Nasal irrigation with Glycyrrhiza glabra extract for treatment of allergic rhinitis - A study of in vitro, in vivo and clinical trial

ETHNOPHARMACOLOGICAL RELEVANCE

Glycyrrhiza glabra, a family of licorice and a traditional Chinese medicine with sweet taste and favorable smell, has anti-inflammatory, anti-allergic and immunomodulatory functions.

AIM OF THE STUDY

We developed a licorice extract (LE) by using glycyrrhiza glabra and administered it through nasal irrigation to treat allergic rhinitis (AR).

MATERIALS AND METHODS

LE was prepared into extract powder, and the anti-inflammatory effect of the LE was evaluated by calcium ionophore-induced activated mast cell model (in vitro). Then, local passive anaphylaxis assays were applied to investigate the anti-IgE-mediated allergic reaction of the LE in mice (in vivo). A developed LE was administered through nasal irrigation to treat AR in clinic settings. A total of 60 participants diagnosed with AR were included in this clinical trial; they were randomly assigned to three interventions: licorice nasal irrigation (LNI), corticosteroid nasal irrigation (CNI), and saline nasal irrigation (SNI). They performed nasal irrigation once a day for 1 month. Both subjective questionnaires (22-item Sino-Nasal Outcome Test [SNOT-22] and visual analog scale [VAS]) and objective examinations (acoustic rhinometry and nasal endoscopy) were used for effectiveness assessments.

RESULTS

All three interventions could improve SNOT-22 scores, but the effects of LNI and CNI were more significant. According to VAS scores for nasal blockage, rhinorrhea, sneezing, nasal pruritus, postnasal discharge, and olfactory disturbance, the effect of LNI was superior to those of CNI and SNI. The results of rhinometry revealed that LNI significantly improved nasal resistance. Endoscopic analysis showed that both LNI and CNI, but not SNI, could significantly improve turbinate hypertrophy. Moreover, the best procedural comfort was found for LNI, which had no side effects or complications during the trial.

CONCLUSIONS

LNI is a natural, safe, and innovative therapy that can effectively treat AR. Its effect is superior to those of CNI and SNI, and it has greatly improved procedural comfort.

Nasal Irrigation: An Imprecisely Defined Medical Procedure

Nasal irrigation (NI) is an old practice of upper respiratory tract care that likely originated in the Ayurvedic medical tradition. It is used alone or in association with other therapies in several conditions—including chronic rhinosinusitis and allergic rhinitis—and to treat and prevent upper respiratory tract infections, especially in children. However, despite it being largely prescribed in everyday clinical practice, NI is not included or is only briefly mentioned by experts in the guidelines for treatment of upper respiratory tract diseases. In this review, present knowledge about NI and its relevance in clinical practice is discussed to assist physicians in understanding the available evidence and the potential use of this medical intervention. Analysis of the literature showed that NI seems to be effective in the treatment of several acute and chronic sinonasal conditions. However, although in recent years several new studies have been performed, most of the studies that have evaluated NI have relevant methodologic problems. Only multicenter studies enrolling a great number of subjects can solve the problem of the real relevance of NI, and these studies are urgently needed. Methods for performing NI have to be standardized to determine which solutions, devices and durations of treatment are adequate to obtain favorable results. This seems particularly important for children that suffer a great number of sinonasal problems and might benefit significantly from an inexpensive and simple preventive and therapeutic measure such as NI.

A Case Study of the Neti Pot's Rise, Americanization, and Rupture as Integrative Medicine in U.S. Media Discourse

