OVERVIEW

What is vasomotor rhinitis?

Vasomotor rhinitis (VMR), also known as vasomotor rhinitis (ICD-11 code: CA08.3).

Literally understood, it is a disease characterized by symptoms such as runny nose and nasal congestion due to the dilation and contraction of blood vessels in the nasal mucosa.

Is vasomotor rhinitis also called non-allergic rhinitis?

Yes.

Vasomotor rhinitis is also referred to as non-allergic rhinitis (NAR). Do not take the term literally and assume that rhinitis minus allergic rhinitis equals non-allergic rhinitis.

In fact, besides allergic and non-allergic rhinitis, there are many other types of rhinitis, such as infectious rhinitis, drug-induced rhinitis, atrophic rhinitis, and so on. The reason for calling vasomotor rhinitis, whose cause is not well understood, "non-allergic rhinitis" is mainly to clearly distinguish it from allergic rhinitis.

Because often, vasomotor rhinitis is mistaken for allergic rhinitis, and sometimes the two conditions even overlap. Therefore, it is important to emphasize differentiation.

There is also a classification system that divides rhinitis into two major categories: allergic rhinitis and non-allergic rhinitis, with the latter further subdivided into infectious rhinitis, drug-induced rhinitis, atrophic rhinitis, vasomotor rhinitis, etc.

Is vasomotor rhinitis common?

Yes, it is so common that we don’t even know exactly how many people suffer from it.

Many people with rhinitis symptoms may not seek medical attention, making it difficult to include them in statistics. Even among those who do see a doctor, many cases are not clearly identified and are classified as other types of rhinitis.

As a result, there is no domestic epidemiological data available. Even in Europe and the U.S., most studies are not large-scale surveys. Roughly speaking, 10% to 40% of the population is troubled by vasomotor rhinitis.

How is vasomotor rhinitis classified?

Further classification of vasomotor rhinitis is not something we need to focus on, as current classifications offer little practical help in explaining or treating the disease. Clinically, there is no need to categorize it further. Let the doctors continue their research. It’s enough to know that some cases of vasomotor rhinitis show evidence of nasal mucosal inflammation, while others do not.

A special subtype of non-inflammatory vasomotor rhinitis is the type where eating spicy or hot food causes "copious runny nose," also known as "gustatory rhinitis."

Inflammatory vasomotor rhinitis also has a special subtype called vasomotor rhinitis with eosinophilia. In this type, nasal mucosal biopsies reveal significant increases in eosinophils and mast cells, and even nasal secretions contain many eosinophils. Since vasomotor rhinitis is defined as rhinitis without a clear cause, some argue that this eosinophil-involved type should be classified separately and not considered a subtype of vasomotor rhinitis.

SYMPTOMS

What are the symptoms of vasomotor rhinitis?

Since it is a type of rhinitis, it naturally shares the typical symptoms: runny nose, nasal congestion, sneezing, and nasal itching. More specifically, what sets vasomotor rhinitis apart from other types is that its primary symptom is a "runny nose." A more classic presentation of vasomotor rhinitis is "profuse nasal discharge upon exposure to dry, cold air."

People often colloquially refer to this as a "cold air allergy," but it is not an actual allergic reaction. It simply involves cold air stimulating the dilation and constriction of nasal mucosal blood vessels and is unrelated to immune system abnormalities.

How does vasomotor rhinitis differ from allergic rhinitis?

The main differences between vasomotor rhinitis and allergic rhinitis are threefold:

1. Allergic rhinitis often flares up during specific seasons or after exposure to particular allergens, whereas vasomotor rhinitis may not be tied to any specific trigger—meaning no allergens can be identified.

2. The most bothersome symptoms of allergic rhinitis are nasal itching, sneezing, and a runny nose, often accompanied by an urge to rub the nose. Vasomotor rhinitis primarily involves nasal congestion, a runny nose, and postnasal drip (a sensation of mucus flowing down the back of the nose and throat).

