Alternative therapies for sinusitis and rhinitis: a systematic review utilizing a modified Delphi method

Abstract

Background Sinusitis and rhinitis are common diseases for which patients seek medical attention. Alternative therapies constitute a multibillion‐dollar industry despite poorly established efficacy and safety profiles. This study was designed to identify and grade the evidence for alternative therapies purported to treat sinusitis and rhinitis. Methods A modified Delphi method was used to establish a consensus opinion among rhinology experts of the current evidence for efficacy, potential harm, and future research needs for alternative therapies in sinusitis and rhinitis. Following the initial Delphi round of discussion, a Google search query was performed to identify topics and review online reports of benefit. Subsequent rounds established search criteria and inclusion/exclusion criteria for a systematic literature review utilizing PubMed, EMBASE, and Cochrane databases. Centre for Evidence‐Based Medicine (CEBM) and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria were used to assess levels of evidence and recommendations. Final Delphi rounds were performed until consensus opinions could be reached. Results Over 60 potential alternative therapies for sinusitis and rhinitis were identified. The literature review included 2066 titles with 220 full‐text articles found to be relevant. Most of the therapies had little to no scientific evidence; however, acupuncture, capsaicin, bromelain, and butterbur extract currently have low to moderate‐high GRADE rating. Allergic rhinitis was the most common disease studied. Conclusion Some alternative therapies show promise as potential treatments for sinusitis and rhinitis, mostly compared to placebo. Comparisons to traditional therapies are lacking. For other alternative therapies, many websites included unsubstantiated claims of benefit and ignored potential side effects for which patients should be warned appropriately.

Therapeutic applications of capsaicin in humans to target conditions of the respiratory system: A scoping review

“…Other published reviews corroborate this picture, highlighting research activity around capsaicin in rhinitis and nasal polyposis. 43,[72][73][74][75] The present review adds to the literature by also charting the more recent emerging body of research on capsaicin for the treatment of chronic unexplained cough 41,69 and for the prevention of pneumonia; 6 and by summarising the available safety data, demonstrating that capsaicin in these particular applications and dosages may generally be considered safe, with no reports of serious adverse events associated with the administration of capsaicin, and that these treatments offer overall fair to good patient acceptability.…”

New concepts in pediatric rhinitis

“…In respect of other "complementary" treatments, acupuncture has moderate-to-high evidence of efficacy for the treatment of subjects with rhinitis, while the petasol butenoate complex (Ze 339), a commercially available tablet containing extract from the leaves of Petasites hybridus (butterbur), has shown moderate beneficial effects on AR symptoms. 129 Capsaicin is efficient for the treatment of non-AR in adults; however, pediatric studies are lacking. 130…”

New Concepts in Pediatric Rhinitis

“…It is however uncertain whether such intervention may be tolerable in children. In respect to other 'alternative' treatments, acupuncture has moderate to high evidence of efficacy for the treatment of subjects with rhinitis, while butterbar has shown showed moderate beneficial effects on AR symptoms [124]. Capsaicin is efficient for the treatment of non-AR in adults; however pediatric studies are lacking [125].…”