In a period of only one decade in the United States, the neti pot shifted from obscure Ayurvedic health device to mainstream complementary and integrative medicine (CIM), touted by celebrities and sold widely in drug stores. We examine the neti pot as a case study for understanding how a foreign health practice became mainstreamed, and what that process reveals about more general discourses of health in the United States. Using discourse analysis of U.S. popular press and new media news (1999-2012) about the neti pot, we trace the development of discourses from neti's first introduction in mainstream news, through the hype following Dr. Oz's presentation on Oprah, to 2011 when two adults tragically died after using Naegleria fowleri amoeba-infested tap water in their neti pots. Neti pot discourses are an important site for communicative analysis because of the pot's complexity as an intercultural artifact: Neti pots and their use are enfolded into the biomedical practice of nasal irrigation and simultaneously Orientalized as exotic/magical and suspect/dangerous. This dual positioning as normal and exotic creates inequitable access for using the neti pot as a resource for increasing cultural health capital (CHC). This article contributes to work that critically theorizes the transnationalism of CIM, as the neti pot became successfully Americanized. These results have implications for understanding global health practices' incorporation or co-optation in new contexts, and the important role that popularly mediated health communication can play in framing what health care products and practices mean for consumers.

Saline nasal irrigation for acute upper respiratory tract infections

BACKGROUND

Acute upper respiratory tract infections (URTIs), including the common cold and rhinosinusitis, are common afflictions that cause discomfort and debilitation and contribute significantly to workplace absenteeism. Treatment is generally by antipyretic and decongestant drugs and sometimes antibiotics, even though most infections are viral. Nasal irrigation with saline is often employed as an adjunct treatment for URTI symptoms despite a relative lack of evidence for benefit in this clinical setting. This review is an update of the Cochrane review by Kassel et al, which found that saline was probably effective in reducing the severity of some symptoms associated with acute URTIs.

OBJECTIVES

To assess the effects of saline nasal irrigation for treating the symptoms of acute URTIs.

SEARCH METHODS

We searched CENTRAL (2014, Issue 7), MEDLINE (1966 to July week 5, 2014), EMBASE (1974 to August 2014), CINAHL (1982 to August 2014), AMED (1985 to August 2014) and LILACS (1982 to August 2014).

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing topical nasal saline treatment to other interventions in adults and children with clinically diagnosed acute URTIs.

DATA COLLECTION AND ANALYSIS

Two review authors (DK, BM) independently assessed trial quality with the Cochrane 'Risk of bias' tool and extracted data. We analysed all data using the Cochrane Review Manager software. Due to the large variability of outcome measures only a small number of outcomes could be pooled for statistical analysis.

MAIN RESULTS

We identified five RCTs that randomised 544 children (three studies) and 205 adults (exclusively from two studies). They all compared saline irrigation to routine care or other nose sprays, rather than placebo. We included two new trials in this update, which did not contribute data of sufficient size or quality to materially change the original findings. Most trials were small and we judged them to be of low quality, contributing to an unclear risk of bias. Most outcome measures differed greatly between included studies and therefore could not be pooled. Most results showed no difference between nasal saline treatment and control. However, one larger trial, conducted with children, did show a significant reduction in nasal secretion score (mean difference (MD) -0.31, 95% confidence interval (CI) -0.48 to -0.14) and nasal breathing (obstruction) score (MD -0.33, 95% CI -0.47 to -0.19) in the saline group. However, a MD of -0.33 on a four-point symptom scale may have minimal clinical significance. The trial also showed a significant reduction in the use of decongestant medication by the saline group. Minor nasal discomfort and/or irritation was the only side effect reported by a minority of participants.

AUTHORS' CONCLUSIONS

Nasal saline irrigation possibly has benefits for relieving the symptoms of acute URTIs. However, the included trials were generally too small and had a high risk of bias, reducing confidence in the evidence supporting this. Future trials should involve larger numbers of participants and report standardised and clinically meaningful outcome measures.

Nasal saline irrigation has no effect on normal olfaction: a prospective randomized trial

BACKGROUND

Nasal saline irrigation is a safe treatment for chronic rhinosinusitis; however, its effect on olfaction is unclear. Cyclic adenosine monophosphate (cAMP) is a key second messenger in the mechanism of olfaction and has been shown to be associated with smell function. In animal studies, olfactory cilia may be harvested by simple saline preparations. This study aimed to characterize the effect of nasal saline irrigation on smell function.

