Nonpharmacological Treatment of Rhinoconjunctivitis and Rhinosinusitis

Infectious and allergic diseases of the upper airways are among the most common illnesses of all age groups. Numerous guidelines have been issued for the evidence-based treatment of these diseases. Therapy involves local or systemic application of well-characterized pharmacologically active medications such as glucocorticosteroids, antihistamines, leukotriene-receptor antagonists, alpha-adrenergic receptor agonists, mast-cell stabilizers, and a monoclonal antibody targeting specific immunoglobulin E. In spite of the fact that the various therapeutic options have proven their efficacy and effectiveness in a myriad of well-designed clinical trials, many patients express their discontent with current therapies. In several surveys a majority of patients stated that they would prefer nonpharmacological " nonchemical " treatment over what is currently prescribed or recommended by their physicians. This desire stands in clear contrast to a systematic review conducted some years ago proving that there was practically no evidence at that time for the efficacy of alternative forms of treatment of allergic diseases of the upper airways. Ever since, several meta-analyses, systematic reviews, and well-designed clinical trials have been published, bearing witness to the scientific basis of some nonpharmacologic options like nasal irrigation in the treatment of different pathologies of the upper airways, namely, for rhinosinusitis and for allergic rhinoconjunctivitis. In this special issue, we want to highlight some new approaches that until lately have found less public attention in this domain. In their article on the clinical efficacy of a spray containing hyaluronic acid and dexpanthenol after surgery in the nasal cavity, I. Gouteva et al. demonstrate beneficial effects on wound healing for two substances that have a long history of local application in the nose but formerly were used separately. The so-called " extremolyte " ectoine is a substance, which was introduced a few years ago as a " natural " treatment of allergic and inflammatory pathologies of the skin and the mucosal tissues. Five articles in this issue illuminate the mechanism of action and the potential benefits of a nasal spray containing ectoine in diseases of various aetiologies like rhinitis sicca or allergic rhinitis. A form of local treatment of the nasal mucosa that is proximate to ectoine is the nasal spray containing liposomes. Its use in allergic rhinitis has been well established. A. Eitenmüller and coauthors present in their article for the first time data on ectoine in chronic rhinosinusitis. For patients who are sceptical about using any sort of active ingredients in their nasal spray, …