Treatment Regimen for Acute Viral Rhinitis in Patients with a History of Rhinitis Medicamentosa

Denis Mak Chi *

Weihaiwei People's Hospital, Weihai, Shandong, China.

*Author to whom correspondence should be addressed.


Aims: The aim of this research is to study the efficacy of intranasal administration of 0.9% saline solution in patients with acute viral rhinitis and a history of Rhinitis medicamentosa.

Materials and Methods: The study included 96 patients with a confirmed diagnosis of acute viral rhinitis and a history of Rhinitis medicamentosa. All patients were equally randomized to two groups. In both groups, patients were treated according to the European Position Paper on Rhinosinusitis and Nasal Polyps with nasal decongestants (oxymetazoline), but in Group 2, the treatment regimen was supplemented with topical use of 0.9% saline solution. Local TNF-α and IL-1β levels were determined in all patients on Days 1, 5, and 10. In addition, on the next day after oxymetazoline withdrawal, a Nasal airway resistance was measured in all patients using active posterior rhinomanometry.

Results: The duration of rhinorrhea and nasal congestion and, respectively, the duration of oxymetazoline administration significantly differed between the groups (p<0.001) and was 7.9±1.1 days for Group 1 and 4.7±0.9 days for Group 2. In general, the dynamics of changes in local TNF-α and IL-1β levels in both groups was similar. Throughout the study, there was a progressive decrease in both inflammatory mediators, with faster changes occurring in Group 2. A strong positive correlation (rs=0.89; p<0.001) between TNF-α and IL-1β levels was established. According to the results of active posterior rhinomanometry on the day following oxymetazoline withdrawal, Nasal airway resistance was significantly higher in Group 1 (p<0.001), which indicates the presence of difficulty breathing in patients of this group. In addition, patient examination showed that manifestations of Rhinitis medicamentosa occurred in 3 (6.25%) patients of Group 1 and in 17 (35.42%) patients of Group 2. Differences between the groups were significant (p<0.01).

Conclusion: The use of topical nasal decongestants, in particular oxymetazoline, in patients with acute viral rhinitis and a history of Rhinitis medicamentosa for more than 7 days has a potential risk of development of a recurrence of Rhinitis medicamentosa. Supplementing the treatment regimen for acute viral rhinitis with the topical use of 0.9% saline solution reduces the duration of treatment and the use of topical decongestants, and therefore prevents the recurrence of Rhinitis medicamentosa.

Keywords: Acute viral rhinitis, Rhinitis medicamentosa, oxymetazoline, 0.9% saline solution, TNF-α, IL-1β

How to Cite

Chi , D. M. (2023). Treatment Regimen for Acute Viral Rhinitis in Patients with a History of Rhinitis Medicamentosa . Asian Journal of Research in Medical and Pharmaceutical Sciences, 12(4), 139–144.


Download data is not yet available.


Winther B, Gwaltney JM Jr, Mygind N, Hendley JO. Viral-induced rhinitis. Am J Rhinol. 1998 Jan-Feb;12(1):17-20.

DOI: 10.2500/105065898782102954 PMID: 9513654.

Quillen DM, Feller DB. Diagnosing rhinitis: allergic vs. nonallergic. Am Fam Physician. 2006 May 1;73(9):1583-90.

PMID: 16719251.

Çatlı T, Atilla H, Miller EK. Acute Viral Rhinitis. All Around the Nose. 2019 May 14:199–202. DOI: 10.1007/978-3-030-21217-9_23 PMCID: PMC7123171.

Jaume F, Valls-Mateus M, Mullol J. Common Cold and Acute Rhinosinusitis: Up-to-Date Management in 2020. Curr Allergy Asthma Rep. 2020 Jun 3;20(7):28. DOI: 10.1007/s11882-020-00917-5 PMID: 32495003; PMCID: PMC7266914.

Graf P. Rhinitis medicamentosa: A review of causes and treatment. Treat Respir Med. 2005;4(1):21-9. DOI: 10.2165/00151829-200504010-00003 PMID: 15725047.

Wahid NWB, Shermetaro C. Rhinitis Medicamentosa. 2022 Sep 5. In: StatPearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2023 Jan. PMID: 30855902.

Ramey JT, Bailen E, Lockey RF. Rhinitis medicamentosa. J Investig Allergol Clin Immunol. 2006;16(3):148-55.

PMID: 16784007.

Ostroumova OD, Shikh EV, Rebrova EV, Ryazanova AY. Lekarstvenno-indutsirovannyi rinit [Rhinitis medicamentosa]. Vestn Otorinolaringol. 2020;85(3):75-82. Russian. DOI: 10.17116/otorino20208503175

PMID: 32628388.

Ott LW, Resing KA, Sizemore AW, Heyen JW, Cocklin RR, Pedrick NM, et al. Tumor Necrosis Factor-alpha- and interleukin-1-induced cellular responses: Coupling proteomic and genomic information. J Proteome Res. 2007 Jun;6(6):2176-85. DOI: 10.1021/pr060665l Epub 2007 May 16. PMID: 17503796; PMCID: PMC2877378.

Klemens C, Rasp G, Jund F, Hilgert E, Devens C, Pfrogner E, Kramer MF. Mediators and cytokines in allergic and viral-triggered rhinitis. Allergy Asthma Proc. 2007 Jul-Aug;28(4):434-41. DOI: 10.2500/aap.2007.28.3017 PMID: 17883911.

Baroody FM, Brown D, Gavanescu L, DeTineo M, Naclerio RM. Oxymetazoline adds to the effectiveness of fluticasone furoate in the treatment of perennial allergic rhinitis. J Allergy Clin Immunol. 2011 Apr;127(4):927-34.

DOI: 10.1016/j.jaci.2011.01.037 Epub 2011 Mar 5. PMID: 21377716.

Graf P, Enerdal J, Hallén H. Ten days' use of oxymetazoline nasal spray with or without benzalkonium chloride in patients with vasomotor rhinitis. Arch Otolaryngol Head Neck Surg. 1999 Oct;125(10):1128-32. DOI: 10.1001/archotol.125.10.1128 PMID: 10522506.

Graf P, Juto JE. Decongestion effect and rebound swelling of the nasal mucosa during 4-week use of oxymetazoline. ORL J Otorhinolaryngol Relat Spec. 1994 May-Jun;56(3):157-60. DOI: 10.1159/000276633 PMID: 7515487.

Graf P, Hallén H. One-week use of oxymetazoline nasal spray in patients with rhinitis medicamentosa 1 year after treatment. ORL J Otorhinolaryngol Relat Spec. 1997 Jan-Feb;59(1):39-44. DOI: 10.1159/000276903 PMID: 9104748.