Rhinitis medicamentosa is a condition characterised by nasal congestion without having getting rhinorrohea or sneezing. This issue is induced by the use of topical nasal decongestants for a prolonged period of time. Use of these topical decongestants for far a lot more than a week is sufficient to consequence in this dilemma. This situation want to be differentiated from rhinitis induced by use of medicine like oral contraceptives, antihypertensives and psychotrophic treatment.
The expression rhinitis medicamentosa was coined by Lake in 1946.
Rebound rhinitis / chemical rhinitis
The nasal mucous membrane is loaded in resistance blood vessels draining into capacitance venous sinusoids. These resistance blood vessels include items like tiny arteries, arterioles and arteriovenous anastomosis. The capacitance vessels (venous sinusoids) are innervated by sympathetic fibers. Sympathetic stimulation triggers activation of alpha 1 and alpha two receptors present-day in the partitions of the capacitance vessels which leads to diminished blood stream and constriction of venous sinusoids triggering nasal decongestion. Parasympathetic stimulation prospects to launch of acetyl choline which enhances nasal secretions. Parasympathetic stimulation also delivers about release of VIP (vasoactive intestinal polypeptides) causing vasodilatation of the resistance blood vessels foremost on to dilatation of sinusoids there by making nasal congestion. In addition to sympathetic and parasympathetic innervation the nasal mucosa is richly endowed with sencory design c fibers. These sensory fibers on stimulation releases neurokinin A, calcitonin gene related peptide and compound P. These substances trigger down regulation of sympathetic vasoconstriction producing nasal congestion.
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The precise pathophysiology of rhinitis medicamentosa is go on to not unique. A wide range of speculation exist. Just about all of them intention on dysregulation of sympathetic / parasympathetic tone by exogenous vasoconstriction molecules.
Possible mechanisms of rhinitis medicamentosa entail:
Secondary lessen in the manufacturing of endogenous norepinephrine by suggests of a damaging feed again system
Sympathomimetic amines utilised as topical decongestants have consequences on the two alpha and beta receptors. Their alpha outcomes predominate over beta results resulting in nasal decongestion. This helpful alpha affect is transient lived even nevertheless beta impression is additional extended. Quickly following cessation of alpha stimulation the sympathomimetic amines continue to retain stimulating beta receptors resulting in rebound nasal congestion.
Rebound greatly enhance in parasympathetic action creating amplified nasal secretion and nasal mucosal congestion