Capsaicin nasal spray can offer moderate to significant symptomatic relief to 70-80% of patients with idiopathic rhinitis (IR). Efficacy was also shown in lab studies. Nasal hyper reactivity (NHR), absence of allergy / infective rhinosinusitis, age limits (18-60), no anatomical nasal abnormalities and absence of response to intranasal steroids need to be present before a diagnosis of IR can be made. There is a group of rhinitis patients in whom the strict criteria of IR are not met and who still satisfy most of them. This group was called a mixed rhinitis (MR) group by the authors. They conducted a study to assess the efficacy of capsaicin nasal spray on MR patients as compared to IR. Authors recruited 28 IR patients and 24 MR patients. They offered both groups the same treatment with capsaicin spray for a total of 12 weeks, after which they performed therapeutic response evaluation in the two groups.

Sixty-eight percent of MR patients showed therapeutic response with 32% showing major symptom relief. Better response was noted in patients who had symptoms of NHR. The authors concluded that capsaicin spray is effective in mixed rhinitis patients as well as in those with idiopathic rhinitis.

Rhinitis and rhinosinusitis encompass multiple aetiologies leading to some difficulty in diagnosis and management. capsaicin spray might have a role in patients who do not respond to traditional treatments. However, a randomised controlled trial with a placebo arm would be helpful in supporting wider use of Capsaicin. 

Therapeutic effect of capsaicin nasal treatment in patients with mixed rhinitis unresponsive to intranasal steroids.
Van Gerven L, Steelant B, Alpizar YA, Talavera K, Hellings PW.
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Hassan Mohammed

North East Deanery, Newcastle, UK.

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