Vasomotor rhinitis (VMR), also called non-allergic rhinitis, is a form of chronic nasal inflammation characterized by nasal congestion, post nasal drip, runny nose, headaches, sinus pain and pressure or ear plugging. Examination of the nose usually reveals mild to moderate nasal obstruction due to swelling in the lining of the nasal passages and swelling of the nasal turbinates. This chronic low-grade inflammation results in “hyper-responsiveness” of the lining of the nose upon inhalation of a variety of nonspecific airborne irritants.
The differentiation between allergic and non-allergic rhinitis is not always readily apparent. An accurate diagnosis can be made only after a history which reveals the typical non-allergic triggers and after ruling out allergies by appropriate testing. On rare occasions, allergic and non-allergic rhinitis can co-exist.
Vasomotor rhinitis most commonly begins after puberty, usually in the second or third decade of life. It generally presents with mild symptoms but it may worsen in early adulthood. Symptoms may come and go or they may remain relatively constant for years. Rarely do symptoms become severe, although they can be chronic and bothersome enough to affect one’s quality of life. The symptoms are generally year-round and are somewhat better in the summer because of more stable weather and temperature conditions.
The actual cause of this abnormality is unknown, although a hormonal etiology is suspected due to the fact that the vast majority of those with VMR are women. The onset of vasomotor rhinitis may be secondary to a viral illness, hormonal changes, or persistent exposure to nasal irritants.
Patients with chronic vasomotor rhinitis are more prone to develop nasal and sinus infections, ‘bad colds’, cough and headaches. With long-standing severe nasal inflammation, enlargement of the nasal turbinates or nasal polyps may occasionally develop. In the majority of cases, vasomotor rhinitis runs a benign, uncomplicated course.
There are many nonspecific irritants which typically bother patients with VMR including tobacco smoke, perfumes, cleaning solutions, paint fumes, exhaust, air pollution, potpourri, new carpet, new fabrics, and other odors. Changes in the weather, i.e., changes in humidity, barometric pressure, and rapid changes in temperature can also bring on symptoms in susceptible individuals. Nasal symptoms can also occur after stimuli as mild chilling, drafts, cold feet, or other mild body temperature changes. Emotional responses of anger, fright, or even unpleasant anticipation and stress may make symptoms worse.
There is generally an absence of symptoms on exposure to various pollens, except during times of excessive pollen exposure when the pollen itself can act as an irritant, not an allergen. Dust, mold spores, and dander allergens should not bother one with VMR unless there is a concomitant allergy.
Patients are more comfortable with the chronic use of a medication, such as nasal steroids, and avoidance of bothersome irritating factors. A cure is usually not obtainable, but a decrease in symptoms can be expected with the use of medications.