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Rhinorrhea and increased chloride secretion through the CFTR chloride channel-a systematic review

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Abstract

Purpose

Allergic and non-allergic rhinorrhea in the forms of acute or chronic rhinosinusitis can mean a watery nasal discharge that is disabling. Primary objective was to review the evidence supporting the hypothesis that rhinorrhea is due to increased chloride secretion through the CFTR chloride channel.

Methods

The structure of the evidence review followed the EQUATOR Reporting Guidelines. Databases searched from inception to February 2022 included Pubmed, EMBASE and the Cochrane library using keywords “Rhinorrhea”, “chloride”, “chloride channel”, “CFTR” and “randomized controlled trial”. Quality assessment was according to the Oxford Centre for Evidence-based Medicine.

Results

49 articles were included. They included randomized controlled trials out of which subsets of data with the outcome of rhinorrhea on 6038 participants were analysed and in vitro and animal studies. The review revealed that drugs, which activate CFTR are associated with rhinorrhea. Viruses, which cause rhinorrhea like rhinovirus were found to activate CFTR. The chloride concentration in nasal fluid showed an increase in patients with viral upper respiratory tract infection. Increased hydrostatic tissue pressure, which is an activator of CFTR was observed in allergic upper airway inflammation. In this condition exhaled breath condensate chlorine concentration was found to be significantly increased. Drugs, which can reduce CFTR function including steroids, anti-histamines, sympathomimetic and anticholinergic drugs reduced rhinorrhea in randomized controlled trials.

Conclusions

A model of CFTR activation-mediated rhinorrhea explains the effectiveness of anticholinergic, sympathomimetic, anti-histamine and steroid drugs in reducing rhinorrhea and opens up avenues for further improvement of treatment by already known specific CFTR inhibitors.

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Data availability is not applicable to this work.

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Acknowledgements

Evidence search: Rhinorrhea. Ms Janine Hall. (7th February 2023). LUTON, UK: Bedfordshire Hospitals Library and Knowledge Service

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  1. Paediatric Department, Luton and Dunstable University Hospital, Luton, LU40DZ, UK

    Michael Eisenhut

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Eisenhut, M. Rhinorrhea and increased chloride secretion through the CFTR chloride channel-a systematic review. Eur Arch Otorhinolaryngol 280, 4309–4318 (2023). https://doi.org/10.1007/s00405-023-08067-w

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