gms | German Medical Science

Introduction: In literature, the paradox reaction to topical administration of sympathicomimetics has been seen as a clue to the presence of a non allergic rhinitis. Data on the frequency of this occurrence is absent, and it is unclear what causes this reaction.

Methods: 1350 patients presenting with nasal obstruction were examined via objective rhinological tests, including rhinomanometry, rhinoresistometry, acoustic rhinometry, olfactory testing (using Sniffin’ Sticks), and clinical examination by an ENT specialist including nasal endoscopy. Detection of an increase in resistance led to further testing using a benzalconium chloride free nasal spray.

Results: Verification of a paradox reaction was possible in 5 patients (0,0037%). All patients displayed normal olfaction. Three patients (0,002%) had possible adverse reactions in the form of a toxic irritative non allergic rhinits. One of 3 patients additionally presented with a rhinitis medicamentosa, and had been using a topic sympathomimetic once a day for more than a year. In 2 other patients (0,00148%) a non allergic rhinopathy was present. Sinus infection could be ruled out as a possible comorbidity in all patients.

Conclusion: The prevalence of a paradox reaction to the application of toxic sympathicomimetics is uncommon, and can be divided into toxic irritative non allergic rhinitis, and non allergic rhinopathy. A possible risk factor is the prolonged use of topic sympathicomimetics.

Der Erstautor gibt keinen Interessenkonflikt an.