Ephedrine-saline nasal wash in allergic rhinitis,☆☆,

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Abstract

Background: Ephedrine nasal wash (0.25% to 1%) was once used in the treatment of sinusitis and other nasal and paranasal symptoms, but there are no reported controlled trials in allergic rhinitis. Methods: In a blinded study, 118 patients with perennial allergic rhinitis were randomly divided into two groups of 65 and 53 patients, respectively, and administered either a placebo or a 1% ephedrine-saline nasal wash once every 48 hours for a period of 4 weeks. These groups were then crossed over after a 4-week interval, and their weekly symptom scores and peak nasal inspiratory flow rates were monitored. Results: Use of ephedrine-saline nasal wash resulted in significant improvement in symptom scores and peak nasal inspiratory flow rates as compared with placebo (p ≤ 0.001). A statistically significant difference between the two groups began in the second week. The effects of treatment lasted for more than 2 weeks after the study, without notable side effects, in most patients. Conclusion: A 1% ephedrine-saline nasal wash is an inexpensive and effective treatment for allergic rhinitis. (J ALLERGY CLIN IMMUNOL 1995;96:597-600.)

Section snippets

Patients

One hundred fifty consecutive patients with allergic rhinitis were selected for this study and subjected to a detailed history and physical examination, estimation of serum IgE levels (by radioimmunoassay), skin prick tests with a battery of common allergens, spirometry (performed with a Flexiflo spirometer [Morgan Instruments Inc., P.K., Andover, Mass]) and peak nasal inspiratory flow rates (PNIFRs) with a Youlten's nasal flowmeter (Clement Clarke International Ltd., London, U.K.).5, 6

The

RESULTS

Before the study, 10 healthy volunteers with no evidence of rhinitis were randomly administered distilled water, saline solution placebo, and ESNW. Each volunteer could identify distilled water as a different medication; however, none could differentiate between placebo and ESNW. As a final test to confirm that the blind was not broken during this study, patients were carefully questioned on completion of phase II; none of the 118 patients could tell the difference between placebo and ESNW.

DISCUSSION

Ephedrine is a noncatechol, phenyl isopropyl amine with a high bioavailability and a long duration of action.7 It may be administered orally (now seldom used) or topically (0.5% to 3% solution as drops) to relieve nasal congestion.7, 8

In this study, a 1% ESNW was evaluated against a placebo and was found to be significantly superior (p ≤ 0.001). Ephedrine, as a vasoconstrictor, is alleged to counteract only one nasal symptom. However, patients were asked to make a global evaluation of symptoms

Acknowledgements

I thank Ms. Varsha for her secretarial assistance during this study.

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From the Allergy Clinic, Bombay Hospital Institute of Medical Sciences, Bombay, India.

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Reprint requests: Wiqar A. Shaikh, MD, Allergy and Asthma Clinic, Shakti Sadan Co-op., Housing Soc Ground Floor "B" Block, Opp. Navjeevan Soc, Lamington Rd., Bombay-400 007, India.

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