3. Allergic rhinitis is frequently associated with other allergic conditions and discomfort in other areas, such as itchy eyes. Vasomotor rhinitis, however, is purely nasal discomfort—possibly just a runny nose.

Does vasomotor rhinitis worsen over time?

Not really. In principle, vasomotor rhinitis does not escalate to an unmanageable severity and usually does not lead to other complications. It persists steadily, bringing nothing more than a runny nose. However, long-term symptoms could potentially contribute to complications like nasal polyps.

Is vasomotor rhinitis the same as what people call "catching a cold from the cold"?

Many people have the experience that "cold weather causes colds." Doctors, however, say colds are caused by viral infections and have nothing to do with temperature.

This leaves people puzzled—why do they seem to catch colds more often in the cold? In reality, some cases are simply vasomotor rhinitis, where exposure to cold triggers a runny nose mistaken for a cold. A cold, as a viral upper respiratory infection, typically involves not only nasal discomfort but also a sore throat lasting several days—unlike vasomotor rhinitis, where nasal symptoms after cold exposure may be brief.

CAUSES

What exactly is vasomotor rhinitis?

Like many diseases, when it comes to the exact cause of vasomotor rhinitis, we can only say disappointingly: the cause is unclear... Doctors have tried to explain the occurrence of vasomotor rhinitis with some theories, but no consensus or solid evidence has been reached.

Perhaps vasomotor rhinitis itself is just a collection of different types of nasal symptoms related to nasal sensitivity. From another perspective, when you are diagnosed with vasomotor rhinitis, you can at least rest assured that there is no major abnormality—simply think of it as "my nose is more sensitive than others." When exposed to the same stimuli, others' noses may not react, but mine starts working hard first.

What are the possible causes of vasomotor rhinitis?

Although we mentioned that the cause is still unclear, doctors are still working hard, so let’s briefly discuss these "hypotheses":

• Damage to the nasal mucosal epithelium: Various injuries occur first, leading to changes in sensitivity.

• Autonomic nervous system abnormalities: Dysfunction of the sympathetic and parasympathetic nervous systems.

• Local IgE-related allergic reactions occurring only in the nasal mucosa.

What are the triggering factors for vasomotor rhinitis?

Although the cause is unclear, we can still identify the triggering factors for vasomotor rhinitis. When these factors are present, they may induce an episode of vasomotor rhinitis.

For example: weather changes (getting colder), strong irritant odors (perfume, cooking fumes), air pollution (car exhaust, etc.), spicy food and alcohol, certain medications (aspirin, etc.), hormonal changes (sexual stimulation, menstruation, etc.). Sometimes, gastric acid reflux is also considered a possible trigger for vasomotor rhinitis.

DIAGNOSIS

How is vasomotor rhinitis diagnosed?

It's important to understand that the diagnosis of vasomotor rhinitis does not rely on tests, meaning it may be diagnosed without any examinations.

So how is vasomotor rhinitis determined? Essentially, the typical symptom of "runny nose after catching a cold" is quite common. Diagnosing vasomotor rhinitis often depends more on personal perception—whether these nasal symptoms are bothersome. If they aren't troubling and can be tolerated, no intervention is needed.

If the nasal symptoms are intolerable, we then assess whether allergic rhinitis, drug-induced rhinitis, or acute rhinosinusitis might be the cause. Only after ruling out these factors do we consider vasomotor rhinitis.

What auxiliary methods can help diagnose vasomotor rhinitis?

While tests are usually unnecessary for diagnosing vasomotor rhinitis, we don’t do nothing at all—primarily to differentiate it from allergic rhinitis when needed. For example, a doctor may examine the nasal mucosa. Unlike the pale or bluish mucosa seen in allergic rhinitis, the mucosa in vasomotor rhinitis is either normal or slightly more swollen and red than usual.

If differentiation remains difficult, tests to rule out allergic rhinitis may be considered. These include allergen skin prick tests and serum allergen-specific IgE tests. In rare cases, nasal endoscopy might be performed to exclude specific sinus issues.

