Severe Rhinitis Medicamentosa Successfully Treated with Rhinolight® Endonasal UV Phototherapy

Aim Report successful application of UV endonasal phototherapy as a treatment for severe rhinitis medicamentosa and allergic rhinitis. Methods Allergic rhinitis confirmed by history and skin prick testing; rhinitis medicamentosa based on history. Both confirmed at nasendoscopy. Symptom score before & after treatment. Introduction of Rhinolight endonasal u/v phototherapy for allergic rhinitis. Single patient report. Results Successful remission of Rhinitis Medicamentosa confirmed with patient after eight sessions Rhinolight endonasal phototherapy. Use of nasal decongestant dropped from 2 bottles/daily x 4 years to zero. Symptoms reduced from 25 pre-treatment to 6 post-treatment. Rhinitis medicamentosa is clinically characterized by nasal congestion without rhinorrhea, postnasal drip, or sneezing that begins after using a nasal decongestant for more than 3 days. Treatment involves discontinuation of the offending drug. Discussion Rhinolight endonasal phototherapy is a new treatment for allergic rhinitis and offered as last resort for a patient with untreated allergic rhinitis and overuse of topical decongestants. Patient reports a significant improvement in symptoms with cessation of topical decongestant. Report a successful application of UV endonasal phototherapy as a treatment for severe rhinitis medicamentosa against a background of long standing allergic rhinitis.

Xylometazoline abuse induced ischemic stroke in a young adult.

INTRODUCTION: substance abuse is an important cause of ischemic stroke in the young. This includes over-the-counter dietary supplements and cough and cold remedies, which were reported to be an independent risk factor for hemorrhagic stroke. CASE REPORT: this article describes a young male patient with acute ischemic infarctions in the posterior inferior cerebellar and posterior cerebral artery territories bilaterally, the right cerebral peduncle, the left pontine tegmentum, and lateral pons following abuse of xylometazoline-containing nasal decongestant for 10 years. CONCLUSION: this is the first report in the literature of posterior circulation strokes because of chronic xylometazoline abuse. We hope to contribute to increase knowledge and awareness of the public about these serious complications of cough-and-cold remedies as well as dietary supplements containing sympathomimetics.

The common cold.

1) Most colds are due to viruses and resolve spontaneously after a few days. Available drugs do not modify the course of a viral cold; 2) Some drugs used to treat colds carry a risk of serious adverse effects. This includes nasal sprays, especially vasoconstrictors such as pseudo-ephedrine and, in young children, menthol, camphor, and terpene derivatives.

Mineralocorticoid hypertension due to a nasal spray containing 9 alpha-fluoroprednisolone.

The finding of hypokalemia and of low plasma renin activity (PRA) in a hypertensive patient suggests a diagnosis of primary hypermineralocorticoidism. Medications containing compounds with mineralocorticoid-like activity (licorice, carbenexolone) may also cause the same syndrome. Recently, we carried out detailed studies on 10 patients with severe hypertension and hypokalemic alkalosis, suppressed PRA and low aldosterone levels. Plasma levels of cortisol and ACTH were suppressed in most of the cases. Measurement of deoxycorticosterone and corticosterone (and in some patient of 18-hydroxydeoxycorticosterone and 18-hydroxycorticosterone) was not significantly higher than normal. Therapeutic trials of dexamethasone and aminoglutethimide were ineffective. In contrast, spironolactone and amiloride treatment resulted in substantial but incomplete amelioration of both hypertension and hypokalemia. All of the patients share a common history of chronic rhinitis and habitual use of large doses of nasal spray containing 9 alpha-fluoroprednisolone and vasoconstrictor agents. Withdrawal resulted in a complete remission of hypokalemia in one to two weeks in all patients. The hypertension and depressed levels of PRA, aldosterone and cortisol took longer to return to normal, varying from case to case; in all but one patient, the values returned to normal within two months. This report reveals another cause of factitious mineralocorticoid excess which may be considered in the differential diagnosis of hypokalemic hypertensive syndromes.