Intranasal administration of virucidal and antiviral therapies may provide added clinical benefit by decreasing viral activity in the nasal pathway, preventing COVID-19 transmission and managing disease severity.
A new review published in the Journal of Allergy and Infectious Disease found that nasal hygiene options, such as nasal sprays, are effective tools to defend against COVID-19 when combined with other approaches, such as social distancing and mask wearing.
The authors proposed that intranasal administration of virucidal and antiviral therapies may provide added clinical benefit by decreasing viral activity in the nasal pathway, preventing COVID-19 transmission and managing disease severity. These approaches could be especially effective in combination with other strategies to modify the viral content in respiratory tracts, according to the report.
Potential antiviral agents for intranasal use include xylitol and grapefruit seed extract (GSE), corticosteroids, and hydrogen peroxide, according to the study. Xylitol is a naturally occurring sugar alcohol, but it demonstrates antiviral properties when administered orally and intranasally. GSE is known to inhibit bacteria growth and its antiviral properties were recently evaluated in vitro with viruses such as the avian influenza virus.
In a recent article published by Go et al, 3 patients with mild-to-moderate COVID-19 were administered xylitol and GSE in a nasal spray. Investigators noted a reduction of clinical course and improvements in symptoms as early as day 4. Furthermore, on day 7, patients tested negative on a repeat RT-PCR nasopharyngeal swab instead of the average 14-day period.
Intranasal corticosteroids are a first-line therapy for allergic rhinitis and have well-established safety and efficacy. Adverse effects are limited, occurring in approximately 5% to 10% of patients, and include dryness, burning, stinging, sneezing, headache, and nasal bleeding.
The Allergic Rhinitic and Its Impact on Asthma Initiative—The European Academy of Allergy & Clinical Immunology (ARIA-EAACI) published a statement regarding the use of intranasal corticosteroids for COVID-19 patients with allergic rhinitis, in which they recommended these patients continue use of the treatment. The statement mentioned that sneezing could worsen if patients were to stop using intranasal corticosteroids, which could lead to the spread of the virus.
Finally, an in vitro study of hydrogen peroxide vapor, a vapor-phase disinfection method that is commonly used for intranasal and gargling, has shown that it has virucidal properties for structurally distinct viruses in inanimate surfaces, suggesting that it could be useful for minimizing COVID-19 infections, according to the study authors. Despite multiple studies and trials, however, the report said larger randomized trials are needed to further validate these findings.
“Limited strategies are currently accessible in modifying the viral content in infected patients’ respiratory tracts, justifying the need for novel therapeutic interventions targeting the principal route of infection,” the authors wrote. “We propose that intranasal administration of virucidal and antiviral therapies may be a novel strategy to provide an added clinical benefit by decreasing the viral activity in the nasal pathway, thus preventing disease transmission, managing the disease severity and limiting complications.”
Go C, Pandav K, Somagutta M, Go J, et al. Intranasal therapy and COVID-19: A comprehensive literature review. Journal of Allergy and Infectious Disease; February 25, 2021. https://probiologists.com/Uploads/Articles/11_637497463703161509.pdf. Accessed February 25, 2021.