What other conditions should be differentiated from vasomotor rhinitis?

Aside from allergic rhinitis, which we’ve repeatedly emphasized, drug-induced rhinitis should also be ruled out when diagnosing vasomotor rhinitis. Drug-induced rhinitis also presents with chronic nasal symptoms and slightly swollen, red mucosa. However, a history of overusing decongestant nasal sprays (e.g., oxymetazoline) can usually be traced.

Long-term use of decongestant nasal sprays can lead to rebound nasal congestion after discontinuation, prompting more frequent use to relieve symptoms. This starts a vicious cycle, eventually resulting in medication dependence.

TREATMENT

What are the treatment medications for vasomotor rhinitis?

Medication therapy for vasomotor rhinitis is generally less effective compared to allergic rhinitis, with a less pronounced response to drugs. However, medications can still be used. Intranasal corticosteroids, such as mometasone furoate, are the first-line treatment. Intranasal antihistamines can also be recommended and, in some cases, used in combination with intranasal corticosteroids.

If the symptoms are limited to a runny nose, intranasal anticholinergic drugs like ipratropium bromide nasal spray can be used (though not available domestically...).

As for oral antihistamines (e.g., loratadine) and decongestant nasal sprays (e.g., oxymetazoline), they are not recommended for various reasons.

Is surgical treatment an option for vasomotor rhinitis?

Proceed with caution! While surgical treatment for vasomotor rhinitis has been explored in some studies, its effectiveness remains unclear. Surgery should only be considered if there are concurrent nasal issues or if standard medication therapy fails after 6–12 months.

Can nasal irrigation relieve symptoms? How should rhinitis patients perform nasal irrigation?

Nasal irrigation can help alleviate symptoms like nasal congestion and a runny nose to some extent.

• Some hospitals offer electric nasal irrigators—patients can undergo nasal irrigation at the hospital.
• Purchase a simple manual irrigator for home use. There are various models of nasal irrigators, and specific usage instructions can be obtained from sales personnel. Add a saline solution to the irrigator with warm water for rinsing, or use plain saline solution. Suitable for adults and children willing to undergo nasal irrigation, it can be used at home or in school dormitories, 1–2 times a day.
• Small spray-type nasal irrigation bottles. The pre-mixed solution is ready for use—just spray a few times into the nostrils. However, the bottle cannot be reused once empty. Portable and convenient for carrying around, it can be used multiple times a day. The gentle spray pressure also makes it suitable for children who resist irrigator-based rinsing.

DIET & LIFESTYLE

How to Alleviate Symptoms of Vasomotor Rhinitis Through Lifestyle Changes?

Since vasomotor rhinitis is not a serious condition, medication may not always be necessary when symptoms arise. Lifestyle adjustments and supportive treatments can often help manage the issue.

The supportive treatment mentioned here refers to nasal irrigation therapy, a foundational approach for many nasal conditions. Whether using saline nasal rinses or saline nasal sprays, cleaning the nasal mucosa can effectively relieve symptoms without risks. Additionally, performing nasal irrigation before applying other nasal medications serves as good preparation for treatment.

PREVENTION

Can Vasomotor Rhinitis Really Be Prevented?

Think about it, we don't even know exactly what causes vasomotor rhinitis, so how can we prevent it... However, we do know which factors can trigger your symptoms, so by avoiding these factors, we can at least reduce the frequency of flare-ups.

For example, identify your own triggers. If symptoms appear after exposure to cold, keep your nose warm and avoid sudden temperature changes. If they occur after eating spicy food, then let your taste buds suffer a bit—cut back on spicy foods. If medication is the trigger, consult your doctor about possible alternatives. Additionally, if you really can't resist using decongestant nasal sprays, limit their use to just a few days. Prolonged use followed by withdrawal can lead to rebound congestion, making you feel worse, and developing medication-induced rhinitis would only add insult to injury.