METHODS

Volunteers with normal olfaction were randomized into a control or irrigation cohort. In the initial appointment, subjects completed a University of Pennsylvania Smell Identification Test (UPSIT) and nasal samples were obtained by 2 methods: the nasal curette and cytobrush. The irrigation cohort performed daily nasal saline irrigations. Both cohorts then returned in 1 week. The UPSIT and nasal cell collection were repeated, and each subject completed a subjective olfactory transition scale. Nasal samples were processed for cAMP levels using a commercial assay.

RESULTS

Thirty-two subjects were enrolled and randomized into each cohort. Control and postirrigation mean UPSIT scores were 36.8 and 36.7 (p = 0.48). No subjects reported a subjective smell loss. Ten pairs of nasal samples were assayed. Using the curette, control and postirrigation cAMP levels were 509 and 490 fmol/(mg/mL), respectively (p = 0.94). Using the cytobrush, respective cAMP levels were 424 and 449 fmol/(mg/mL), respectively (p = 0.94).

CONCLUSION

Nasal saline irrigation has no subjective or objective effect on olfaction. It also does not appear to affect cAMP levels, a potential marker of smell function.

[The use of laser Doppler flowmetry for the estimation of the influence of intranasal medications on microcirculation in nasal cavity mucosa]

AIM OF THE STUDY

to investigate the influence of various intranasal medications on the microcirculatory bed in nasal cavity mucosa using the original method of laser Doppler flowmetry.

METHODS

this comprehensive study of the influence of intranasal medicines on nasal cavity mucosa using laser Doppler flowmetry was designed to evaluate the mucociliary clearance, breathing efficiency of the nose, and subjective symptoms of its impairment. The outcomes of a single application of intranasal medications were estimated in 90 rhinologically healthy subjects; in 15 of them, the micrcirculatory blood flow in the nasal cavity was investigated in the early postoperative period with the use of intranasal decongestants and irrigation products.

RESULTS

this study has demonstrated the relationship between the changes in the microcirculatory bed and the application of intranasal medications acting on nasal mucosa. Moreover, these agents were shown to affect intranasal mucosa and its microcirculatory bed following rhinological surgical interventions. Tachyphylaxis of the microcirculatory bed after the administration of the decongestants developed earlier than previously thought. At the came time, irrigation therapy exerted the beneficial effect on the state of the intranasal microcirculatory bed in the postoperative period.

Saline nasal irrigation for acute upper respiratory tract infections

BACKGROUND

Acute upper respiratory tract infections (URTIs), including the common cold and rhinosinusitis, are common afflictions that cause discomfort and debilitation, and contribute significantly to workplace absenteeism. Treatment is generally by antipyretic and mucolytic drugs, and often antibiotics, even though most infections are viral. Nasal irrigation with saline is often employed as an adjunct treatment for chronic or allergic sinusitis, but little is known about its effect on acute URTIs.

OBJECTIVES

To evaluate the efficacy of saline nasal irrigation in treating the symptoms of acute URTIs.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, issue 2) which contains the Acute Respiratory Infections (ARI) Group's Specialised Register, MEDLINE (1966 to May 2009), EMBASE (1974 to May 2009), CINAHL (1982 to May 2009), AMED (1985 to 2009) and LILACS (May 2009).

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing topical nasal saline treatment to other interventions in adults and children with clinically diagnosed acute URTIs.

DATA COLLECTION AND ANALYSIS

Two review authors (DK, GS) independently assessed trial quality and extracted data. All data were analysed using Cochrane Review Manager software.

MAIN RESULTS

Three RCTs (618 participants) were included. Most results showed no difference between nasal saline treatment and control. However, there was limited evidence of benefit with nasal saline irrigation in adults. One study showed a mean difference of 0.3 day (out of eight days) for symptom resolution, but this was not significant. Nasal saline irrigation was associated with less time off work in one study. Minor discomfort was not uncommon and 40% of babies did not tolerate nasal saline drops.

AUTHORS' CONCLUSIONS

Included trials were too small and had too high a risk of bias to be confident about the possible benefits of nasal saline irrigation in acute URTIs. Future trials should involve much larger numbers of participants and be rigorously designed and controlled.