Vasomotor Rhinitis: Current Concepts and Emerging Therapies

Aldawas G, Bhat I N (October 28, 2025)  Cureus 17(10): e95631. doi:10.7759/cureus.95631

Abstract

Practical treatment algorithm for vasomotor rhinitis (VMR)

Vasomotor rhinitis (VMR) is a non-infectious, non-allergic subtype of rhinitis, which is characterized by nasal blockage, liquid runny rhinorrhea, and increased sensitivity to nonspecific nasal triggers (such as changing temperature and smell). Although VMR is a disease with a high prevalence rate, it is wrongly diagnosed and under-treated due to its clinical manifestation with allergic rhinitis. Databases such as PubMed, EMBASE, and Cochrane Library were searched to obtain articles published between 2000 and 2025. Randomized controlled trials, cohort studies, and major clinical guidelines were included, while case reports and non-English studies were excluded to ensure consistency and reproducibility of the findings. Existing evidence shows that multiple regulations of the autonomic nervous system, neuropathway neuroplasticity and inflammation, and excessive quantitative stimulation of transient receptor potential (TRP) channels all play a role in the pathophysiology of VMR. Variable therapies include corticosteroids, intranasal antihistamines, and anticholinergics, although ipratropium bromide has had the best dependability results in terms of rhinorrhea.

Surgical procedures that may be considered include intranasal capsaicin, botulinum toxin injections, ablation of the posterior nasal nerve (radiofrequency ablation or cryotherapy), and vidian neurectomy, but these interventions are not yet conclusively demonstrated or established as promising to help the patient with refractory symptoms. VMR is a condition that has not been adequately studied but is common and requires a progressive management style that relies on triggers. Whereas conventional intranasal treatment is the most appropriate in the first case, nerve-specific treatment has promising outcomes in the case of relapse.