Abstract
Nonpharmacological therapies with a good tolerability and safety profile are of interest to many patients with allergic rhinitis, as a relevant proportion of them have reservations about guideline-concordant pharmacological therapies due to their local irritations and side effects. Ectoine is a bacterial-derived extremolyte with an ability to protect proteins and biological membranes against damage caused by extreme conditions of salinity, drought, irradiation, pH, and temperature. Evidence from preclinical and clinical studies attests its effectiveness in the treatment of several inflammatory diseases, including allergic rhinitis. In this review, we analyzed 14 recent clinical trials investigating ectoine nasal spray in patients with allergic rhinitis and/or conjunctivitis, including sensitive patient groups like children or pregnant women. Some studies investigated monotherapy with ectoine; others investigated combination therapy of ectoine and an antihistamine or a corticosteroid. Analysis of the study results demonstrated that patients with mild-to-moderate symptoms of allergic rhinitis can be successfully treated with ectoine-containing nasal spray. When applied as monotherapy, ectoine exerted noninferior effects compared to first-line therapies such as antihistamines and cromoglicic acid. Using ectoine as an add-on therapy to antihistamines or intranasal glucocorticosteroids accelerated symptom relief by days and improved the level of symptom relief. Importantly, concomitant treatment with ectoine was proven beneficial in a group of difficult-to-treat patients suffering from moderate-to-severe rhinitis symptoms. Taken together, the natural substance ectoine represents a viable alternative for allergic rhinitis and conjunctivitis patients who wish to avoid local reactions and side effects associated with pharmacological therapies.
Highlights
Ectoine is a natural extremolyte found in bacteria which grows under extreme conditions of salinity, drought, irradiation, pH, and temperature [1, 2]
Analysis of the study results demonstrated that patients with mild-to-moderate symptoms of allergic rhinitis can be successfully treated with ectoinecontaining nasal spray
All studies investigating a monotherapy with ectoine invariably attested positive effects of ectoine monotherapy in alleviating symptoms of allergic rhinitis
Summary
Ectoine is a natural extremolyte found in bacteria which grows under extreme conditions of salinity, drought, irradiation, pH, and temperature [1, 2]. Ectoine binds strongly to water molecules [3], thereby forming a protective hydrate shield around proteins and other biomolecules [4]. It works via a mechanism known as “preferential exclusion” [5]; i.e., it is preferentially excluded from the hydrate shield, leading to the alteration of the aqueous solvent structure [6, 7], which protects proteins from damage and irreversible denaturation and stabilizes biological membranes [3, 8,9,10]. Promising findings from clinical trials harnessed ectoine as a therapeutic agent for several inflammatory diseases such as atopic dermatitis [18], upper airway inflammations like pharyngitis/laryngitis [19, 20], rhinosinusitis and acute bronchitis [21] as reviewed by Casale and colleagues [22], rhinitis sicca [23], chemotherapy-induced mucositis [24], and lung inflammation caused by environmental pollutants [25], even in long-term applications in children to prevent upper respiratory infections [26] or treatment of vernal keratoconjunctivitis [27]
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