This condition typically occurs after 5 to 7 days of use of such medications. Patients often try increasing both the dose and the frequency of nasal sprays upon the onset of RM, worsening the condition. The swelling of the nasal passages caused by rebound congestion may eventually result in permanent turbinatehyperplasia, which may block nasal breathing until surgically removed.
Commercial introduction of Oxymetazoline brand Afrin. The prolonged use of nasal vasoconstrictors cause rhinitis medicamentosa
While the mechanism of RM is unclear, several theories have been proposed.
The treatment of RM involves withdrawal of the offending nasal spray. Both a "cold turkey" and a "weaning" approach can be used. Cold turkey is the most effective treatment method, as it directly removes the cause of the condition, yet the time period between the discontinuation of the decongestant and the relief of symptoms may be too long for some individuals (particularly when trying to go to sleep when they are unable to breathe through their nose). The use of Over the Counter (OTC) saline nasal sprays may help open the nose without causing RM if the spray does not contain a decongestant (or preservative) . Symptoms of congestion and runny nose can often be treated with corticosteroid nasal sprays under the supervision of a physician. For very severe cases, oral steroids or nasal surgery may be necessary.
There are anecdotal reports of persons having success by withdrawing treatment from one nostril at a time.
A study has shown that the anti-infective agent benzalkonium chloride, which is frequently added to topical nasal sprays as a preservative, aggravates the condition by further increasing the rebound swelling.
^Graf, P.; Hallén, H.; Juto, J. E. (1995). "Benzalkonium chloride in a decongestant nasal spray aggravates rhinitis medicamentosa in healthy volunteers". Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology25 (5): 395–400. PMID7553241. edit
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