Alternative treatments for rhinitis could be worth a try

Nasal sprays containing a drug-free aqueous gel emulsion or essential oils appear to help relieve symptoms of allergic rhinitis, as shown in two studies presented at AAAAI 2023.

In the first study, a single-dose administration of the thixotropic drug-free nasal spray AM-301 significantly reduced symptoms triggered by either grass pollen (n=36; least square mean change in Total Nasal Symptom Score [TNSS], –1.09 points, 95 percent confidence interval [CI], –1.65 to –0.54; p<0.0001) or house dust mite (n=37; least square mean change in TNSS, –1.08 points, 95 percent CI, –1.87 to –0.28; p<0.01) relative to no treatment in individuals with seasonal or perennial allergic rhinitis. [AAAAI 2023, abstract 337]

When compared with a hydroxypropyl methylcellulose (HPMC)-based nasal spray, AM-301 performed comparably, without significant between-group difference in the change in the TNSS. However, the HPMC spray had poorer subjective ratings of efficacy, with patients and clinicians considering the nasal spray less efficacious.

A semi-quantitative evaluation of fluorescence-labelled AM-301 distribution and residence time in the nose and oropharynx showed that the agent was able to coat the vestibule and inferior turbinate mucosa for 3–4 hours, as well as the middle turbinate for up to 60 minutes. Fluorescence appeared in the oropharynx after 20–30 minutes.

Finally, AM-301 had favourable safety and tolerability.

“AM-301 [works by forming] a protective barrier inside the nose to prevent the contact of the nasal mucosa with allergens,” according to lead researcher Dr Anne Marie Salapatek of Cliantha Research in Mississauga, Ontario, Canada.

Based on the findings, Salapatek believes that AM-301 represents an attractive drug-free treatment alternative to the currently available medicated nasal spray options.

A more natural option

Meanwhile, an essential oil nasal spray formulation containing menthol, eucalyptol, thymol, camphor, birch oil, pine oil, cinnamon, and mint also provided relief for symptoms.

In a retrospective study involving 18 participants (age 16–80 years, 14 women) with seasonal allergic rhinitis, treatment with the essential oil nasal spray for a minimum of 1 week led to a significant reduction in Sino-nasal Outcome Test (SNOT-22) scores (p=0.003). [AAAAI 2023, abstract 326]

The mean SNOT-22 score dropped from 37.1 points at baseline to 20.1 points at the final assessment, translating to a 40.2-percent improvement in total symptom score.

Self-reported symptom severity decreased across 20 out of 22 symptoms, with the greatest reductions seen in 12 items including runny nose, cough, postnasal discharge, and quality of life features.

“Allergic airway disease imposes a large burden on the quality of life, with an increasing percentage of this population using integrative medicine that includes include herbal medicine and essential oil therapy,” said principal author Dr Leonard Bielory, a professor of medicine, allergy, immunology, and ophthalmology at the Hackensack Meridian School of Medicine in Nutley, New Jersey, US.

Already, the essential oil spray has shown some signal of benefit in a population of patients with perennial allergic rhinitis patients, as evaluated using the Allergic Rhinitis Control Test, Bielory said. The present data suggest that the spray “could be an option for patients who wish to explore more natural methods of allergic symptom relief.”