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Rhinitis is defined as inflammation of the membranes
lining the nose, characterized by nasal symptoms
including itching, rhinorrhea and nasal congestion. Rhinitis
represents a global health problem affecting between 10% and
25% of the world population.
Rhinitis can be classified into Allergic, infective and
The most common form of nonallergic rhinitis is the
idiopathic condition also known as vasomotor rhinitis. Individuals
categorized as such are those who not only lack conventional
evidence of allergic disease but are also devoid of any evidence of
sinusitis/nasal polyposis, anatomic abnormalities, or a known
The first-line treatment for VMR is medical therapy in
the form of topical corticosteroid and topical antihistamine
sprays (which are indicated for NAR as well as AR).
Ipratropium bromide (0.03%) is the only topical anticholinergic
approved for treatment of NAR with no systemic side effects
except for occasional dryness and epistaxis.
Topical capsaicin has been shown to be an efficacious
treatment for NAR based on its modulating effects on C-fibers,
but because of its irritant qualities, its use is often limited by patient intolerance, there are no oral antihistamines or
anticholinergics currently approved for NAR.
BTX is a new postulated modality of treatment for
NANIR, It provides the parasympathetic blockade in intrinsic
rhinitis when injected into the nose.
The current body of literature shows a clear
symptomatologic benefit of BTX on both intrinsic and allergic
Use of BTX in the nose has proven to be well tolerated,
with no significant morbidity.