Published Online: March 31, 2014
Patients with rhinitis often self-medicate with over-the-counter drugs such as decongestant nasal sprays. However, prolonged use of these sprays may result in rebound congestion of the nasal mucosa. As a result, patients become trapped in a vicious cycle of overuse and dependence that can last for months or years (a condition called rhinitis medicamentosa). Unfortunately, accurate data on the magnitude of this problem are currently lacking.
In a recent article published in The Journal of Allergy & Clinical Immunology: In Practice, Mehuys et al characterized individuals self-medicating persistent rhinitis and determined the prevalence of and risk factors for nasal decongestant overuse. In this observational study, 895 participants completed a questionnaire to assess current symptoms, rhinitis medication, and previous physician diagnosis. Nasal decongestant overuse was defined as daily use for at least one year.
The authors found that almost all patients suffered from moderate to severe rhinitis. Nasal obstruction was their predominant symptom. The majority of patients had a physician diagnosis of their current symptoms, and about half had consulted for rhinitis in the past year. However, the most striking finding of this survey was the high prevalence (49%) of nasal decongestant overuse, despite the fact that most (80%) were educated about the limit on duration of use. Use of nasal corticosteroids was strongly (but inversely) associated with nasal decongestant overuse. The risk of nasal decongestant overuse was also reduced by use of other medications (oral H1-antihistamines and oral decongestants), use of nasal saline, and more symptoms of itchy/runny eyes or colored nasal discharge. Risk was increased by more severe blocked nose, longer duration of symptoms, presence of sleep disturbance, higher body mass index, and prior advice to limit the duration of intranasal decongestant use.
This study draws attention to the problem of nasal decongestant overuse among subjects self-medicating persistent rhinitis. Patient education alone seems not to be effective in tackling this problem. The findings of this study call for further and deeper research to identify the most effective intervention strategies.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.