A runny or stuffy nose is a common and annoying condition. At times allergen exposures are the culprit, but there are other times when allergies may be incorrectly blamed.

Vasomotor rhinitis is a name given to a rather common nasal problem in which blood vessels, nerves, and membranes of the nose have an exaggerated response to certain triggers. While this condition masquerades as an allergy, it is not. The diagnosis of vasomotor rhinitis is made by an allergist on the basis of the patient’s description of his/her symptoms, examination of the membranes of the nose and skin tests to inhaled allergens. These allergens will show either entirely negative or very weakly reactive and do not correlate with the patient’s history.

Symptoms of vasomotor rhinitis are overreactions by the nose to many common things in the environment. Mucous, clear fluid, congestion, and nasal blockage result. Sometimes these symptoms are accompanied by mild nasal and eye irritation or itching as well. It is not known why certain persons have a tendency to have this type of inflammation. Although it can occur in children and teenagers, it typically starts in later life. Also, this problem can be caused or aggravated by hormonal changes in the body and by certain blood pressure and hormonal medication. In more severe cases of vasomotor rhinitis, the membranes in the nose may continue to stay very swollen for so long that the sinuses cannot drain properly and become frequently or chronically infected. Also, in some cases, growths called nasal polyps may also occur and block the nasal cavity even more.

Common Irritants

The nose normally adjusts to many variations in the environment. For people with vasomotor rhinitis, some of these environmental conditions trigger their symptoms. These irritants may include all or some of the following:

  • Extremes in temperature-very hot or cold air
  • Extremes in humidity-very dry or moist air
  • Strong odors
  • Particulate irritants-pollution, smoke, house dust
  • Hot, cold, or spicy food
  • Food or drink which affects blood vessels (i.e. alcoholic beverages)
  • Body position-lying down commonly produces blockage
  • Emotional factors

Management

Treatment is often not simple and needs to be worked out for each patient individually. This condition can be controlled but not cured. Usually, treatment consists of avoidance of airborne irritants to the greatest possible extent, over-the-counter and prescription nasal sprays, nasal irrigation with saline solution, decongestant medications by mouth, and treatment of sinus infections, if present. In some cases, steroids taken orally or by injection may be necessary at the beginning of treatment or for major flare-ups. If nasal polyps develop and do not shrink with the certain types of medications, they may need to be surgically removed.

Treatments which should be used with caution or avoided by patients with vasomotor rhinitis:

Over the counter nasal sprays (such as Afrin, etc.).

These preparations open up the nose for a few hours and make the patient feel better for a while but if used for extended periods of time the membranes may swell even more (rebound) when the spray wears off. This compounds the problem and creates a vicious cycle leading to very severe inflammation of the lining of the nose and possibly other complications. These medications can be effective when used appropriately; some physicians will prescribe their use in some patients. They should never be used over five days in a three week period.

Allergen injection treatment (allergy shots).

Some patients have inflammation of the nasal membranes caused by allergic reactions which have symptoms similar to vasomotor rhinitis. These may improve with allergy injections. However, if skin tests are negative or weak and results do not correlate with symptoms, allergy injections, although well intended, will not help.

Use of antibiotics.

When nasal symptoms become more severe, some patients may benefit from antibiotic treatment. However, if the following symptoms are not present antibiotics will not generally be helpful. The symptoms are as follows: fever, thick yellow or green discharge from the nose, or abnormal sinus x-rays. It is also important to remember that a physician should monitor antibiotic treatment.

Vasomotor rhinitis is common and can be a difficult condition to treat. With the help of a specialist trained to treat upper airway conditions, as well as some patience, relief can be found.

About the author

Dr. Nathanael Brady is a board-certified allergy, asthma and immunology physician and is the owner of Pike Peak Allergy & Asthma
Dr. Nathanael Brady

Dr. Nathanael Brady is a board-certified allergy, asthma and immunology physician and is the owner of Pike Peak Allergy & Asthma. He is originally from Michigan, training at Michigan State University, Ohio State University and Case Western University. When not seeing patients, he spends his time wrangling his three young children with his wife Jennifer.

Pikes Peak Allergy & Asthma
595 Chapel Hills Drive, Site 102
Colorado Springs, CO 80920