Autonomic nervous system dysfunction and the effect of vitamin D level in vasomotor rhinitis patients

Introduction
Considering the role of the autonomic nervous system in thermoregulation, studies showing that it plays an important role in the pathophysiology of vasomotor rhinitis triggered by temperature change have been known for a long time.

Aim
The present study was to evaluate patients with vasomotor rhinitis who have no organic causes for symptoms of thermodysregulation such as chills, hot flashes/sweating, and to determine the effect of regulator hormone vitamin D on symptoms of rhinitis and thermoregulation.

Material and methods
Between January and December 2019, a total of 183 patients were diagnosed with non-allergic persistent rhinitis. Smoking history and drugs used were questioned. Allergy tests were performed with either a skin prick test or specific IgE measurement. Patients were evaluated for endocrinological diseases, anemia and vitamin D levels. Presence of nasal polyposis was evaluated with anterior rhinoscopy. Currently there is no validated test method that can show autonomic dysfunction. We prepared a questionnaire consisting of 24 questions that evaluates thermodysregulation and used it in this survey.

Results
130 patients were diagnosed as vasomotor rhinitis. The distribution of patients by gender was 26 men and 104 women. All patients had persistent moderate to severe rhinitis. A total of 81 (62%) patients had cold intolerance and 49 (38%) had heat intolerance. Of the patients with cold intolerance, 76 stated that their complaints have increased upon a sudden decrease in external environmental temperature. All patients with heat intolerance were complaining of excessive sweating. With regular sports activities, 24 patients reported decreased rhinitis symptoms. Of the patients with vasomotor rhinitis, symptoms of rhinitis decreased in 42 (32%) due to sunbathing. A total of 69 (53%) patients received vitamin D replacement therapy. All of these patients stated that their complaints decreased after vitamin D replacement.

Conclusions
We showed that the coexistence of vasomotor rhinitis and thermoregulation disorder is common. We think that thermoregulation disorder may be due to autonomic nervous system dysfunction and may share common mechanisms with vasomotor rhinitis.