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pregnancy rhinitis

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Nasal congestion is a common companion to pregnancy, with pregnancy rhinitis, i.e., nasal congestion absent an identified cause other than pregnancy, occurring in roughly one in five pregnancies

  • common manifestations of pregnancy rhinitis include nasal congestion and rhinorrhea; both of these symptoms are exacerbated by ongoing use of over-the-counter (OTC) nasal decongestant sprays

  • management options:
    • environmental modification can optimize intranasal functioning
      • simple measures such as elevation of the head of the bed, adequate fluid intake, proper room humidity, and avoidance of cigarette smoke and other environmental irritants are essential
    • intranasal saline instillation is a low risk and often effective intervention, as are OTC nasal strips
    • exercise
    • nasal corticosteroids could be effective, but they have not been shown to be effective in isolated pregnancy rhinitis
      • nasal corticosteroids have not been shown to be effective in a trial of fluticasone (1)
      • however nasal corticosteroids are often used in the management of this condition
      • congenital malformations were studied in 2014 infants whose mothers had used inhaled budesonide for asthma in early pregnancy (2)
        • no increase in rate of congenital malformations was observed compared with the general population rate
    • nasal decongestants provide good temporary relief, women tend to overuse them
      • in the last few decades, the awareness of rhinitis medicamentosa has increased
        • resulting rhinitis medicamentosa can produce complete nasal obstruction and a host of subsequent discomforts, including substantial sleep disturbances
        • women with pregnancy rhinitis tend to use nasal decongestants for prolonged periods of time, and are at risk of developing this additional condition
    • systemic corticosteroids and oral decongestants should not be used
    • invasive methods of turbinate reduction may be effective, but are not recommended

Notes:

  • rhinitis medicamentosa as a contributing factor
    • rhinitis medicamentosa, a syndrome of rebound nasal congestion following use of intranasal topical decongestants, frequently exacerbates the nasal congestion of pregnancy rhinitis
      • rebound hypercongestion, coupled with the memory of initial relief, thereby initiates a cycle of progressive use and accelerating hypercongestion. Such hypercongestion quickly reaches a level of complete nasal obstruction marked by total unresponsiveness to further applications of topical decongestants
      • any patients using intranasal decongestants for a longer period should be advised to discontinue use immediately.

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