Spring is here, which for millions of people means itchy noses, watery eyes,
and nasal congestion. For many allergy sufferers, relief is often just a quick
spritz away; prescription and over-the-counter (OTC) nasal sprays are one of
the most common ways to treat nasal congestion caused by allergies or
But for an estimated 7% of the United States population, relying too much on
decongestant nasal sprays can actually cause more congestion -- a
drug-induced condition called rhinitis medicamentosa.
Summer is ending, you’re heading into fall. But you’re still sneezing and sniffling all day and into the night. What’s going on?
Odds are you’re among the 10% to 30% of Americans who suffer from hay fever, or allergic rhinitis. And most cases of hay fever are caused by an allergy to fall pollen from plants belonging to the genus Ambrosia -- more commonly known as ragweed.
Rhinitis medicamentosa is most often seen among people who self-medicate
with OTC decongestant sprays. Rhinitis medicamentosa may also occur in people
with viral upper respiratory tract infections, such as colds, who sought relief
for their symptoms. Up to 50% of respiratory infection patients may develop
Rhinitis medicamentosa is under-reported, under-diagnosed, and
under-researched, according to a report published in the March 2010 issue of
Clinical and Experimental Allergy.
"Despite many prescription warnings and manufacturer labels listing
certain medications as causing rhinitis, drug-induced rhinitis still often goes
undiagnosed," the researchers wrote. Increased awareness, they said, could help
these patients get the proper treatment.
Rhinitis medicamentosa occurs when a decongestant nasal spray is used
repeatedly for more than three to five consecutive days, leading to nasal
passage damage and the inability to respond to the decongestant.
There are several types of nasal sprays, from over-the-counter (OTC)
decongestants and antihistamines to saline solutions and prescription
OTC decongestant nasal sprays work because they contain chemicals -- oxymetazoline, phenylephrine, xylometazoline, and naphazoline -- which
quickly unclog the nose by constricting the blood vessels in the nasal
lining. These sprays provide quick relief, but they also wear off "usually
in 30 minutes or less," says Marilene B. Wang, MD, an otolaryngologist at UCLA.
"The person will experience a rebound, where the nasal congestion is actually
worse than before the spray was used."
Consequences of Overuse
Decongestant nasal spray overuse can also lead to a missed diagnosis of
what's really causing the inflammation, as well as an increased risk for sinus
infections, headaches, coughing, nasal passage swelling, and congestion, and --
rarely -- septal perforation, in which the membrane dividing the nostrils
develops a tear.
The issue is overuse, not the products themselves.
"Many consumers turn to topical nasal sprays because they are safe and
effective when used as directed," says Elizabeth A. Funderburk, a spokeswoman
for the Consumer Healthcare Products Association. "We know that people demand a
range of options and different delivery forms work for different people. As
with all OTC medicines, it is important that consumers always read and follow
the label. The labeled directions state that you should not use topical nasal
decongestants (nasal sprays or gels) for more than three days, because frequent
or prolonged use may cause nasal congestion to recur or worsen."