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an inflammation of the mucous membrane lining the nose (usually associated with nasal discharge) (同)coryza

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鼻炎

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/12/02 17:23:00」(JST)

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Rhinitis medicamentosa (or RM) is a condition of rebound nasal congestion brought on by extended use of topical decongestants (e.g., oxymetazoline, phenylephrine, xylometazoline, and naphazoline nasal sprays) that work by constricting blood vessels in the lining of the nose.

Presentation

This condition typically occurs after 5 to 7 days of use of such medications. Patients often try increasing both the dose and the frequency of nasal sprays upon the onset of RM, worsening the condition. The swelling of the nasal passages caused by rebound congestion may eventually result in permanent turbinate hyperplasia, which may block nasal breathing until surgically removed.^[1]

Commercial introduction of Oxymetazoline brand Afrin. The prolonged use of nasal vasoconstrictors cause rhinitis medicamentosa

Pathophysiology

While the mechanism of RM is unclear, several theories have been proposed.

Sympathomimetic amines, such as phenylephrine and pseudoephedrine, stimulate both alpha and beta adrenergic receptors. At first, the vasoconstrictive effect of alpha-receptors dominates. This effect fades first, allowing the vasodilation due to beta-receptor stimulation to emerge.^[2]

Imidazolamine derivatives, such as oxymetazoline, may participate in negative feedback on endogenous norepinephrine production. Therefore, after cessation of prolonged use, there will be inadequate sympathetic vasoconstriction in the nasal mucosa, and domination of parasympathetic activity can result in increased secretions and nasal edema.^[3]^[4]

However, if oxymetazoline is used only nightly for allergic rhinitis, it can be used longer than one week without risk of rhinitis medicamentosa.^[5]

Treatment

The treatment of RM involves withdrawal of the offending nasal spray. Both a "cold turkey" and a "weaning" approach can be used. Cold turkey is the most effective treatment method, as it directly removes the cause of the condition, yet the time period between the discontinuation of the decongestant and the relief of symptoms may be too long for some individuals (particularly when trying to go to sleep when they are unable to breathe through their nose). The use of Over the Counter (OTC) saline nasal sprays may help open the nose without causing RM if the spray does not contain a decongestant or preservative. Symptoms of congestion and runny nose can often be treated with corticosteroid nasal sprays under the supervision of a physician. For very severe cases, oral steroids or nasal surgery may be necessary.

There are anecdotal reports of persons having success withdrawing, by withdrawing treatment from one nostril at a time.^[6]

A study has shown that the anti-infective agent benzalkonium chloride, which is frequently added to topical nasal sprays as a preservative, aggravates the condition by further increasing the rebound swelling.^[7]

Causes

Common issues that lead to overuse of topical decongestants:

Deviated septum
Upper respiratory tract infection
Vasomotor rhinitis
Cocaine use
Pregnancy (these products are not considered safe for pregnancy)
Chronic rhinosinusitis
Hypertrophy of the Inferior Turbinates

References

^ Rhinitis Medicamentosa, > Epidemiology, > Morbidity
^ Passali D, Salerni L, Passali G, Passali F, Bellussi L (2006) Nasal decongestants in the treatment of chronic nasal obstruction: efficacy and safety of use. Expert Opin Drug Saf 5(6):783–790.
^ Lacroix J (1989) Adrenergic and nonadrenergic mechanisms in sympathetic vascular control of the nasal mucosa. Acta Physiol Scand Suppl 581:1–63
^ Elwany S, Stephanos W (1983) Rhinitis medicamentosa—an experimental histopathological and biochemical study. ORL J Otorhinolaryngol Relat Spec 45(4):187–194
^ Baroody FM, Brown D, Gavanescu L, Detineo M, Naclerio RM (2011). "Oxymetazoline adds to the effectiveness of fluticasone furoate in the treatment of perennial allergic rhinitis.". J Allergy Clin Immunol 127 (4): 927–34. doi:10.1016/j.jaci.2011.01.037. PMID 21377716. http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21377716.
^ Saltus, Richard (March 14, 2006), "Nasal Sprays Can Bring on Vicious Cycle", New York Times, http://www.nytimes.com/2006/03/14/health/14spra.html
^ Graf, P.; Hallén, H.; Juto, J. E. (1995). "Benzalkonium chloride in a decongestant nasal spray aggravates rhinitis medicamentosa in healthy volunteers". Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology 25 (5): 395–400. PMID 7553241. edit

UpToDate Contents

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1. 鼻炎の概要 an overview of rhinitis
2. 慢性非アレルギー性鼻炎 chronic nonallergic rhinitis
3. 鼻閉塞の臨床症状、診断、および治療 clinical presentation diagnosis and treatment of nasal obstruction
4. 妊娠中のアレルギー疾患の認識およびマネージメント recognition and management of allergic disease during pregnancy
5. アレルギー性鼻炎の薬物療法 pharmacotherapy of allergic rhinitis

English Journal

Rebound congestion and rhinitis medicamentosa: Nasal decongestants in clinical practice. Critical review of the literature by a medical panel.

Mortuaire G, de Gabory L, François M, Massé G, Bloch F, Brion N, Jankowski R, Serrano E.SourceService d'ORL et de chirurgie cervico-faciale, hôpital Huriez, CHRU de Lille, rue Michel-Polonovski, 59037 Lille cedex, France. Electronic address: g-mortuaire@chru-lille.fr.
European annals of otorhinolaryngology, head and neck diseases.Eur Ann Otorhinolaryngol Head Neck Dis.2013 Jun;130(3):137-44. doi: 10.1016/j.anorl.2012.09.005. Epub 2013 Feb 1.
INTRODUCTION: Systemic and topical nasal decongestants are widely used in otorhinolaryngology and general practice for the management of acute rhinosinusitis and as an adjuvant in certain forms of chronic rhinosinusitis. These products, very effective to rapidly improve nasal congestion, are sometim
PMID 23375990

Chapter 14: Nonallergic rhinitis.

Settipane RA, Kaliner MA.SourceDepartment of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA. russell_settipane@brown.edu
American journal of rhinology & allergy.Am J Rhinol Allergy.2013 May-Jun;27 Suppl 1:S48-51. doi: 10.2500/ajra.2013.27.3927.
Rhinitis is characterized by one or more of the following nasal symptoms: congestion, rhinorrhea (anterior and posterior), sneezing, and itching. It is classified as allergic or nonallergic, the latter being a diverse syndrome that is characterized by symptoms of rhinitis that are not the result of
PMID 23711042