Botulinum Toxin for Rhinitis

Rhinitis (JJ Oppenheimer and J Corren, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Rhinitis

Abstract

Purpose of Review

Rhinitis is a common clinical entity. Besides nasal obstruction, itching, and sneezing, one of the most important symptoms of rhinitis is nasal hypersecretion produced by nasal glands and exudate from the nasal vascular bed. Allergic rhinitis is an IgE-mediated inflammatory reaction of nasal mucosa after exposure to environmental allergens. Idiopathic rhinitis describes rhinitis symptoms that occur after non-allergic, noninfectious irritants. Specific allergen avoidance, topical nasal decongestants, nasal corticosteroids, immunotherapy, and sinonasal surgery are the main treatment options. Because the current treatment modalities are not enough for reducing rhinorrhea in some patients, novel treatment options are required to solve this problem.

Recent Findings

Botulinum toxin is an exotoxin generated by Clostridium botulinum. It disturbs the signal transmission at the neuromuscular and neuroglandular junction by inhibiting the acetylcholine release from the presynaptic nerve terminal. It has been widely used in neuromuscular, hypersecretory, and autonomic nerve system disorders. There have been a lot of published articles concerning the effect of this toxin on rhinitis symptoms. Based on the results of these reports, intranasal botulinum toxin A administration appears to be a safe and effective treatment method for decreasing rhinitis symptoms in rhinitis patients with a long-lasting effect.

Summary

Botulinum toxin type A will be a good treatment option for the chronic rhinitis patients who are resistant to other treatment methods.

Keywords

Rhinitis Allergic rhinitis Vasomotor rhinitis Idiopathic rhinitis Botulinum toxin A 

