Allergic rhinitis symptoms improve with essential oil nasal spray

SAN ANTONIO — Nasal spray using essential oils may alleviate physical and functional impairments in allergic sinonasal-related diseases, according to data presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.

Essential oils may represent an option for patients with allergic airway disease who may want to explore more natural methods for symptom relief, Leonard Bielory, MD, FAAAAI, of Hackensack Meridian School of Medicine, told Healio.

“Patients like to be given choices,” Bielory said.

The spray’s composition

Bielory defined an essential oil as a distillate from a plant source that includes various esters and aldehydes, which are compounds that can be smelled.

Leonard Bielory

The retrospective chart review involved 14 women and four men (aged 16-80 years) with seasonal allergic rhinitis treated with an essential oil nasal spray formulation comprising menthol, eucalyptol, thymol, camphor, birch oil, pine oil, cinnamon, mint and benzoin (Sinusol, New Life Pharma) for at least 1 week.

“Menthol can be used as a topical therapy for rhinitis due to its coolant effect,” Bielory said. “Menthol acts through the menthol and cold receptor, transient receptor potential channel melastatin 8, in normal human nasal mucosa.”

Also, Bielory said, the steam distillation of eucalyptus leaves generates an oil that is rich in 1,8-cineole, with one previous study indicating that patients experienced a cooling sensation and increased nasal airflow after 5 minutes of inhalation.

“Eucalyptus preparations have been studied as a nasal decongestant during acute infectious rhinitis when applied in conjunction with camphor, menthol or steam, with improvements in symptoms,” he said.

Thymol and hesperidin have been effective in suppressing nasal allergic symptoms and inflammation in an animal model, Bielory continued. Additionally, he said, patients have inhaled benzoin in steam to relieve symptoms from asthma, bronchitis and colds.

“It appears to have positive effects on allergic experimental rhinitis, probably due to histamine H1-receptor blockage and the inhibition of histamine release while at the same time providing a mucosal barrier,” Bielory said.

Study results

Using the 22-item version of the Sino-Nasal Outcome Test, the researchers assessed patients at baseline and during subsequent visits. SNOT-22 grand total scores significantly fell by 45.9% after at least 1 week of using the spray, from 37.1 (standard deviation [SD], 23.1) at baseline to 20.1 (SD, 15.5) in the final measurement (P = .003).

Symptoms improved in 20 of the 22 items as well, with significant improvements in the pre- and post-treatment mean scores of 12 items, including:

• loss of smell/taste: 1.11 to 0.33 (70.3%; P = .03);
• ear pain: 0.89 to 0.28 (68.5%; P = .017);
• cough: 2.11 to 0.83 (60.7%; P = .002);
• runny nose: 2.61 to 1.28 (51%; P = .001);
• thick nasal discharge: 1.89 to 0.94 (50.3%; P = .007);
• ear fullness: 1.33 to 0.67 (49.6%; P = .048);
• post-nasal discharge: 2.78 to 1.5 (46%; P = .004);
• nasal obstruction: 3 to 1.89 (37%; P = .011);
• sneezing: 2.67 to 1.72 (35.6%; P = .012);
• difficulty falling asleep: 1.39 to 0.5 (64% (P = .019);
• lack of good night’s sleep: 1.89 to 0.89 (52.9%; P = .013); and
• waking up at night: 1.78 to 0.94 (47.2%; P = .043).

“These numbers are all improvements at week 1, but patients said they noticed improvements almost immediately, within 24 to 48 hours,” Bielory said.

Specifically, patients who reported improvements included those who had experienced loss of smell due to COVID-19, Bielory said.

There were no side effects with the spray, Bielory continued, although one patient discontinued use because of the aroma.

“It was too strong for him. I told him he could dilute it,” Bielory said.

A previous survey of 295 patients with allergic rhinitis in 2021 indicated that patients preferred the spray over intranasal steroids as well, Bielory added, including 77% of adults aged 21 to 65 years and 63% of seniors aged 65 to 80 years. Pediatric patients did not report a preference.

“Children don’t like anything up their nose, so they didn’t care whether it was this or a steroid,” Bielory said.

Conclusions

Based on these results, Bielory said that this essential oil nasal spray formulation could help alleviate the physical and functional impairments that patients with allergic sinonasal-related diseases may experience without steroids.

“Steroid phobia is out there,” Bielory said. “Why not give an option to your patients?”

References:

• Burrow A, et al. Acta Otolaryngol. 1983;doi:10.3109/00016488309132886.
• Kilic K, et al. Eur Arch Otorhinolaryngol. 2018;doi:10.1007/s00405-018-5222-y.

For more information:

Leonard Bielory, MD, FAAAAI, can be reached at drlbielory@gmail.com.