Rhinitis Medicamentosa Caused by Imidazoline Topical Decongestants: Literature Review

Abstract

Aims: The aim of the study is to systematize available scientific data on rhinitis medicamentosa caused by imidazoline topical decongestants. Materials and Methods: To meet the aim of the study, publications from open scientific databases accessible via the Internet were reviewed based on the following search terms: “rhinitis medicamentosa”, “rebound congestion”, “imidazoline”, and “topical decongestants”. Results: Rhinitis medicamentosa holds one of the leading positions among chronic non-allergic rhinitis, primarily characterized by nasal congestion. Ineffective examination and treatment of patients with allergic and non-allergic rhinitis, anatomic anomalies of the nasal cavity, and wide accessibility of nasal decongestants in pharmacies have contributed to a significant spread of this problem. Rhinitis medicamentosa typically occurs after prolonged (>5 days) use of topical decongestants. Imidazoline decongestants act as α-agonists, causing constriction of blood vessels; their prolonged use can result in mucous membrane swelling and tachyphylaxis. The main histopathological changes associated with rhinitis medicamentosa include epithelial destruction, nerve-ending degeneration, edema, and fibrosis. Rhinitis medicamentosa is rather difficult to treat, and the outcome is not always satisfactory. Conclusions: Because of the difficulty and lack of efficacy of treatment for rhinitis medicamentosa, new ways of prevention are brought to the fore. Prevention of this pathological condition by combining imidazoline topical decongestants with other groups of topical drugs is one of the possible ways to solve this problem.