasal decongestants are listed as secondline drugs for allergic rhinitis treatment in the guidelines [1].…”