Possible role of plasminogen activator in the occurrence of profuse watery rhinorrhea after topical application of epinephrine to the nasal mucosa.

Epinephrine and lidocaine have been used for the diagnosis and treatment of nasal diseases. However, watery rhinorrhea and frequent sneezing occur in many patients after topical application of these drugs to the nasal mucosa. This study was aimed at characterizing these side effects, and developing a means to prevent such side effects. A questionnaire was given to each patient who complained of side effects after treatment with epinephrine and lidocaine, and the answers were analyzed with respect to the occurrence and features of the symptoms after the treatment. Eosinophil and mast cell numbers were determined in nasal smears from the patients with side effects. These side effects were different from rhinitis medicamentosa and allergic rhinitis, and were due to epinephrine, not to lidocaine or to the preservatives in the epinephrine. Tranexamic acd, an inhibitor of plasmin, was effective in blocking the side effects.