Posted by Barry G. Acker
on May 08, 2000 at 10:33:40:
In Reply to: vasomotor rhinitis, info from a allergist web site, text only posted by charlie on March 02, 2000 at 19:27:56:
: Are there any indicator which point to diabetes as a possible underlying cause for VMR? I have diabetes (NIDDM) and I don't have for the most part the stuffy nose; but I do have the almost constant thin watery nasal drainage and sneezing, mostly in the morning.
I have to avoid any kind of powder laundry detergent ( I can't even walk down that aisle in the super market without sneezing). About the only thing I have found to give some relief is the nasal saline irrigation I do in the morning and evening.
: VASOMOTOR RHINITIS
: Vasomotor rhinitis can cause you much frustration and discomfort. While there is no cure for this condition, there are ways to help.
: As with most chronic problems, the key to control is understanding on your part. This is a difficult problem to explain, but hopefully, this information will help you live with this problem more comfortably.
: WHAT IS IT?
: The cause of vasomotor rhinitis remains obscure despite its recognition for many years. We do know that the lining inside an affected nose overreacts to anything that irritates it. Blood vessels enlarge (vasodilate) and this results in chronic swelling and nasal obstruction. There is some evidence that individuals with vasomotor rhinitis have an imbalance in the nerve supply to the nose which leads to the dilated blood vessels.
: Persons with vasomotor rhinitis, because of chronic swelling, have difficulty in breathing nasally. They may have a small to copious amount of thin, watery nasal discharge, a recurrent postnasal drip, or no discharge at all. Because of the chronic swelling, normal drainage may be blocked which may lead to recurrent sinus or ear infections. Some individuals also experience burning of the eyes.
: WHAT MAKES IT WORSE?
: The thing that aggravates vasomotor rhinitis most specifically is aerosol products. These may include hair sprays, deodorants, insecticides and many others. Other non-specific factors which aggravate this condition are cigarette smoke, air pollution, ozone, formaldehyde, perfumes, chemical odors, even changes in weather, temperature or humidity (especially rainy weather). Any type of irritant that you can inhale into the nose may aggravate symptoms.
: IS IT AN ALLERGY?
: The answer is no, despite what any skin testing or other laboratory data may suggest. Individuals with allergic symptoms usually present to the allergist with a history of sneezing spells (usually greater than 5 sneezes per spell), itching of the eyes, nose and throat, and a large amount of watery nasal discharge. These symptoms may occur only during certain seasons or sometimes year-round.
: People with allergic rhinitis usually have a positive family history for allergy and usually respond favorably to antihistamines and corticosteroid (anti-inflammatory) drugs. The individual with vasomotor rhinitis usually does not. In addition to the historical data to help distinguish allergic from vasomotor rhinitis, allergy testing can be done to differentiate these 2 types of chronic rhinitis. If allergies are ruled out, then vasomotor rhinitis is likely, but remember, these conditions can co-exist and synergistically increase one's symptoms.
: WHAT CAN HELP?
: These measures may reduce your symptoms to a pleasantly surprising degree. Obviously, you need to avoid the agents you know to be a problem. Two of the most frequent irritants are cigarette smoke and chronic use of nose drops or sprays. If you smoke or live with a family member who smokes heavily, it is unlikely that your symptoms will ever be in complete control. You will need to stop cigarette smoke exposure completely!
: Nose drops and sprays (Afrin, Neosynephrine, etc.) will produce dramatic improvement in the symptoms of vasomotor rhinitis due to the ability of shrinking or contacting the blood vessels. Used occasionally, they are a helpful treatment. Used consistently, these preparations cause "rebound swelling", that is, the more you use them, the more you need them, until they do more harm than good. Try not to use these preparations for more than 2-3 days in a row. Use them as a last resort when all else fails.
: Non-specific irritants should be avoided. Use a roll-on deodorant instead of sprays. If you must use hair spray, use the pump type. Avoid high concentrations of house dust. We will furnish you with information regarding the approach to house dust control if you wish. Certain drugs, such as blood pressure medication, may cause problems which simulate vasomotor rhinitis. Check with us if there is any question in this regard. If you must treat your home with insecticide, try to be elsewhere during the actual application. During periods of heavy pollution, drive your care with the windows and vents closed.
: SPECIFIC MEASURES
: Salt water nose spray may be useful in vasomotor rhinitis. Some patients derive significant help from either a room or central humidifier, especially in the winter when heaters are turned on and the air is very dry.
: Decongestants give the most consistent relief by shrinking the nasal blood vessels. Sometimes it is a trial and error thing to find the right one for you, but it can be done. These drugs are quite safe, even if taken for prolonged periods. On occasion, some people experience nervousness or insomnia, which usually goes away with a; minor dosage decrease. If you have high blood pressure, please advise us of this since decongestants may aggravate hypertension.
: Antihistamines are less effective in vasomotor rhinitis because histamine is a mediator in allergic rhinitis. Some antihistamines may be helpful when used in combination with decongestants.
: Intranasal corticosteroids are safe and are at times helpful in vasomotor rhinitis. Atropine spray can correct part of the overactive intranasal nerve supply and help some people. If nasal blockage is a predominant symptom, surgical procedures may alleviate the problem if medications fail to help.
: You can help by learning to recognize a common complication which occurs in individuals with this problem - sinus infection. because the sinus openings may be blocked due to chronic swelling, the sinuses will not drain properly. This lead to infection which can present as tooth pain, facial fullness or discolored drainage.
: The best thing you can do is take your medications as directed and do not get discouraged. We will do our best to answer any questions you may have. The more you know, the better your problems will be controlled.
: thank you