OVERVIEW

What is drug-induced rhinitis?

Drug-induced rhinitis refers to nasal inflammation symptoms caused by excessive local use of nasal medications. These drugs mainly include nasal decongestants such as xylometazoline hydrochloride nasal drops, but may also involve other medications.

Patients often experience nasal congestion, which tends to worsen at night compared to daytime and is more severe when sedentary than during activity. Nasal discharge may be present, along with occasional dryness, discomfort, and a burning sensation in the nose. Medical examination may reveal swollen and red nasal mucosa.

For treatment, the first step is to discontinue the causative medication. Depending on the condition, topical or systemic corticosteroids are often required to alleviate nasal congestion symptoms. If ineffective, other treatment options may be considered.

Is drug-induced rhinitis common?

Drug-induced rhinitis is frequently observed in young and middle-aged adults, but its overall prevalence remains unclear. Contributing factors include patients with acute/chronic rhinosinusitis or allergic rhinitis using nasal decongestants for symptom relief, which complicates accurate statistical assessment of total prevalence.

SYMPTOMS

What are the common symptoms and manifestations of drug-induced rhinitis?

Patients with drug-induced rhinitis mainly experience nasal congestion, which typically worsens at night compared to daytime and is more severe when sedentary than during activity. There may be nasal discharge, along with occasional dryness, discomfort, and a burning sensation in the nose. Medical examination may reveal swollen and red nasal mucosa.

How does drug-induced rhinitis develop?

Nasal decongestants are generally over-the-counter medications, allowing patients to purchase them easily from pharmacies without a prescription. However, after regular use for several days, stopping the medication can lead to rebound nasal congestion, prompting patients to use nasal decongestants more frequently to relieve symptoms.

This initiates a vicious cycle where the medication causes nasal congestion, which is then temporarily alleviated by the same medication. Over time, both the dosage and frequency of use gradually increase, ultimately leading to dependence.

CAUSES

What causes drug-induced rhinitis?

• The cause of drug-induced rhinitis is the inappropriate use of nasal drops, including nasal decongestants, or other non-isotonic solutions, excessively concentrated medications, overdosing, or prolonged use. These factors may affect the vasomotor function of the nasal turbinate tissues.

• Drug-induced rhinitis may also be triggered by oral medications such as antihypertensive drugs, contraceptives, sildenafil, and nonsteroidal anti-inflammatory drugs (NSAIDs), which can disrupt the vasomotor function of the nasal turbinate tissues.

• There are also reports that certain preservatives, such as benzalkonium chloride, may induce drug-induced rhinitis.

Who is more prone to drug-induced rhinitis?

Patients with a history of using nasal decongestants, including those with acute or chronic rhinosinusitis, allergic rhinitis, and other related conditions.

What nasal decongestants do patients with drug-induced rhinitis rely on?

Commonly used nasal decongestants include ephedrine, oxymetazoline, and xylometazoline.

DIAGNOSIS

How to diagnose drug-induced rhinitis?

When diagnosing drug-induced rhinitis, doctors not only consider clinical symptoms such as nasal mucosal swelling and redness but also, most importantly, require a patient history of using causative medications like nasal decongestants.

Which diseases can drug-induced rhinitis be easily confused with? How to differentiate?

Drug-induced rhinitis is often confused with rhinosinusitis and allergic rhinitis. However, patients with drug-induced rhinitis have a history of using causative medications such as nasal decongestants.

TREATMENT

Which department should I visit for drug-induced rhinitis?

Otolaryngology (ENT).

Can drug-induced rhinitis heal on its own?

If the causative medication is not discontinued, the rhinitis will only worsen and cannot resolve on its own.

How is drug-induced rhinitis treated?

• The treatment of drug-induced rhinitis primarily involves discontinuing the causative medication.

• Additionally, when patients stop using nasal decongestants, topical corticosteroids such as fluticasone propionate nasal spray are often required to alleviate nasal congestion symptoms. Topical medication allows high drug concentrations to reach the affected mucosa, making it the most appropriate long-term treatment. Although nasal congestion may temporarily worsen after stopping the causative medication, this does not indicate treatment failure.

• In cases of severe nasal congestion where topical treatment cannot penetrate the nasal mucosa, a short course of oral corticosteroids (e.g., prednisone 0.5 mg/kg for 5 days) may be necessary during the discontinuation of decongestants.

• With prolonged overuse of nasal decongestants, full recovery may take up to a year.

• Depending on the patient's condition, a doctor may recommend partial turbinectomy, electrocautery, microwave, laser, or radiofrequency therapy.

What are the common medications for drug-induced rhinitis?

For drug-induced rhinitis, medications can only relieve symptoms but not cure the condition. Discontinuing the causative medication is the primary solution. The following drugs may be used:

• Corticosteroid nasal sprays, such as budesonide, mometasone furoate, fluticasone furoate, or beclomethasone dipropionate. Dosage: 1–2 sprays per nostril, 1–2 times daily. Once-daily formulations are more convenient.

• If corticosteroid nasal sprays are ineffective, a short course of oral corticosteroids (e.g., prednisone 0.5 mg/kg for 5 days) may be prescribed.

• Non-sedating antihistamines, such as loratadine (10 mg once daily), desloratadine (5 mg once daily), cetirizine (10 mg once daily), or levocetirizine (2.5 mg or 5 mg once daily).

• Saline nasal sprays can be used multiple times a day.

Can drug-induced rhinitis be cured permanently?

Generally, yes.

In mild cases, discontinuing the causative medication may lead to recovery. However, with prolonged overuse of nasal decongestants, full recovery may take up to a year.

Some patients may experience poor treatment outcomes and require greater patience.

DIET & LIFESTYLE

What should patients with drug-induced rhinitis pay attention to in their diet and lifestyle?

Patients with drug-induced rhinitis can maintain a normal diet, but since many also suffer from other types of rhinitis, they may need to take extra precautions in daily life:

• Stay warm and protect against cold, adjusting clothing and bedding promptly with temperature changes to minimize temperature differences;

• Avoid catching colds, as they can trigger or worsen rhinitis symptoms;

• Maintain mental and emotional well-being, as excessive anger, depression, or stress may also trigger or aggravate rhinitis;

• Patients taking long-term antihypertensive medication should be aware of potential nasal congestion and avoid overusing nasal decongestants.

Do patients with drug-induced rhinitis need follow-up examinations?

Yes.

Patients with drug-induced rhinitis should maintain regular contact with their doctor to better manage the condition. During treatment, the doctor will adjust the treatment plan based on symptom control. The specific follow-up frequency will be determined by the doctor.

PREVENTION

Can drug-induced rhinitis be prevented? How to prevent drug-induced rhinitis?

When using over-the-counter nasal decongestants, the following methods can help minimize the risk of drug-induced rhinitis:

• Limit use to a maximum of about 5 days, or no more than 3 days during pregnancy;

• Do not exceed the recommended frequency of use;

• Patients taking long-term antihypertensive medications should be aware of potential nasal congestion symptoms and avoid using nasal decongestants casually.

How to prevent recurrence of drug-induced rhinitis?

The best approach is to avoid using the causative medications whenever possible. If necessary, use them for short courses and at low frequencies.