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Summary.
Rhinitis
medicamentosa (RM)
is a condition
induced by overuse
of nasal
decongestants. The
term RM, also called
rebound or chemical
rhinitis, is also
used to describe the
adverse nasal
congestion that
develops after using
medications other
than topical
decongestants. Such
medications include
oral ß-adrenoceptor
antagonists,
antipsychotics, oral
contraceptives, and
antihypertensives.
However, there are
differences in the
mechanism through
which congestion is
caused by topical
nasal decongestants
and oral medications.
Very few prospective
studies of RM have
been performed and
most of the
knowledge about the
condition comes from
case reports and
histologic studies.
Histologic changes
consistent with RM
include nasociliary
loss, squamous cell
metaplasia,
epithelial edema,
epithelial cell
denudation, goblet
cell hyperplasia,
increased expression
of the
epidermal growth
factor receptor, and
inflammatory cell
infiltration. Since
the cumulative dose
of nasal
decongestants or
time period needed
to initiate RM has
not been
conclusively
determined, these
medications should
only be used for the
shortest period
necessary. Validated
criteria need to be
developed for better
diagnosis of the
condition. Stopping
the nasal
decongestant is the
first-line treatment
for RM. If necessary,
intranasal
glucocorticosteroids
should be used to
speed recovery.
Key words:
Rhinitis
medicamentosa.
Congestion.
Decongestants.
Sympathomimetic
amines. Imidazolines |
