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Drug-Induced Atrophic Rhinitis

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Atrophic Rhinitis

Abstract

Drug-induced rhinitis is a nonallergic rhinitis that results from a chronic damage perpetuated on the nasal mucosa by the reiterated inhalation of pharmacologic agents, which induce chronic ischemia and inflammation that may ultimately lead to the atrophy of nasal mucosa and to the destruction of nasal osteocartilaginous structures.

This chapter analyzes two specific conditions: rebound rhinitis, also known as rhinitis medicamentosa (RM), and cocaine-induced rhinitis.

The former, RM, is caused by the misuse of over-the-counter nasal decongestants containing vasoconstrictive agents that mimic the effects of the sympathetic system. They are used to treat nasal congestion, obstruction, and mucus discharge but the relief they offer is short, followed by a rebound congestion that easily starts a vicious cycle which eventually leads to mucosal damage and, sometimes, atrophic rhinitis.

The latter represents a social burden as the abuse of cocaine is widespread among the Western world. The habit to snort cocaine causes traumatic and ischemic injury on the nasal mucosa that may evolve into a proper rhinitis with irreversible damages on nasal structures. Few predisposed patients might also develop severe cocaine-induced midline destructive lesions (CIMDLs), which represent a challenge for clinicians who are called to reach a diagnosis and plan treatment.

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Abbreviations

ANCA:

Anti-neutrophil cytoplasmic antibodies

CIMDL:

Cocaine-induced midline destructive lesion

GPA:

Granulomatosis with polyangiitis

HNE:

Human neutrophil elastase

RM:

Rhinitis medicamentosa

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Authors and Affiliations

  1. Section of Otorhinolaryngology, Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy

    Mariapia Guerrieri, Pier Giorgio Giacomini, Barbara Flora & Lorenzo Silvani

  2. ENT Department, University of Rome Tor Vergata, Rome, Italy

    Stefano Di Girolamo

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  1. Mariapia Guerrieri
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  2. Pier Giorgio Giacomini
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  5. Stefano Di Girolamo
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  1. ENT Department, University of Rome Tor Vergata, Rome, Italy

    Stefano Di Girolamo

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Guerrieri, M., Giacomini, P.G., Flora, B., Silvani, L., Di Girolamo, S. (2020). Drug-Induced Atrophic Rhinitis. In: Di Girolamo, S. (eds) Atrophic Rhinitis. Springer, Cham. https://doi.org/10.1007/978-3-030-51705-2_4

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  • DOI: https://doi.org/10.1007/978-3-030-51705-2_4

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