VASOMOTOR RHINITIS (NON-ALLERGIC RHINITIS)
Rhinitis (nasal inflammation) is a common disease worldwide, caused by inflammation of the tissue lining the inside of the nose, and causes a significant problem on the patient's quality of life.
Rhinitis, along with many other diseases, creates a significant socio-economic burden on society. Causes that cause rhinitis can be divided into allergens or other causes. It appears that most rhinitis patients experience problems with major non-allergic triggers. Therefore, it is extremely important to distinguish non-allergic or both (allergic and non-allergic) rhinitis from allergic rhinitis.
Vasomotor Rhinitis (Irritant rhinitis) is also known as non-allergic, non-infectious rhinitis. “Vase” refers to the nerves that stimulate the blood vessels “motor”, nasal tissue and blood vessels. It is sometimes called idiopathic non-allergic rhinitis to describe rhinitis for which we cannot find an underlying cause. Vasomotor rhinitis (VMR) represents a global health problem affecting 10% to 25% of the world's population.
Non-allergic rhinitis (vasomotor rhinitis) is a condition manifested by chronic sneezing, nasal congestion or runny nose. . Although these symptoms are similar to allergic rhinitis (hay fever), non-allergic rhinitis is different because an allergic rhinitis is caused by an overreaction of the immune system. Non-allergic rhinitis occurs without the development of IgE antibodies due to an excessive response in the immune system. As we know, allergy occurs as a result of the immune system's overreaction to a harmless substance known as an allergen.
Allergic rhinitis can later turn into allergic asthma and may also coexist with other allergic diseases. Vasomotor rhinitis is not life-threatening. For patients with persistent complaints, symptoms may be bothersome, but they are not serious and do not progress to asthma.
Non-allergic rhinitis can affect children and adults, but is more common after age 20. Triggers that cause non-allergic rhinitis complaints may vary. Various chemical-containing odors or irritants that we may encounter throughout our lives, air changes Foods, some medications, certain foods and chronic diseases may cause symptoms of vasomotor rhinitis.
Non-allergic rhinitis is diagnosed after an allergic cause is excluded. Vasomotor rhinitis can be diagnosed as a result of allergy tests performed by allergists.
HOW DOES VASOMOTOR RHINITIS OCCUR?
Vasomotor rhinitis varies widely, sometimes can be continuous, starts suddenly, develops quickly and is usually short-term. It is a disease that develops due to the excessive response of the nasal mucosa, accompanied by complaints of temporary nasal congestion, runny nose, postnasal drip, and rarely itching and sneezing.
Vasomotor rhinitis mainly affects the nerve endings lining the nose, causing swelling of the capillaries in the nose. It is due to being overly sensitive. When the blood vessels in the nose expand or swell, congestion occurs in the nose due to edema, and the mucus resulting from fluid leakage out of the vessels causes nasal discharge.
In vasomotor rhinitis, the neural structure in the nose is disrupted, which must be in balance. It is seen that the sympathetic and parasympathetic nervous systems shift towards the parasympathetic nervous system. There are studies showing that the sympathetic system is reduced and the parasympathetic system is more dominant. It has been shown that the structure lining the nose of these patients responds excessively to the stimulation of nerve endings at the cellular level.
It is not known why the blood vessels in the nose suddenly enlarge and dilate. There are some common triggers that cause this reaction.
The following causes rapid dilation of the vessels due to excessive response in the nerve endings in the nose.
Irritants in the environment such as perfumes, odors, food odors and smoke, or cigarette smoke. Chemical substances you are exposed to in some professions.
Changes in weather conditions, changes in temperature, pressure or humidity, especially dry weather, can cause it.
Drinking hot or spicy foods and alcoholic beverages can also cause swelling of the membranes inside your nose and It may cause nasal congestion.
Inorganic dust (dust other than house dust mites), air pollution.
Some medications, such as Aspirin, ib Apart from uprofen or beta blockers (Propranolol, Metoprolol, Atenolol), sedatives, antidepressants, oral contraceptives, drugs used for erectile dysfunction and prostate hypertrophy, estrogen-containing hormone drugs are among the most common drugs that cause stress (emotional or physical), such as In some cases, it may cause vasomotor rhinitis.
It must be distinguished from other non-allergic rhinitis causes. These include
Eosinophilic nonallergic rhinitis (NARES)
Occupational rhinitis
Hormonal rhinitis,
Rinitis medicamentosa,
Gustatory rhinitis: usually caused by stimulation of the vagus nerve within a few hours of eating.
Infections and non-allergic rhinitis such as Atrophic rhinitis need to be distinguished from vasomotor rhinitis.
WHAT ARE THE CAUSES OF VASOMOTOR RHINITIS?
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Vasomotor Rhinitis is a chronic rhinitis that occurs with intermittent (coming and going) sneezing attacks, nasal discharge and nasal congestion due to the dilation of the blood vessels in the mucosa in the nose.
