Sinusitis is one of the most common colds during the cold season. It is estimated that about one in seven cases of rhinitis results in acute rhinosinusitis. In most cases, this variant of upper respiratory tract infections is harmless – nevertheless, drug treatment is advisable. Mucolytic anti-inflammatory drugs of herbal origin can gently and effectively support the self-healing powers.
In addition to impaired nasal breathing and mucus secretion, typical symptoms include facial pain and olfactory disturbances, and occasionally fever and headache. If the duration of symptoms is less than 12 weeks, it is referred to as an acute course. Viral infections are the most common cause, although acute bacterial rhinosinusitis* with severe inflammatory infiltration of the sinus mucosa may develop in approximately 0.5-2% of cases [1]. About 80% of the courses are self-limiting – usually the symptoms heal within two weeks even without therapy. Since the symptoms can significantly affect the quality of life, drug treatment is nevertheless recommended. However, the guidelines advise against antibiotics in most cases because the benefits do not outweigh the harmful side effects [1]. However, there are evidence-based effective, well-tolerated treatment alternatives.
*
The most common pathogens are pneumococci (36-40%) and Haemophilus influenzae (22-50%), followed by Staphylococcus aureus (3-5%), Streptococcus pyogenes (3%), and Moraxella catarrhalis (2%) [1].
Pelargonium sidoides demonstrably reduces symptoms
The standardized extract EPs® 7630 (Kaloba®) [2] obtained from the roots of Pelargonium sidoides has evidence-based antiviral, antibacterial and mucolytic activity and supports the control of respiratory infections. The use of EPs® 7630 is recommended by EPOS** and the International Consensus treatment on Allergy & Rhinology for rhinosinusitis [3,4]. Peric et al. showed that this phytopharmacological preparation is an effective and well-tolerated alternative to antibiotic therapy in uncomplicated courses of acute bacterial rhinosinusitis. demonstrate in a study published in 2020 [5]. Fifty study participants with mild to moderate acute bacterial rhinosinusitis*** were randomly assigned to the verum condition (n=25) or the control group (n=25) and received either EPs® 7630 (3× 20 mg daily) or amoxicillin (3× 500 mg daily) for 10 days. Treatment effects were collected by assessment of the specialist and self-assessment of the patients. Pelargonium sidoides showed significantly greater improvement after a treatment period of 10 days for the parameters of nasal obstruction, facial expression/pain, loss of sense of smell, mucosal swelling, and mucopurulent secretion, as well as in the symptom total score (TSW). Bacteriological evaluation revealed that the EPs® 7630 treated group had significantly fewer patients with positive cultures of Streptococcus pneumoniae (p<0.001), Haemophilus influenzae (p=0.016) and Moraxella catarrhalis (p=0.0031) at the end of treatment. In the amoxicillin condition, colonization with Streptococcus pneumoniae (p=0.002) and Haemophilus influenzae (p=0.031) was significantly reduced. Overall, the results suggest a better clinical efficacy of EPs® 7630, which can be explained by a stronger influence on the production of inflammatory mediators in the nasal mucosa.
**EPOS = European Position Paper on Rhinosinusitis and Nasal Polyps 2020 [3].
***Verification of the diagnosis according to the criteria for an acute respiratory infection of the Clinical Practice Guidelines of the American Academy of Otolaryngology Head and Neck Surgery plus a positive result in the bacterial smear.
Influencing the immune response through effects on chemokine production.
As shown in another study, EPs® 7630 affects the production of chemokines that regulate neutrophils and monocytes of inflammatory lesions in the nasal mucosa [6]. More specifically, the production of monocyte-related chemokines is increased and that of neutrophil-related ones is decreased. Twenty-six patients with mild to moderate acute non-suppurative rhinosinusitis (NPAR) were studied. The diagnosis was verified using the EPOS criteria**. The control group included 25 study participants without nasal mucosal diseases. Patients with NPAR were treated with EPs® 7630 (20 mg, 3× daily) for 10 days. The concentration of thirteen chemokines in nasal secretions (flow cytometry) and endoscopic findings were evaluated. Ten days of treatment with EPs® 7630 resulted in a significant increase in the levels of MCP-1 and MIP-1-β, while those of MIP-1-α, ENA-78 and IL8 decreased significantly. Moreover, all symptoms of NPAR improved, and the same was true for endoscopic findings. Tolerance of the treatment was excellent, with no side effects reported.
Literature:
- DGHNO-KHC/DEGAM 2017: Rhinosinusitis: S2k guideline, www.awmf.org, last accessed 09.12.2020.
- Swissmedic: Kaloba®, www.swissmedicinfo.ch
- Fokkens WJ, et al: European position paper on rhinosinusitis and nasal polyps 2020. rhinology 2020; 58(Suppl S29): 1-464.
- Orlandi RR, et al: International Consensus Statement on Allergy & Rhinology : Rhino-sinusitis. Int Forum Allergy Rhinol 2016; 6(1): S22-S209.
- Perić A, et al: Herbal Drug EPs 7630 versus Amoxicillin in Patients with Uncomplicated Acute Bacterial Rhinosinusitis: A Randomized, Open-Label Study. Annals of Otology, Rhinology and Laryn-gology 2020: 1-8.
- Perić A, et al: Effects of Pelargonium sidoides extract on chemokine levels in nasal secretions of patients with non-purulent acute rhinosinusitis. Journal of drug assessment 2020; 9 (1): 145-150.
HAUSARZT PRAXIS 2020; 15(12): 25
