What Is Vasomotor Rhinitis

Overview

Do you know there are other reasons to have a runny nose besides hay fever (allergic rhinitis)?

Somepeople may experience clear, watery nasal drainage and congestion despite not been exposed to particular  allergens or not contracted any   viral or bacterial infection. One of the common reasons  is a condition called vasomotor rhinitis.

Vasomotor rhinitis (VMR) is a type of non-allergic rhinitis that happens when the tissues inside your nose become swollen (inflamed), leading to unpleasant symptoms like a runny nose, nasal congestion, sneezing, or postnasal drip. Vasomotor rhinitis is also known as idiopathic rhinitis.

Vaso refers to blood vessels, whereas motor means the nerves that innervate the tissues of the nasal cavity and blood vessels. While the term "rhinitis" refers to the inflammation of the nose. You may find that vasomotor rhinitis has cold-like symptoms similar to an allergic reaction, but it is not particularly caused by exposure to allergens like mould, pollen, etc. It does not result from any bacteria or viral infection either; instead, the symptoms occur with no evident cause. However, many researchers believe that VMR is likely caused by certain triggers that increase sensitivity in most people as a response.

Causes

Vasomotor rhinitis is characterised by intermittent episodes of a runny nose (rhinorrhea), sneezing, nasal congestion, and cough. It is usually referred to as "chronic rhinitis" because of its ongoing occurrence all around the year.

VMR occurs when the blood vessels of the nose expand, causing the nasal lining to fill with fluid and blood.

The exact cause of this type of nonallergic rhinitis is still not fully understood. However, people with vasomotor rhinitis are often hypersensitive to triggering factors. This sensitivity to  triggers can exaggerate their normal nasal response to the exposed irritant, which does not bother most people.

The following are some of the known triggers that can lead to a symptomatic reaction.

Environmental triggers:

Some common surrounding factors may include:

• Dry or cold air
• Air pollution/smog
• Drop in temperature
• Chemical fumes
• Tobacco smoke
• Occupational exposure to airborne materials or chemical irritants
• After consuming spicy food or beverages. (also referred to as gustatory rhinitis)
• Physical or emotional stress
• Strong odours

Medication triggers:

In some cases, certain medications might lead to nasal swelling and inflammation. This include

• Overuse of nasal decongestant sprays (Rhinitis medicamentosa)
• ACE inhibitors to treat high blood pressure
• Medicines for high blood pressure like alpha- and beta-blockers
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Hormone medications such as birth control pills
• Medications for erectile dysfunction (ED)
• Sedatives
• Antidepressants

Hormonal triggers:

Hormonal imbalance often triggers a vasomotor rhinitis reaction. This is also termed "hormonal rhinitis," which includes:

• Puberty
• Menopause
• Pregnancy
• Menstruation
• Hypothyroid states

Signs and symptoms

In vasomotor rhinitis, individuals may experience the symptoms throughout the year. It may persist for several weeks or remain constant. Some of the commonly observed symptoms include

• Sneezing.
• Runny nose.
• Stuffed nose.
• Post nasal drip-mucus dripping down the back of your throat.
• Headaches.
• Temporary loss of smell.
• Cough.

Management and treatment 

Since vasomotor rhinitis is not curable, it is difficult for many patients  to manage and treat this condition.¹

However, if you can identify the triggers that lead to your symptoms, treatment can be easily manageable by avoiding the trigger. You can also  try  over-the-counter medicine, and get the right prescription from a doctor.

Though avoiding the trigger is the best option,  you are often unable to do so.

You may be able to manage your condition by using humidified air, which canease your symptoms.

Rinsing the nasal passages with salt water (saline solution) can clean up the nasal cavities.

Some prescribed medicines can help relieve the inflammation in the nostrils.  Which includes

• Decongestant nasal sprays to ease nasal congestion.
• Nasal sprays of antihistamines and corticosteroids can help in reducing nasal inflammation.
• Anticholinergic-based nasal sprays can ease rhinorrhoea (runny nose).

FAQs

How is vasomotor rhinitis diagnosed?

Healthcare providers generally conduct a physical examination of your throat and nose, followed by a medical history review.    Doctors may perform further testing to evaluate the condition in some cases. Some common diagnosis testing includes:

• Allergy testing: It is typically recommended by doctors to rule out any possibility of allergies that may be causing your symptoms. Allergy testing involves using a blood sample or a skin prick to help find out the amounts of specific allergens
• Nasal endoscopy: In some cases, doctors may use an endoscope (a long, flexible tube) to examine the inside of the nasal passages. This examination helps healthcare providers identify other complications, like nasal polyps, that may cause rhinitis symptoms. Nasal polyps are soft, non-cancerous growth in the lining of the nasal passages
• Computed tomography (CT scan): This test involves X-rays that help doctors to evaluate a detailed picture of the inner section of the nose to observe any structural irregularities such as deviated nasal septum or nasal polyps

How can I prevent vasomotor rhinitis?

It may not be possible to prevent vasomotor rhinitis. However, , you can reduce the risk by avoiding the triggers thaty worsen your symptoms. Identifying the triggers can also help prevent future flare-ups.

Who are at risk of vasomotor rhinitis?

People might be at risk of developing vasomotor rhinitis if:

• They are exposed to irritants such as tobacco smoke, smog, and exhaust fumes
• They are older than 20 years old. Unlike allergic rhinitis, VMR generally occurs in adults after the age of 20
• They have been using decongestant nasal sprays or drops for several days. Prolonged usage may cause severe nasal congestion when the effects of decongestants subside. This is often called rebound congestion
• Assigned females at birth (AFAB) are more at risk of getting vasomotor rhinitis. Nasal congestion  get more severe  during menstruation and pregnancy due to hormonal changes
• You are periodically exposed to irritants in your work environment (occupational rhinitis). People who have occupational exposure to triggers, like construction materials and chemicals might develop non-allergic rhinitis. According to a study, individuals with prolonged exposure to occupational irritants may progress to have asthma in later life. That said, occupational rhinitis is vital in preventing occupational asthma²
• If you have a  health condition like diabetes, chronic fatigue syndrome, or hypothyroidism, this might worsen  nonallergic rhinitis

How common is vasomotor rhinitis?

Among the different subtypes of non-allergic rhinitis, vasomotor rhinitis is the most common type. It is typically very common and affects around 7% of the adult population.¹ Moreover, assigned females at birth are more susceptible to non-allergic rhinitis than assigned males at birth.³

When should I see a doctor?

It is recommended to schedule an appointment with your healthcare provider if:

• Your runny/stuffy nose and nasal congestion worsen or won't go away
• Your symptoms are not relieved by self-care and medications
• You observe troublesome side effects from the prescribed or over-the-counter medications for your rhinitis

Your healthcare provider can help you determine the triggering factor and advise you on treatment options that can help relieve your symptoms.

Summary

Vasomotor rhinitis (VMR) is a  non-allergic rhinitis that occurs when the blood vessels in the nasal passage expand, causing the nasal lining to fill with blood and fluid. Vasomotor rhinitis symptoms are similar to allergic rhinitis, but no apparent allergic reaction is involved in the former condition. 

Although much research has indicated that vasomotor rhinitis is usually caused by hypersensitivity to certain triggering factors, there is no way to prevent the VMR condition. The associated symptoms are often unpleasant and poorly managed, with chronic episodes that may persist throughout the year.

However, identifying and avoiding triggers, using first-line treatment medications, can  ease the symptoms and prevent future flare-ups. Furthermore, if the symptoms persist or do not improve over time, you should seek medical advice from your doctor to alleviate your condition. This willalso rule out other health complications.