Alcoholic beverages, regardless of type, dilate blood vessels throughout the body, including the nose, and frequently cause an increase in nasal congestion. In addition, alcohol is dehydrating and may lead to a thickening of nasal secretions. It does not generally lead to other symptoms, such as sneezing, itching, or nasal discharge.
The effect of alcohol is transient and is usually recognized by the patient after multiple experiences. In rare cases, a patient may be allergic to a component in the beverage, such as hops or yeast, which may trigger nasal symptoms as well as other systemic complaints.
Smoking tobacco, whether it be in the form of cigarettes, cigars, or water pipes, has also been observed to con-tribute to nasal symptoms. It is speculated that the tars and products of combustion act as irritants to the mucous membrane, leading to increases in congestion, sneezing, and nasal secretions. While it is unlikely that patients are allergic to the tobacco itself, the dried leaves may contain appreciable amounts of various types of mold, which may act as respiratory allergens in sensitized individuals. Similar comments may be made regarding marijuana, which can act as a potent irritant and trigger of nasal symptoms but is unlikely to act as an allergen.
Cocaine is most frequently used intranasally, and many chronic users complain of nasal irritation, nasal crusting, recurrent nosebleeds, nasal stuffiness, and facial pain. The most likely source of these symptoms is the constriction in blood vessels in the mucous membrane and septum, which may ultimately result in a perforation or hole in the septum (so-called “coke nose”). Because nasal congestion is a common complaint in cocaine users, many self-treat with nasal decongestants, such as oxymetazoline, which adds to the problem because it also leads to the constriction of blood vessels.