Oxymetazoline Hydrochloride Combined With Mometasone Nasal Spray for Persistent Nasal Congestion (Pilot Study)

To the Editor: Nasal glucocorticosteroids (NGCS) are considered first-line therapy for allergic rhinitis and are effective therapy for nonallergic rhinitis, especially vasomotor rhinitis and nonallergic rhinitis with eosinophilia syndrome.1–4 Nasal congestion can persist despite maximum treatment with NGCS. Although oral and topical antihistamines are effective in relieving this symptom,5,6 neither oral nor topical antihistamines are as effective in relieving this symptom compared with NGCS.7,8 Oxymetazoline (OXY) is a decongestant and the addition of oxymetazoline to a NGCS should add a considerable decongestant benefit. However, its use is recommended only for 3–14 days because of the risk of rhinitis medicamentosa (RM), increased nasal congestion caused by prolonged use of such drugs.9 NGCS are helpful in reducing the amount of rebound congestion in patients with perennial allergic rhinitis with RM. They also decrease nasal mucosal edema, recruitment of neutrophils and mononuclear cells, cytokine production, and late-phase nasal mediators. They may offer a protective benefit from the development of RM. Oxymetazoline may also decrease turbinate enlargement, thereby permitting better nasal distribution of NGCS. Data are limited about efficacy and safety of OXY used with NGCS for nasal congestion (NC) not adequately responding to recommended doses of NGCS.