Vasomator rhinitis, which is included in non-allergic rhinitis, is a chronic rhinitis. It is seen to occur with stimuli such as a dry atmosphere, air pollutants, spicy foods, alcohol, intense emotional changes and some drugs, and it is seen as a result of an excessive reaction to such external factors.
In fact, pollen, dust, mold. or chemical-containing particles in the air, including animal dander such as cats, dogs, birds, can disturb some people without causing an allergic reaction, that is, even though they are not actually allergic to these things.
Unlike allergic rhinitis, vasomator rhinitis usually occurs. It begins in adulthood and is not worsened by exposure to classic allergens such as pollen, house dust mites, dogs or cats. In other words, these allergens do not cause an allergic reaction through the IgE-mediated pathway in the immune system, as seen in allergic patients. Because vasomator rhinitis can be caused by changes in temperature, humidity, and/or barometric pressure, patients may experience increases in seasonal complaints associated with these changes in climatic conditions experienced in spring and autumn. Therefore, vasomator rhinitis, which increases seasonally, can be confused with seasonal allergic rhinitis.
People with vasomotor rhinitis consume heat exchange chemicals. They are extraordinarily sensitive to all kinds of irritation, such as particles or emotional and hormonal changes, and significant nasal symptoms can occur even when exposed to low concentrations of irritants.
People with vasomotor rhinitis often complain of "wet" and "dry" noses. People are divided into two groups. These reactions can be provoked by non-specific irritating stimuli such as cold dry air, perfumes, paint fumes and cigarette smoke.
What are the main characteristics of vasomotor rhinitis?
There is usually no history of allergy.
There is no infection causing complaints in the patient.
Vasomotor rhinitis can present itself in a variable way. While nasal congestion, runny or dry nose, sneezing and postnasal drip are observed, unlike the allergic form, it rarely causes itching in the nose, and additionally itching in the eyes or throat.
Although the nasal discharge is intense, it is especially headache without being accompanied by nasal itching. It may be accompanied by frontal headache.
After meals (especially spicy foods), some patients experience more runny nose or congestion.
Persistent or intermittent nasal symptoms that can be triggered by environmental conditions that do not bother normal individuals.
There may sometimes be a seasonal variation due to changes in temperature and humidity.
Environmental factors include strong odor, exposure to cold weather, changes in temperature, humidity and/or air pressure, as well as Drinking alcoholic beverages and changes in menstrual hormone levels may cause nasal complaints.
HOW IS VASOMOTOR RHINITIS DIAGNOSIS?
The diagnosis of vasomotor rhinitis is made primarily by clinical history and exclusion of other known causes.
The diagnosis of vasomotor rhinitis is based on the history of the patient's complaints and identification of their triggers. In particular, allergic rhinitis must be excluded. Allergy tests, most commonly skin prick tests and blood allergy tests, are used to reveal the causes of the patient's symptoms.
After the history of the patient's complaints is carefully taken, a careful nose and throat examination is usually required for diagnosis. li. After the history and examination, some tests may be performed. Allergy skin prick testing and other allergy tests should be performed to ensure there is no allergic basis. These tests will affect our treatment approach.
In the differential diagnosis of non-allergic rhinitis, diseases such as hypothyroidism and acromegaly should be taken into consideration. It would be more appropriate for blood and other tests to be performed by allergists to differentiate vasomotor rhinitis from non-allergic eosinophilic rhinitis (NARES) and to distinguish it from other non-allergic rhinitis.
HOW IS VASOMOTOR RHINITIS TREATED?
Although there are treatment options for vasomotor rhinitis, there is no clear and definitive treatment. Treatment options available to patients with long-term complaints are primarily aimed at avoiding irritating factors. For symptoms, we can use washing solutions containing salt water that we can prepare at home or buy from pharmacies, or symptomatic drug treatment. It also includes surgical interventions for neurectomy and inferior turbinate hypertrophy to treat the imbalance in the sympathetic and parasympathetic nervous system.
What are the precautions in the treatment of vasomotor rhinitis?
Avoiding the causes that cause vasomotor rhinitis complaints is extremely important. . Avoiding environmental triggers such as strong odors (perfume, soap, paint, etc.) and air pollutants (smoke, tobacco smoke) that are respiratory irritants may be recommended to prevent symptoms from worsening.
Keep the interior of your home in a stable condition. Using a humidifier to maintain temperature and adjust the humidity of the air can help reduce rhinitis symptoms. You should also try to keep your home and workplace free of dust, smoke, and other allergens and environmental irritants. Many patients with vasomotor rhinitis must take precautions against dust in the house, which is the strongest irritant, although not in an allergic way.
Drinking alcoholic beverages, especially beer and wine, often aggravates vasomotor rhinitis symptoms and can be considered factors that are likely to be avoided. Some medications, especially NSAIDs such as aspirin or blood pressure medications containing Reserpine and Propranalol, can make the symptoms worse. Apart from these, about the medications you take
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