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 infection.
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.
For lots of people, allergy treatment is reactive. You get stuffed up, your eyes water, and then you go to the medicine cabinet for relief. But many doctors say that we’ve got it the wrong way around. Instead, we should be taking the medicine before we have symptoms. Call it allergy pretreatment.
“We always tell people to start taking medicine before the allergy season begins,” says Jonathan A. Bernstein MD, an allergist and professor of clinical medicine at the University of Cincinnati. “People...
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.
Rhinitis medicamentosa is under-reported, under-diagnosed, and under-researched, according to a report published in the journal 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, steroids, and antihistamines to saline solutions and prescription drugs.
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.