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Vasomotor rhinitis: an update.

A comparison of pertinent features of three types of rhinitis, with emphasis on etiology, and immunologic factors, is made. Separation of nasal allergy from vasomotor rhinitis and from nasal polyposis is attempted. The ambiguity of terms used by various authors, which has caused confusion in the classification of rhinitis, is noted. It is the author's opinion that allergic rhinitis, vasomotor rhinitis and nasal polyposis are nasal diseases with their own identity in the majority of instances. However, this identity is not always clearly evident. Too often, allergic principles of treatment, particularly immunotherapy, are advised, and not found to be helpful.

Diagnosis, Differential↗

Mast cells, eosinophils and IgE-positive cells in the nasal mucosa of patients with vasomotor rhinitis. An immunohistochemical study.

Vasomotor rhinitis (VMR) is a disorder of unknown pathogenesis. Forty patients with VMR were carefully selected on the basis of inclusion and exclusion criteria proposed by Mygind and Weeke. Nasal biopsy specimens were taken in the patient group as well as in a group of ten controls. Brush cytology was also taken in the VMR group. Inflammatory cells were identified and counted in the nasal mucosa, with the use of immunohistochemical techniques and a panel of monoclonal antibodies. Eosinophils were studied with the use of BMK13, EG2, and Giemsa. Mast cells were studied with anti-chymase (B7), anti-tryptase (G3) and toluidine blue. Sections were stained with IgE as well. There was no significant difference in the number of eosinophils, mast cells and IgE-positive cells between the two groups. Additionally, in contrast with other reports, in sections that were double-stained with anti-chymase and anti-tryptase, single chymase-positive cells were found.

Adolescent↗

Vasomotor rhinitis--pathophysiological aspects.

Vasomotor rhinitis is commonly defined as an unspecific hyperractivity of the nasal mucosa. The symptoms might be due to increased parasympathetic activity to the nose with the release of vaso-secretory active substances. Experimental data from the cat suggest that the postganglionic parasympathetic mediator of nasal secretion is cholinergic, whereas the vascular responses appears to be due to a different mechanism. Apart from a rich sympathetic and parasympathetic innervation of the nasal mucosa there are other nerve fibres containing substance-P (SP) and vasoactive intestinal polypeptide (VIP). The secreto-vasomotor responses can be influenced by activation of these fibres and the atropine resistant vasodilatation seen following Vidian nerve stimulation thus may partly be due to activation and release of SP and VIP. Furthermore, other vasoactive substances released such as e.g. SRS or Kallikrein may participate in these reactions.

Animals↗

Vasomotor rhinitis update.

PURPOSE OF REVIEW: This review was conducted to examine new data on vasomotor rhinitis, a common clinical problem. RECENT FINDINGS: Recent publications highlight advances in the study of the pathophysiology of vasomotor rhinitis. Electron microscopic and ultracytochemical evaluation of the nasal mucosa in vasomotor rhinitis demonstrates an emerging role of neuropeptides and nitric oxide in the pathogenesis of vasomotor rhinitis. Ozone, cigarette smoke, and other environmental factors may trigger neurogenic mechanisms that lead to vasomotor rhinitis. Objective tests have documented the presence of hypoactive sympathetic autonomic dysfunction. Such assessments also suggest autonomic dysfunction as a possible link between vasomotor rhinitis and gastroesophageal reflux disease. Recent publications propose nasal secretory protein analysis as a possible diagnostic tool. Evidence-based review of treatment outcomes shows topical sprays of azelastine, budesonide, and ipratropium to be of benefit in vasomotor rhinitis. SUMMARY: A better understanding of the role of nitric oxide and neuropeptides in the pathogenesis of vasomotor rhinitis has opened new avenues in research, diagnosis, and management. Clinical diagnosis may be aided by the analysis of nasal secretory proteins. Effective treatments include antihistamine, anticholinergics, and steroid nasal sprays.

Autonomic Nervous System↗

Immunohistochemical localization of 3-nitrotyrosine in the nasal respiratory mucosa of patients with vasomotor rhinitis.

CONCLUSION: This study demonstrates that, in the nasal respiratory mucosa of patients with vasomotor rhinitis, oxidative stress following peroxynitrite formation is confined to the respiratory epithelium. This suggests that the role of peroxynitrite in vasomotor rhinitis differs from its role in other diseases of the respiratory tract. The results of this study also support the concept that different pathogenetic mechanisms are probably involved in vasomotor rhinitis. OBJECTIVE: Previous studies indicated that nitric oxide (NO) is involved in the pathogenesis of vasomotor rhinitis, strong expression of NO synthase being detected in the smooth muscle cells of the cavernous sinuses and in the respiratory epithelium. However, most adverse effects of high levels of NO originate from the reaction of NO with superoxide anions to form peroxynitrite. Therefore, in this study we evaluated the involvement of peroxynitrite in the pathogenesis of vasomotor rhinitis. MATERIAL AND METHODS: Sites of peroxynitrite formation were identified by immunolabelling for 3-nitrotyrosine (3NT), its footprint in tissues. Samples of nasal mucosa were obtained from vasomotor rhinitis patients and from control subjects who had undergone corrective surgery of the nasal septum. All samples were obtained by reduction of the inferior turbinate. RESULTS: Examination of specimens from vasomotor rhinitis patients revealed that 3NT is absent in epithelium with a normal appearance, cells of the subepithelial connective tissue, the glands and the blood vessels, including the cavernous sinuses. In contrast, intense 3NT immunolabelling was found in the disrupted respiratory epithelium. 3NT was not present in any of the specimens from control subjects.

