Drug-Induced Rhinitis

One type of non-allergic, non-infectious rhinitis (NIR), representing the heterogeneous group is drug-induced rhinitis (DIR), which can be arranged into four and more subtypes related to pharmaceutical treatment (local inflammatory type, neurogenic type, idiopathic type, and rhinitis medicamentosa, a distinct phenotype caused by excessive use of intranasal decongestant sprays). DIR management implicates pharmacological and a non-pharmacological components only after the proposal to terminate and withdraw the causative medication; these components include factors inducing the disease and patients’ education. A patient’s individual sub-phenotype should be considered for management classification. Nowadays, intranasal glucocorticosteroids are considered to be the most reliable means available for DIR treatment. Intranasal antihistamines antagonizing H1 receptors are used for treating nasal congestion, but their effect is much weaker than that of intranasal corticosteroids. In particular occasions, oral decongestants can be applied, and oral corticosteroids are last-resort treatment for symptoms resistant to all other therapeutic intervention, but their use is limited to the short term. Notwithstanding that there are no obvious data proving the benefit, nasal irrigation with isotonic or hypertonic saline is the auxiliary treatment usually applied in almost all rhinitis phenotypes. Rarely applied treatments include nasal cromolyn, sedatives/hypnotics, diode laser inferior turbinate reduction, and surgical referral for submucosal resection of the inferior turbinate bones, which may be indicated only in cases of extensive medical treatment failure. In this review article, we present a literature review on prevalence, mechanisms, mediators, treatment options, safety, and efficacy issues of drugs and QoL of the patients with DIR.