Which category of allergic rhinitis medications is most likely to cause rhinitis medicamentosa with prolonged use?

Rhinitis medicamentosa refers to a condition characterized by rebound nasal congestion that occurs with the overuse of intranasal medications. Intranasal decongestants are particularly associated with this phenomenon when used for more than three consecutive days. These medications, such as oxymetazoline and phenylephrine, provide quick relief from nasal congestion by constricting blood vessels in the nasal passages. However, with prolonged use, the nasal tissues can become reliant on the medication, leading to a worsening of congestion once the drug wears off, prompting the user to take more of the medication, thus creating a cycle of dependency.

Intranasal corticosteroids, while effective for managing allergic rhinitis, do not cause rhinitis medicamentosa, as they do not lead to the same vasoconstrictive rebound effect. Leukotriene antagonists are also not associated with this condition, as they primarily work through a different mechanism involving inflammation and allergic responses. Oral antihistamines similarly do not lead to rebound congestion because they do not act directly on the nasal tissues in the same way that decongestants do.

Thus, the category most likely to result in rhinitis medicamentosa with prolonged use is intranasal decongestants, making this