The Allergic Aspect of Vasomotor Rhinitis

Abstract

The allergist and the rhinologist often are confronted with cases of nonseasonal coryza uncomplicated by infection of the nasal passages or paranasal sinuses. The characteristic pathologic picture is that of a pinkish gray boggy mucosa with rhinorrhea and serous discharge, the bogginess resulting from epithelial hyperplasia. The patient complains of stuffiness of the nose with periods of complete obstruction. He usually gives a history of violent sneezing, worse at certain times, as on getting up in the morning or going to bed, and of being awakened at night by inability to breathe through his nose. This is the type of coryza that is generally labeled vasomotor rhinitis.In the early stages the patient is apt to describe his condition as a "head cold," thus suggesting the possibility of a basic infectious state of the nasal passages and sinuses, or perhaps a superimposed infection. It is not uncommon for nasal allergy and infection to coexist, since the obstruction and impairment of aeration caused by allergic edema favor the development of infection in the nasal mucosa. The patient may also speak of his condition as "sinusitis," which he believes to flare up from time to time.The differential diagnosis can easily be made by examining the nasal secretions for bacteria and eosinophils and the blood for eosinophilia and by transillumination and roentgen examination of the accessory sinuses. At the same time, mechanical obstructions in the form of deflected septums, spurs or polypi and evidence of cystic changes in the nasal and paranasal structures should be looked for. If no signs of infection or other local pathologic changes can be discovered, but the eosinophil cells in the blood and the nasal secretions are found to be increased and there is also a family history of allergy, the case may be regarded as one of vasomotor rhinitis of probable allergic origin.As is well known, this malady often shows stubborn resistance to therapy and requires extensive and exhaustive study from the allergic

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