Adult↗

[Clinical effectiveness of magnetolaser therapy of vasomotor rhinitis].

Magnet-laser therapy was used to treat vasomotor rhinitis in 90 patients. A constant magnet of 50 mT was applied to the exterior of the nose, and an infrared laser beam was applied via a light-guide to the reflexogenic zones of concha inferior. The radiation power density was 5 mW/cm2. The magnetic exposure time was 6-10 min and the laser exposure time was 3-5 min for each half of the nose. The therapeutic course was 8-12 sessions. The therapeutic results depended on the type of vasomotor rhinitis, clinical disorders, and duration of the disease. Good results were seen in 84 (93.3%) patients out of 90 cases. Stable remission was recorded in 61.1% patients, significant improvement of clinical manifestations of vasomotor rhinitis was observed in 32.2% cases. Best results were reported in patients with autonomic forms of vasomotor rhinitis who suffered from short-term disease and vasodilation disorders.

Adolescent↗

Autonomic nervous system evaluation using heart rate variability parameters in vasomotor rhinitis patients.

OBJECTIVE: To evaluate the autonomic nervous system in vasomotor rhinitis patients using heart rate variability parameters. PATIENTS AND METHODS: The heart rate variability parameters (SDANN, SDNN, SDNN index, RMSSD, pNN50, triangular index) of 26 patients with vasomotor rhinitis were compared with those of 25 control subjects. RESULTS: The decrease in the SDANN and SDNN index in the vasomotor rhinitis patients is statistically significant. Likewise, the SDNN and triangular index decreased but not to a statistically significant degree. The decrease in rMSSD and pNN50, which are signs of parasympathetic nervous system hyperactivation, in the patient group is statistically significant when compared with the control group (p < .005). CONCLUSION: The results of this study suggest that there might be an abnormality in the autonomic nervous system of vasomotor rhinitis patients, which might be due to a hyperactive parasympathetic nervous system.

Adult↗

Vasomotor rhinitis: clinical efficacy of azelastine nasal spray in comparison with placebo.

The H(1) antagonist azelastine is used in nasal sprays for the treatment of allergic rhinitis, but its therapeutic efficacy in vasomotor rhinitis is unknown. We performed a multicenter randomized double-blind placebo-controlled study of the efficacy and tolerance of azelastine nasal spray in 89 adult patients with vasomotor rhinitis (confirmed by negative Phadiatop). Following a washout period, patients were treated for 15 days with one puff three times daily per nostril of azelastine (n = 44) or placebo (n = 45) nasal spray. Efficacy was evaluated by the reduction in symptomatology and by rhinoscopy. Intent-to-treat analysis revealed better results in the azelastine group for all assessed symptoms; the significance level was reached for nasal obstruction on day 15 (p = 0.042). Using per protocol analysis (in 85 patients complying with the protocol), the significance level was reached for nasal obstruction on day 15 (p = 0.017) and for the percentage of success in rhinorrhea (p = 0.023). In the azelastine group, rhinoscopy examination showed a significantly higher reduction in the inflammatory level and edema of the nasal mucosa (p = 0.03 and 0.02 for VAS on day 15 respectively, per protocol analysis). General efficacy assessment by the physician and the patient was in favor of azelastine (with significance levels <0.01). No drowsiness or serious adverse event was reported, and the frequency of mouth dryness and headaches was similar in the two treatment groups. The present study demonstrates the efficacy of azelastine nasal spray in the treatment of vasomotor rhinitis. The best achieved results were a decrease in nasal obstruction and mucosal edema. Further studies are required to investigate if this therapeutic benefit results from H(1) antagonism or from another, not well-characterized pharmacological action of azelastine.

Administration, Intranasal↗

Mechanisms of vasomotor rhinitis.

Nonallergic non-infectious perennial rhinitis (NANIPER) is a heterogeneous disorder comprising several pathophysiological entities. The etiology of some of these disorders (e.g. drug-induced rhinitis, nonallergic rhinitis with eosinophilia syndrome [NARES], occupational rhinitis, hormonal rhinitis, emotion-induced rhinitis, physical/chemical irritant-induced rhinitis) is well established. In contrast, the aetiology of idiopathic forms of rhinitis (also known as vasomotor rhinitis) is largely unknown. Mechanistic studies have suggested that non-IgE-mediated inflammatory and/or neurogenic processes may be involved. There is evidence that localized inflammation is the underlying cause of symptoms in drug-induced rhinitis and NARES, since eosinophilia is an important pathophysiological component in these conditions. In contrast, neurogenic reflex mechanisms initiated by environmental factors appear to be involved in idiopathic rhinitis. It has been suggested that there may be an imbalance of the sympathetic and parasympathetic nervous systems, with parasympathetic hyper-activity and sympathetic hypo-activity resulting in nasal congestion and rhinorrhoea. Indirect evidence suggests that C-fibres may also play an important role in the pathophysiology of idiopathic rhinitis.

Drug-Related Side Effects and Adverse Reactions↗