Intranasal Anticholinergics for Treatment of Chronic Rhinitis: Systematic Review and Meta‐Analysis

Abstract

Objective Topical intranasal anticholinergics are commonly prescribed for the relief of chronic rhinitis and associated symptoms, warranting thorough assessment of the supporting evidence. The present study aimed to evaluate the safety and efficacy of anticholinergic nasal sprays in the management of allergic and non‐allergic rhinitis symptom severity and duration. Methods A search encompassing the Cochrane Library, PubMed/MEDLINE, and Scopus databases was conducted. Primary studies describing rhinorrhea, nasal congestion, and/or postnasal drip outcomes in rhinitis patients treated with an anticholinergic spray were included for review. Results The search yielded 1,029 unique abstracts, of which 12 studies (n = 2,024) met inclusion criteria for qualitative synthesis and 9 (n = 1,920) for meta‐analysis. Median follow‐up was 4 weeks and ipratropium bromide was the most extensively trialed anticholinergic. Compared to placebo, anticholinergic treatment was demonstrated to significantly reduce rhinorrhea severity scores (standardized mean difference [95% CI] = −0.77 [−1.20, −0.35]; −0.43 [−0.72, −0.13]) and duration (−0.62 [−0.95, −0.30]; −0.29 [−0.47, −0.10]) in allergic and non‐allergic rhinitis patients respectively. Benefit was less consistent for nasal congestion, postnasal drip, and sneezing symptoms. Reported adverse effects included nasal mucosa dryness or irritation, epistaxis, headaches, and pharyngitis, though comparison to placebo found significantly greater risk for epistaxis only (risk ratio [95% CI] = 2.19 [1.22, 3.93]). Conclusion Albeit treating other symptoms with less benefit, anticholinergic nasal sprays appear to be safe and efficacious in reducing rhinorrhea severity and duration in both rhinitis etiologies. This evidence supports their continued use in the treatment of rhinitis‐associated rhinorrhea. Level of Evidence 1 Laryngoscope, 133:722–731, 2023

Postnasal drip and chronic cough in patients with chronic rhinitis treated with temperature‐controlled radiofrequency neurolysis

“…Separately, surgical resection of the PNN also did not result in improvement in PND in a small study 25 . In a systematic review and meta‐analysis on the effect of intranasal anticholinergics for the treatment of CRS reported inconsistency in the improvement of PND among studies 26 . Together, these observations support further research in this area.…”

Using Ipratropium Bromide Nasal Spray Response as a Screening Tool in the Diagnostic Workup of Cerebrospinal Fluid Rhinorrhea

“…17,27,28 IBNS has been shown to decrease the amount and duration of rhinorrhea in various forms of rhinitis in both males and females 6 years or older. 14,[29][30][31][32][33] IBNS can reduce rhinorrhea within 5 min of application, with maximal effect at 1-4 h, and generally remains effective for 4-8 h. 33,34 This rapid onset of action makes it an ideal screening tool. Of note, as IBNS will not lead to long-term cessation of rhinorrhea, it is important for clinicians to ask patients whether IBNS leads to at least temporary rhinorrhea cessation.…”

“…IBNS is a quaternary amine anticholinergic medication that binds and inhibits muscarinic receptors on nasal mucosal glands 17,27,28 . IBNS has been shown to decrease the amount and duration of rhinorrhea in various forms of rhinitis in both males and females 6 years or older 14,29–33 . IBNS can reduce rhinorrhea within 5 min of application, with maximal effect at 1–4 h, and generally remains effective for 4–8 h 33,34 .…”

“…Ipratropium bromide nasal spray (IBNS) is an FDA-approved treatment shown to be highly effective at reducing rhinorrhea caused by various forms of rhinitis by inhibiting cholinergic stimulation to nasal mucosal glands. 14 Presuming conditions other than nasal CSF leaks can cause UCTR, one purpose of this study was to determine the utility of IBNS as a screening test in the diagnostic workup of CSF rhinorrhea. In addition, other clinical features and patient factors were assessed for their ability to increase or decrease one's suspicion of UCTR being CSF.…”