Rhinitis medicamentosa: symptoms, how to treat it?

What is rhinitis medicamentosa?

Rhinitis medicamentosa refers to rhinitis caused by a side effect of medication. However, it has the same signs as classic rhinitis. “It must be remembered that rhinitis is “a catch-all” which is defined by a inflammation of the nasal passages. It is differentiated from the nasopharyngitis or rhinosinusitis. Rhinitis causes a feeling of discomfort and can present different symptoms: stuffy nose, feeling of having to blow your nose, runny nose but also itching, sneezing and associated signs such as headaches and sinus heaviness“, explains Dr Vincent Burcia, ENT and secretary general of SNORL.

Initially, to diagnose rhinitis, whether medicinal or not, the symptoms must be bilateral, that is to say that the symptoms are felt on both sides of the nose. If the symptoms are only felt on one side (unilateral), this means that it is not rhinitis. In a second time, the ENT carries out an interrogation : How long has the patient had these symptoms? Did they appear suddenly or gradually? Is this a first episode or is it recurring? If it’s recurring, is there a seasonality? Is there an obvious external element such as the completion of work? An allergological assessment is also carried out. The doctor also checks if his patient is exposed to a toxic substance in his environment or at his workplace. This questioning and the patient’s ability to specify their symptoms will help with the diagnosis. “If the patient suspects drug-induced rhinitis, he must present himself with his prescription up to date during the consultation.”

“Where possible, we exclude the processing in question”

What medications are involved?

Certain drug classes cause rhinitis:

• Some hormonal replacement or deprivation treatments (estrogen-progestogen pills) or supplements for the treatment of breast cancer. “The ENT mucosa is very sensitive to hormones.”
• Some antihypertensive treatmentsin particular ACE inhibitors (ACE inhibitors).
• A abuse of medications aimed at unblocking the nose like vasoconstrictors. “Patients feel like they are unblocking their noses so they use it chronically, which leads to dependence on this medication.”
• Some anti-inflammatories.

What treatments to treat it?

“As far as possible, we exclude the treatment in question and we analyze if within 15-30 days the symptoms improve. According to the treatment, we suggest an alternative to the practitioner at the origin of the medical prescription but it is up to him to decide whether or not he can change the treatment. Please note, the patient must never stop their treatment alone.“In addition to this solution, it is possible to start treatment against rhinitis: have a good nasal hygiene by carrying out regular nose washings once or twice a day.

Thanks to Dr Vincent Burcia, ENT and general secretary of SNORL.