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Effectiveness of Chamomile Extract as a Therapeutic Additive to Nasal Spray for Allergic Rhinitis


Reviewed: Atar Y, Karaketir S, Aydogdu I, et al. Comparison of isotonic seawater nasal spray containing chamomile liquid extract and other isotonic seawater nasal washing solutions for allergic rhinitis. Ann Otol Rhinol Laryngol. April 2022;131(4):427-434. doi:10.1177/00034894211025411.

By Mariann Garner-Wizard

Allergic rhinitis (AR) is a condition that causes cold-like symptoms, such as runny nose, itchy eyes, congestion, sneezing, and sinus pressure. AR significantly affects quality of life (QoL) and productivity, and inflammation caused by allergic reactions can lead to severe symptoms. Nasal mucociliary clearance (NMC), a barrier-type defense mechanism in which inhaled irritants and microorganisms are trapped in the mucus layer and removed, relies on mucin secretion and flow. In AR, impaired NMC contributes to inflammation and nasal obstruction.

By the 19th century, Western medicine adopted nasal washing, an ancient practice that likely originated in India’s traditional Ayurvedic medicine. It is useful in sino-nasal conditions and postoperative otolaryngology and can reduce the use of prescription drugs. Isotonic seawater (IS), which is seawater with reduced salinity, is used widely as a nasal wash, although its effects are not fully understood. It likely thins mucus and helps remove irritants from the nasal cavity.

Chamomile (Matricaria chamomilla syn. Chamomilla recutita, Asteraceae) has many reported biologically active compounds including luteolin, chamazulene, a-bisabolol, bisabolol oxides A and B, and apigenin. It has been used to treat pollen allergies, muscle spasms, menstrual disorders, insomnia, anxiety, gastrointestinal disorders, hemorrhoids, rheumatic pain, wounds, and ulcers. Chamomile has reported anti-allergy, anti-inflammatory, antimicrobial, antidepressant, cytotoxic, and antipruritic (anti-itching) effects.

In a previous study, patients who underwent septorhinoplasty (hybrid surgery that combines the aesthetic benefits of a rhinoplasty and also corrects a deviated septum to improve airflow and breathing) and were subsequently treated with IS containing natural sea salts combined with chamomile liquid extract (CLE) in a nasal spray (Kamillosan® Ocean Spray Nasal; Meda Pharma GmbH & Co.; Bad Homburg, Germany) had significant improvement in nasal sensibility (sensitivity to sensory stimuli) and NMC. Another previous study found that IS with CLE significantly improved symptoms in people with chronic rhinosinusitis compared to placebo. The authors of this 2022 study compared effects of three nasal washing solutions with conventional care in 132 adults in a randomized, controlled clinical trial.

The authors recruited participants diagnosed with mild persistent AR (based on Allergic Rhinitis and its Impact on Asthma [ARIA] criteria) from an outpatient clinic at a hospital in Turkey. Those who were excluded had moderate to severe persistent or intermittent AR, atrophic rhinitis, nasal polyps, moderate to severe septal deviation, septal perforation, asthma, chronic-acute sinusitis, cranial pathology, or anosmia (loss of the sense of smell); had histories of malignancy, ciliary disorder, chronic disease, smoking, or intellectual disability; or had undergone nasal or intracranial surgery, among other criteria.

All participants used a nasal steroid spray (mometasone furoate), with two sprays in each nostril once each morning as per ARIA guidelines and were assigned randomly to one of four groups (n = 33 for each). Group A received 100 mL of Kamillosan; Group B received 100 mL of Stérimar® Nasal Hygiene (SOFIBEL-Laboratoires Fumouze; Levallois-Perret, France), an IS nasal spray; Group C received 60 mL of Otribebe® Monodoz (GlaxoSmithKline Laboratoire de la Mer; Saint-Malo, France), a hypervalent seawater nasal wash administered via a sinus rinse kit (Abfen Farma; Ankara, Turkey); and Group D received mometasone furoate only. Adjunctive washes were used three times in each nostril twice daily. Blinding is not mentioned. The comparative nature of the study may have made blinding impractical.

Age, gender, and mean duration of AR were similar in all groups at baseline. The Sino-Nasal Outcome Test-22 (SNOT-22) and saccharin test for NMC were employed at baseline and after four weeks of treatment. The SNOT-22, a self-administered assessment of sino-nasal symptoms and QoL, has been validated in people with AR. To test NMC, saccharin is placed inside each nostril separately and time to taste sensation in the mouth is measured. Shorter times indicate better NMC. Results from both nostrils were averaged for individual scores. Baseline SNOT-22 and NMC scores were compared with those after four weeks, and mean differences were compared between groups.

Nine participants were lost to follow-up, and 123 completed the study (32 in Group A, 27 in Group B, 31 in Group C, and 33 in Group D).

Compared to baseline, Group A’s mean SNOT-22 and NMC scores improved significantly (P ≤ 0.001 for both) as did those in Group B (SNOT-22, P ≤ 0.001; NMC, P = 0.10). In Group C, mean SNOT-22 scores improved significantly (P ≤ 0.001), but NMC scores did not. Similarly, Group D SNOT-22 scores improved significantly (P = 0.048), but NMC scores did not.

Improvements in SNOT-22 and NMC scores before and after treatment were significantly better in Group A versus Group D (P ≤ 0.001 and P = 0.001, respectively) and in Group B versus Group D (P = 0.010 and P = 0.048, respectively). Group C improvements in SNOT-22 scores were significantly greater than in Group D (P = 0.018); NMC changes were not. Group A SNOT-22 scores improved significantly more (P = 0.010) than in Group B; NMC scores did not.

SNOT-22 and NMC scores improved significantly more in Group A than in Group C (P = 0.003 and P = 0.010, respectively). Between Groups B and C, differences in improvement were not significant (SNOT-22, P = 0.818; NMC, P = 0.300). All groups had significant improvements in SNOT-22 scores during the study, but NMC scores improved significantly only in Group A (Kamillosan) and Group B (Stérimar) groups.

The authors concluded that Kamillosan may be an effective, inexpensive, and well-tolerated adjunct treatment for AR. They suggested CLE should be investigated as an ingredient in other washing treatments for AR.