Cochrane for Clinicians
Putting Evidence into Practice
Capsaicin for Nonallergic Rhinitis
Am Fam Physician. 2016 Aug 1;94(3):217-218.
Is intranasal capsaicin effective for nonallergic rhinitis?
Intranasal capsaicin is safe and effective for reducing symptoms of nonallergic rhinitis (number needed to treat = 4; 95% confidence interval [CI], 1 to 22). There is insufficient evidence to compare the effectiveness of capsaicin to other topical or systemic medications. (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)
Nonallergic rhinitis is a broad term used to describe a heterogeneous group of sinus diseases that are not triggered by aeroallergens.1 The prevalence of nonallergic rhinitis is 5% to 10% worldwide,2 and symptoms include nasal congestion, blockage or obstruction, sneezing, clear rhinorrhea, and nasal itching. Nonallergic rhinitis is diagnosed by exclusion of symptoms related to aeroallergen exposure or infection and anatomic abnormalities through the history and physical examination.3 The authors of this Cochrane review evaluated the effectiveness of intranasal capsaicin in the management of nonallergic rhinitis.
This Cochrane review included two randomized controlled trials (RCTs) and two quasi-RCTs with a total of 302 participants 16 to 65 years of age with nonallergic rhinitis. They all had symptoms lasting at least one hour per day for at least five days during the two weeks preceding the study. Patients with allergic rhinitis, acute or chronic rhinosinusitis, autoimmune rhinitis, or rhinitis related to anatomic abnormalities were excluded. Nasal capsaicin was used in total daily dosages of 42 to 107 mcg given during various treatment periods of three days to four weeks. The primary outcomes were overall symptom scores (global symptom scores, daily record chart score), individual symptom scores (nasal congestion, rhinorrhea, sneezing, nasal itching), and adverse effects. The risk of bias in these studies was low to unclear.
Overall, the results support the use of intranasal capsaicin as an effective way to manage nonallergic rhinitis.
REFERENCESshow all references
1. Lieberman P, Pattanaik D. Nonallergic rhinitis. Curr Allergy Asthma Rep. 2014;14(6):439....
2. Van Gerven L, Alpizar YA, Wouters MM, et al. Capsaicin treatment reduces nasal hyperreactivity and transient receptor potential cation channel subfamily V, receptor 1 (TRPV1) overexpression in patients with idiopathic rhinitis. J Allergy Clin Immunol. 2014;133(5):1332–1339.
3. van Rijswijk JB, Gerth van Wijk R. Capsaicin treatment of idiopathic rhinitis: the new panacea? Curr Allergy Asthma Rep. 2006;6(2):132–137.
4. Kushnir NM. The role of decongestants, cromolyn, guafenesin, saline washes, capsaicin, leukotriene antagonists, and other treatments on rhinitis. Immunol Allergy Clin North Am. 2011;31(3):601–617.
5. National Asthma Counsel Australia. Managing allergic rhinitis in people with asthma. 2012. http://www.nationalasthma.org.au/uploads/publication/allergic-rhinitis-asthma-hp.pdf. Accessed November 22, 2015.
6. Scadding GK, Durham SR, Mirakian R, et al.; British Society for Allergy and Clinical Immunology. BSACI guidelines for the management of allergic and non-allergic rhinitis. Clin Exp Allergy. 2008;38(1):19–42.
These are summaries of reviews from the Cochrane Library.
This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.
A collection of Cochrane for Clinicians published in AFP is available at http://www.aafp.org/afp/cochrane.
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