Patient Education

VASOMOTOR (NONALLERGIC) RHINITIS

Copyright 2002, Regional Allergy & Asthma Consultants, PA

WHAT IS VASOMOTOR RHINITIS?

Vasomotor rhinitis (VMR)is a condition in which the tiny blood vessels lining the nose (vaso) may swell and make the nose stuffy, and in which the mucus glands in the nose may be overactive (motor), leading to excessive runny nose or postnasal drainage. The drainage may be thin and watery, and run primarily from the front of the nose, or may be quite thick and chronic, draining down the back of the throat, leading to cough, hoarseness, or throat irritation. The phlegm may be quite difficult to clear, particularly upon first awakening.

Symptoms of VMR are similar to those of allergies, with frequent congestion, runny nose and/or postnasal drip. Patients with VMR, however, usually have less sneezing and itching than our allergic patients. Some patients have both conditions, and when they occur together, the two may aggravate one another.

WHO GETS VASOMOTOR RHINITIS?

VMR can occur at any age, although it tends to be more common as people get older. VMR is usually not inherited.

WHAT CAUSES VASOMOTOR RHINITIS?

The underlying cause of VMR is unknown, although it is probably related to signals occurring in the nerves that connect the brain to the nose. There are numerous potential triggers for this condition, but all share a common thread: the body is perceiving some physical change or threat to which it feels it must reflexively respond by "protecting" itself. It does so by making the nose more stuffy or runny.

Common triggers include sudden changes in temperature, barometric pressure, or humidity, such as going from the outside into air-conditioning, or turning on your car's air-conditioning. Some patients with VMR will have more difficulties during the spring and fall due to the changes in temperature and humidity that occur during these times of the year.

Any strong odor (perfumes, potpourri, laundry detergent, new carpeting) will bother people, as will cigarette smoke, automobile exhaust, or any other form of air pollution. Indeed any particulate matter in the air, including pollens, dust, mold, or animal dander can bother people with VMR, even though they are not actually allergic to these things. It is important to understand that VMR is a nonspecific response to virtually any change or impurity in the air, as opposed to allergic rhinitis (or hay fever), which involves a response to a specific protein in pollen, dust, mold, or animal dander.

Some patients will find that eating causes more nasal drainage or congestion. This is because the digestive process includes the production of mucus in the gastrointestinal tract. The nerves and reflexes that control this are very closely related to the nerves controlling the nose, and sometimes this reaction of mucus production "spills over" to the nose when eating. We all have this, to a certain extent, with spicy and cold/frozen foods.

HOW IS VASOMOTOR RHINITIS DIAGNOSED?

We usually diagnose VMR by taking a careful history and performing a thorough exam of the nose and throat. In addition, we often perform allergy testing to make sure there is no allergic basis for some of the symptoms, since this would affect our treatment approach.

HOW IS VASOMOTOR RHINITIS TREATED?

Unfortunately, there is no "cure" for VMR.  Several medications are available to help alleviate symptoms.  Unlike allergic rhinitis, there is no specific or preventive therapy, such as allergy injections, to permanently reduce the body's sensitivity to what is triggering the problem.  It is also harder to avoid the triggers of VMR. 

 

One of the most effective treatments may be over-the-counter nasal saline spray or mist, which can be used as often as needed to soothe the nose and loosen any thick mucus.

 

Do not use over-the-counter nasal decongestant sprays, such as Afrin, as they will only worsen the problem by further irritating the lining of the nose, leading to increased congestion or drainage. 

 

Steroid-containing nasal sprays are often helpful, as well, and can be used immediately following nasal saline (but not vice versa as the saline would wash away the medicated spray).  These medications work by reducing inflammation in the nose and are particularly helpful when there is significant congestion or thick postnasal mucus.  These are not the type of steroids athletes sometimes abuse, and at recommended doses, do not get absorbed into the body enough to cause any significant side effects.  They act solely on the lining of the nose, much like cortisone cream relieves skin irritation.  They do need to be used for at least several days at time, and often long-term, for best results. 

 

There are some non-steroidal nose sprays which are often helpful for people with VMR.  One is called Astelin and the other, Atrovent.  Astelin is an antihistamine with some additional anti-inflammatory effects, whereas Atrovent blocks the mucus-producing glands in the nose.  Both are available by prescription and can be used either on a regular basis or just when needed.

 

Sometimes, an oral decongestant pill may also be used to dry up watery drainage or to relieve congestion, but these may cause insomnia or aggravate hypertension, so are generally used sparingly, particularly in elderly patients. 

 

In patients with bothersome thick postnasal drainage, an expectorant (mucus thinner) can be quite helpful, and is usually not associated with any significant side effects.  Occasionally, antibiotics are needed to treat a low-grade sinus infection that may have been smoldering as a result of the chronic congestion and drainage of VMR.  We can usually detect these infections by a careful history and exam, but occasionally need to obtain x-rays or a sinus CT scan for confirmation. 

 

Finally, it is most important that patients with VMR, or indeed any respiratory problem, not smoke or be exposed to secondhand smoke.  Cigarette smoke contains numerous toxic and irritating particles and gases that aggravate the lining of the nose, increasing both congestion and mucus production.  The fine cigarette particles harmful to our respiratory tracts stay airborne for up to 24 hours and rapidly spread throughout an entire home.  Therefore, cigarette smoking must be moved completely outdoors and out of the car.  It is not adequate for other family members to smoke only in a designated room, or to smoke only when the patient is away from home.  Even the most sophisticated and powerful air cleaning devices are quickly outpaced by smoke, and are not a substitute for always keeping smoking outdoors. 

 

As always, we are here to maximize your long-term health and well‑being.  We look forward to working with you in a number of ways to effectively meet that goal. 


 

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Last updated 05/02/2002

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