Drug rhinitis

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Classification according to ICD-10
J30.4 Allergic rhinopathy, unspecified
J31.0 Chronic rhinitis
ICD-10 online (WHO version 2019)

As drug rhinitis ( lat. Rhinitis medicamentosa or Rhinopathia medicamentosa ) or privinismus referred to a drug rhinitis (ie a cold) by prolonged use of decongestant acting nasal spray or nasal drops .

The name privinism is derived from the nasal drops marketed under the trade name Privin ( naphazoline ) for decades, whose long-term use ultimately leads to permanent swelling instead of the desired decongestion of the mucous membrane in the nasal concha . Most of the time, the term rhinitis medicamentosa is now generally used for drug-induced rhinitis , as it is observed in rare cases after taking beta blockers , ACE inhibitors or oral contraceptives ; According to other sources, it is reserved for rhinitis caused by decongestant drugs.

Pathophysiology

Drugs with a decongestant effect stimulate the α- adrenoceptors and thus cause the blood vessels in the nasal mucous membrane to constrict , which leads to their swelling. The exact mechanism for the development of privinism is not known; vasodilatory effects and intravascular edema may be involved.

therapy

Normalization of nasal breathing can be achieved by discontinuing the decongestant preparations, provided that the poor nasal breathing is not based on an anatomical (e.g. septal deviation ) or allergic cause that should be treated accordingly. After a period of time, which can be more than a week, the swelling of the nasal mucous membrane subsides again. This time is perceived as tormenting by those affected, as the originally treated symptom appears to an increased extent. Local treatment with glucocorticoids such as budesonide , fluticasone or mometasone furoate (nasal spray) may be indicated during this time to alleviate the symptoms. Alternatively, a simple tapering therapy is also possible. By tapering off, the agonizing withdrawal symptoms do not occur. It has proven useful to dilute the nasal spray by 50% with saline solution (NaCl 0.9%) every five days (easy tapering therapy).

Individual evidence

  1. ↑ R. Probst: Ear, Nose and Throat Medicine. Thieme Verlag, 2008, p. 49.
  2. ↑ M. Maldona do Fernández, J. Mullol: Nonallergic rhinitis and primary ciliary dyskinesia. In: M. Anniko (Ed.): Otorhinolaryngology, Head and Neck Surgery (European Manual of Medicine). Springer Verlag, 2008, p. 216.
  3. ^ A b P. Graf: Rhinitis medicamentosa: a review of causes and treatment . In: Treatments in respiratory medicine . tape 4 , no. 1 , 2005, p. 21-29 , doi : 10.2165 / 00151829-200504010-00003 , PMID 15725047 .
  4. ^ JT Ramey, E. Bailen, RF Lockey: Rhinitis medicamentosa. In: Journal of investigational allergology & clinical immunology. Volume 16, Number 3, 2006, pp. 148-155, PMID 16784007 (review).
  5. ↑ https://www.webdoc-schneider.de/index.php/easy-ausschleichtherapie