Notes

Compliance with Ethical Standards

Conflict of Interest

Drs. Ozcan and Ismi declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.•
    Bousquet J, Khaltaev N, Cruz AA, et al. Allergic Rhinitis and Its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen. Allergy. 2008;63 suppl 86:8–160. This report is about updating the new classification of allergic rhinitis.CrossRefPubMedGoogle Scholar
  2. 2.
    International Consensus Report on Diagnosis and Management of Rhinitis. International Rhinitis Management Working Group. Allergy. 1994;49 Suppl 19:1–34.Google Scholar
  3. 3.
    Ozcan C, Vayisoglu Y, Dogu O, Gorur K. The effect of intranasal injection of botulinum toxin A on the symptoms of vasomotor rhinitis. Am J Otolaryngol. 2006;27:314–8.CrossRefPubMedGoogle Scholar
  4. 4.•
    Rohrbach S, Junghans K, Köhler S, Laskawi R. Minimally invasive application of botulinum toxin A in patients with idiopathic rhinitis. Head Face Med. 2009;5:18. This study is the first clinical study presenting the effect of sponge-soaked application of botulinum toxin-A.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.•
    Bachert C. Persistent rhinitis—allergic or nonallergic? Allergy. 2004;59 Suppl 76:11–5. This review outlines how to differentiate allergic rhinitis from the non-allergic rhinitis and what is important to diagnose non-allergic rhinitis.CrossRefPubMedGoogle Scholar
  6. 6.•
    Shaari CM, Sanders I, Wu BL, Biller HF. Rhinorrhea is decreased in dogs after nasal application of botulinum toxin. Otolaryngol Head Neck Surg. 1995;112:566–71. This experimental study firstly showed the effect of BTX-A on nasal secretion.PubMedGoogle Scholar
  7. 7.
    Widdicombe JG. Neuroregulation of the nose and bronchi. Clin Exp Allergy. 1996;26 Suppl 3:32–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Ismi O, Ozcan C, Karabacak T, et al. Local of neurotrophin-3 in neuronal inflammation of allergic rhinitis: preliminary report. Balk Med J. 2015;32:364–70.CrossRefGoogle Scholar
  9. 9.
    Tai CF, Baraniuk JM. A tale of two neurons in the upper airways: pain versus itch. Curr Allergy Asthma Rep. 2003;3:215–20.CrossRefPubMedGoogle Scholar
  10. 10.
    Laing TA, Laing ME, O’Sullivan ST. Botulinum toxin for treatment of glandular hypersecretory disorders. J Plast Reconstr Aesthet Surg. 2008;61:1024–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Bentivoglio AR, Del Grande A, Perracca M, Ialonga T. Clinical differences between botulinum neurotoxin type A and B. Toxicon. 2015;107:77–84.CrossRefPubMedGoogle Scholar
  12. 12.
    Tighe AP, Schiavo G. Botulinum neurotoxins: mechanism of action. Toxicon. 2013;67:87–93.CrossRefPubMedGoogle Scholar
  13. 13.
    Naumann M, Jost W. Botulinum toxin treatment of secretory disorders. Mov Disord. 2004;19 suppl 8:137–41.CrossRefGoogle Scholar
  14. 14.
    Persaud R, Garas G, Silva S, Stamatoglou C, Chatrath P, Patel K. An evidence-based review of botulinum toxin (Botox) applications in non-cosmetic head and neck conditions. J R Soc Med Sh Rep. 2013;4:10.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Naumann M, Dressler D, Hallett M, et al. Evidence-based review and assessment of botulinum neurotoxin for the treatment of secretory disorders. Toxicon. 2013;67:141–52.CrossRefPubMedGoogle Scholar
  16. 16.
    Laskawi R. The use of botulinum toxin in head and face medicine: an interdisciplinary field. Head Face Med. 2008;4:5.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Wen WD, Yuan F, Wang JL, Hou YP. Botulinum toxin therapy in the ovalbumin-sensitized rat. Neuroimmunomodulation. 2007;14:78–83.CrossRefPubMedGoogle Scholar
  18. 18.
    Kim KS, Kim SS, Yoon JH, Han JW. The effect of botulinum toxin type A injection for intrinsic rhinitis. J Laryngol Otol. 1998;112:248–51.CrossRefPubMedGoogle Scholar
  19. 19.
    Dykewicz MS, Hamilos DL. Rhinitis and sinusitis. J Allergy Clin Immunol. 2010;125:103–15.CrossRefGoogle Scholar
  20. 20.
    Aoishi K, Takahashi H, Hato N, et al. Treatment of allergic rhinitis with intranasal infusion of botulinum toxin type A in mice. 2016; 147:132-6.Google Scholar
  21. 21.•
    Rohrbach S, Olthoff A, Laskawi R, Giefer B, Götz W. Botulinum toxin type A induces apoptosis in glands of guinea pigs. Ann Otol Rhinol Laryngol. 2001;110:1045–50. This experimental study is the first study showing histological changes especially apoptosis of nasal glands after intranasal botulinum toxin application.CrossRefPubMedGoogle Scholar
  22. 22.
    Gunes MS, Kulahli I, Kokoglu K, et al. Evaluation of the effect of intranasal infiltrated botulinum toxin-A on a model of allergic rhinitis in rabbits: an experimental study. Int J Pediatr Otorhinolaryngol. 2016;83:51–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Zhu Z, Stone HF, Thach TQ, Garcia L, Ruegg CL. A novel botulinum neurotoxin topical gel: treatment of allergic rhinitis in rats and comparative safety profile. Am J Rhinol Allergy. 2012;26:450–4.CrossRefPubMedGoogle Scholar
  24. 24.
    Rohrbach S, Laskawi R. Minimally invasive application of Botulinum toxin type A in nasal hypersecretion. ORL J Otorhinolaryngol Relat Spec. 2001;63:382–4.CrossRefPubMedGoogle Scholar
  25. 25.•
    Unal M, Sevim S, Dogu O, Vayisoglu Y, Kanik Y. Effect of botulinum toxin type A on nasal symptoms in patients with allergic rhinitis: a double-blind, placebo-controlled clinical trial. Acta Otolaryngol. 2003;123:1060–3. This report firstly showed the effect of intraturbinal injection of BTX-A in allergic rhinitis patients.CrossRefPubMedGoogle Scholar
  26. 26.
    Wang J, Chen F, Meng M, Zhang X, Chen Y, Huang W, et al. The influence of botulinum toxin type A on vasomotor rhinitis and morphological study. [Article in Chinese]. Lin Chuang Er Bi Yan Hou Ke Za Zhi. 2003;17:643–5.PubMedGoogle Scholar
  27. 27.
    Yang TY, Jung YG, Kim YH, Jang TY. A comparison of the effects of botulinum toxin A and steroid injection on nasal allergy. Otolaryngol Head Neck Surg. 2008;139:367–71.CrossRefPubMedGoogle Scholar
  28. 28.
    Sapci T, Yazici S, Evcimik MF, et al. Investigation of the effects of intranasal botulinum toxin type A and ipratropium bromide nasal spray on nasal hypersecretion in idiopathic rhinitis without eosinophilia. Rhinology. 2008;46:45–51.PubMedGoogle Scholar
  29. 29.
    Nowak K, Szyfter W. Application of botulinum toxin A in chronic intrinsic rhinitis. [Article in Polish]. Otolaryngol Pol. 2011;65:103–5.CrossRefPubMedGoogle Scholar
  30. 30.•
    Braun T, Gürkov R, Kramer MF, Krause E. Septal injection of botulinum neurotoxin A for idiopathic rhinitis: a pilot study. Am J Otolaryngol. 2012;33:64–7. This article showed the effect of nasal septal BTX-A injection in idiopathic rhinitis patients.CrossRefPubMedGoogle Scholar
  31. 31.
    Abtahi SM, Hashemi SM, Abtahi SM, Bastani B. Septal injection in comparison with inferior turbinates injection of botulinum toxin A in patients with allergic rhinitis. J Res Med Sci. 2013;18:400–4.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Hashemi SM, Okhovat A, Amini S, Pourghasemian M. Comparing the effects of botulinum toxin-A and cetirizine on the treatment of allergic rhinitis. Allergol Int. 2013;62:245–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Shemshadi H, Azimian M, Kamrani AAK, Onsori MA. Botulinum toxin type A on an intranasal sponge for chronic allergic rhinitis: randomized clinical trial. Iran Rehabil J. 2013;11:5–11.Google Scholar
  34. 34.
    Mozafarinia K, Abna M, Khanjani N. Effect of botulinum neurotoxin A injection into the submucoperichondrium of the nasal septum in reducing idiopathic non-allergic rhinitis and persistent allergic rhinitis. Iran J Otorhinolaryngol. 2015;27:253–9.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Pattanaik D, Lieberman P. Vasomotor rhinitis. Curr Allergy Asthma Rep. 2010;10:84–91.CrossRefPubMedGoogle Scholar
  36. 36.
    Vayisoglu Y, Ozcan C, Pekdemir H, Gorur K, Pata YS, Camsari A. Autonomic nervous system evaluation using heart rate variability parameters in vasomotor rhinitis patients. J Otolaryngol. 2006;35:338–42.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology, School of MedicineMersin UniversityMersinTurkey

Personalised recommendations