Botolinum toxin in rhinitis: Literature review and posterior nasal injection in allergic rhinitis.

[BACKGROUND] Current pharmacological management of allergic rhinitis (AR) varies in onset, duration, symptom control, and requires frequent administration. Single-dose botulinum toxin (BTX) has been documented in various trials as a treatment option in rhinitis.

[OBJECTIVE] We review the current literature on the use of BTX in rhinitis and investigate the efficacy and safety profile of a novel intranasal injection site for AR control.

[STUDY DESIGN] Single-arm pilot study.

[METHODS] Ten adult patients having moderate to severe AR with proven house dust-mite allergy were recruited. Each patient received 12.5 units of Botox injected to the posterior lateral wall of each side of the nose under endoscopic guidance. Immediate postprocedural discomfort and Total Nasal Symptom Score (TNSS) at 2 and 4 weeks were used as primary outcome measures. Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) was used as secondary outcome measure.

[RESULTS] Overall TNSS (minimum = 0; maximum = 20) showed an improvement from a mean of 15.1 (preinjection) to 7.6 (2 weeks) and 7.7 (4 weeks). Greatest effect was seen in subscales of rhinorrhea (4.0-1.7) followed by sneeze, nasal congestion, and itch. Mean discomfort of the procedure was scored 5.7 over 10. RQLQ scores similarly showed an improvement in all domains of quality of life. Two subjects complained of mild headache not requiring any medical intervention.

[CONCLUSION] Based on our review of current literature, BTX shows clear efficacy on symptoms of both intrinsic and allergic rhinitis, with a good safety profile. Single-dose posterior nasal injection demonstrates good efficacy and duration of action, with moderate discomfort.

[LEVEL OF EVIDENCE] 4. Laryngoscope, 127:2447-2454, 2017.