What is Rebound Congestion?

Man using nasal spray
Man using nasal spray. ballyscanlon/Getty Images

What is Rebound Congestion?

To understand rebound congestion, you first need to understand how congestion occurs. Many people think that congestion is caused by mucus that blocks the nasal passages. This is only partially true.

The underlying cause of congestion lies in the blood vessels that line your nose. Certain conditions can cause these vessels to become swollen (get larger) or constrict (get smaller).

When the blood vessels in your nasal passageways become swollen due to a cold virus, allergies, sinusitis, hormonal changes, exercise or any one of a number of other reasons, congestion occurs. When the vessels constrict (shrink), however, there is more space in the airways and your symptoms subside. So medications used to treat congestion usually cause the nasal blood vessels to constrict or get smaller.

The reasons why rebound congestion occurs are complicated and not well understood. What doctors and scientists do know is that within as little as three days after taking a nasal decongestant (such as Afrin (oxymetazoline), Sudafed (pseudoephedrine), or phenylephrine), you may again begin to feel severe congestion, which is only relieved by additional use of the nasal decongestant. Thus, a vicious cycle is set up. You may also have headaches, anxiety, and restlessness but the condition is generally characterized by congestion with an absence of runny nose or sneezing.

These and other symptoms may occur however, if the underlying condition for which the nasal decongestant was originally used has not resolved. For example, if you started taking Afrin for an allergy, and that allergy has not been successfully treated you may have other symptoms besides congestion. Symptoms generally do not change according to the time of year or whether you are indoors or outdoors.

Rebound congestion can also be called rhinitis medicamentosa (RM), or chemical rhinitis, and some people will refer to this as an addiction to nasal sprays. Rebound congestion can be difficult to cure, which is why it is so important that you use these nasal sprays sparingly and exactly as the label indicates.

Many people who are suffering from rebound congestion mistakenly believe that their condition is caused by allergies, sinusitis or other underlying medical conditions.

If rebound congestion continues untreated it can actually lead to other conditions including: chronic sinusitis, atrophic rhinitis and enlarged turbinates. If you have you have rhinitis medicamentosa you may also frequently snore or experience sleep apnea, a condition which can lead to serious health problems.

Treatment for Rebound Congestion

If you are already addicted to a nasal spray, talk to your doctor. Some doctors may recommend a gradual decrease in the use of the medication until you are completely weaned off it. This may be preferable than trying to quit the medication outright, which may result in severe congestion for a number of days.

There is also a medication called Rhinostat that may be useful in easing this process.

Rhinostat is essentially the same medication you're addicted to, but is dispensed in a manner that very carefully controls the dosage. For example, if your rebound congestion was caused by Afrin and your doctor gave you a prescription for "Rhinostat" you would essentially receive Afrin in a special bottle that allows you to very gradually decrease the dose because of the way it is dispensed.

Another class of medications, called nasal corticosteroids ,may also be helpful during the process of weaning off of nasal decongestants. Oral steroids are also sometimes used. The first week is usually the most difficult and you may experience severe congestion and headaches which then begin to subside.

Treating the underlying condition for which nasal decongestants were originally used is also an important part of the treatment process.

Sources:

Division of Allergy & Clinical Immunology. Rhinitis Medicamentosa. Accessed: April 25, 2010 from http://www.jiaci.org/issues/vol16issue03/1.pdf

The Ear Nose and Throat Center. Nasal Congestion. Accessed: April 25, 2010 from http://www.entcenter.net/id149.htm

Medscape. Rhinitis Medicamentosa. Accessed: March 30, 2016 from http://emedicine.medscape.com/article/995056-overview#a5

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