Place of nasal decongestants in the treatment of acute infectious rhinosinusitis in children

A.E. Abaturov, E.A. Agafonova, L.L. Petrenko, V.L. Babich


Acute infectious rhinosinusitis is the most common clinical form of respiratory pathology in childhood. Despite the fact that in 90 % of cases the main etiological factor leading to the development of rhinosinusitis is viral infection, 13 % of them are complicated by bacterial inflammation. Acute respiratory di­seases with manifestations of rhinosinusitis constantly recurring in the child can lead to the formation of allergic, non-allergic rhinitis and chronic rhinosinusitis — multifactorial chronic inflammatory diseases of the upper respiratory tract. The pathogenesis of acute infectious rhinosinusitis, in spite of the abundance of data, has been underinvestigated. The article highlights the problem of acute infectious rhinosinusitis treatment in children from the standpoint of modern ideas about the development of inflammatory process in the nasal mucosa, the role of innate immunity, and the functioning of mucociliary clearance. Data on the clinical manifestations of acute infectious rhinosinusitis are presented, clinical and diagnostic criteria for its detection are given. The mechanisms of action of nasal decongestants are described, as well as the features of their use, the immunological and anti-inflammatory effects of these drugs. Attention is focused on the mechanisms of action of oxymetazoline. Recommendations for the use of oxymetazoline in pediatric practice are given.


children; acute respiratory diseases; rhinosinusitis; decongestants; oxymetazoline


Asmanov AI, Pivneva ND. Acute rhinitis in children: tactics of treatment and diagnosis. Praktika pediatra. 2017;(4):67-70. (in Russian).

Berdnikova NG. Decongestants: from proven means to improved combinations. RMJ. 2011;23(19):1446-1449. (in Russian).

Bereznyakov IG. Review of new North American recommendations on diagnosis and treatment of acute rhinosinusitis in children and adults. Bolezni i antibiotiki. 2012;(7):25-29. (in Russian).

Dobretsov KG. Acute rhinosinusitis in children. Voprosy Sovremennoi Pediatrii. 2015;14(1):155-157. (in Russian).

Karpova EP, Tulupov DA. Nasal vasoconstrictive drugs in pediatric practice. Effektivnaa farmakoterapia. 2012;(29):18-22. (in Russian).

Nosulya YeV, Kim IA, Vinnikov AK. Acute rhinitis: features of diagnosis and treatment in children. Pharmateca. 2012;(238):34-38. (in Russian).

Radzig EYu. Features of the course and treatment of acute rhinitis in infants and young children. RMJ. 2011; 22(19):1391-1394. (in Russian).

Tulupov DA. Acute rhinitis in children. Voprosy Sovremennoi Pediatrii. 2012;11(5):124-128. (in Russian).

Badr DT, Gaffin JM, Phipatanakul W. Pediatric Rhinosinusitis. Curr Treat Options Allergy. 2016 Sep;3(3):268-281. doi: 10.1007/s40521-016-0096-y.

Beck-Speier I, Oswald B, Maier KL, Karg E, Ramseger R. Oxymetazoline inhibits and resolves inflammatory reactions in human neutrophils. J Pharmacol Sci. 2009 Jul;110(3):276-84.

Beck-Speier I, Dayal N, Karg E, Karg E, Ramseger R. Oxymetazoline inhibits proinflammatory reactions: effect on arachidonic acid-derivedmetabolites. J Pharmacol Exp Ther. 2006 Feb;316(2):843-51. doi: 10.1124/jpet.105.093278.

Bjerknes R, Steinsvåg SK. Inhibition of human neutrophil actin polymerization, phagocytosis and oxidative burst by components of decongestive nose drops. Pharmacol Toxicol. 1993 Jul;73(1):41-5.

Brook I. Acute sinusitis in children. Pediatr Clin North Am. 2013 Apr;60(2):409-24. doi: 10.1016/j.pcl.2012.12.002.

Chandran SK, Higgins TS. Chapter 5: Pediatric rhinosinusitis: definitions, diagnosis and management--an overview. Am J Rhinol Allergy. 2013 May-Jun;27 Suppl 1:S16-9. doi: 10.2500/ajra.2013.27.3896.

Choksi SP, Babu D, Lau D, Yu X, Roy S. Systematic discovery of novel ciliary genes through functional genomics in the zebrafish. Development. 2014 Sep;141(17):3410-9. doi: 10.1242/dev.108209.

Chow AW, Benninger MS, Brook I et al. IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults. Clin Infect Dis. 2012 Apr;54(8):e72-e112. doi: 10.1093/cid/cir1043.

Deckx L, De Sutter AIM, Guo L, Mir NA, van Driel ML. Nasal decongestants in monotherapy for the common cold. Cochrane Database Syst Rev. 2016 Oct 17;10:CD009612.

Dykewicz MS, Hamilos DL. Rhinitis and sinusitis. J Allergy Clin Immunol. 2010 Feb;125(2 Suppl 2):S103-15. doi: 10.1016/j.jaci.2009.12.989.

Eskiizmir G, Hircin Z, Ozyurt B, Unlu H. A comparative analysis of the decongestive effect of oxymetazoline and xylometazoline in healthy subjects. Eur J Clin Pharmacol. 2011 Jan;67(1):19-23. doi: 10.1007/s00228-010-0941-z.

Esposito S, Marchisio P, Tenconi R, et al. Diagnosis of acute rhinosinusitis. Pediatr Allergy Immunol. 2012 Aug;23 Suppl 22:17-9. doi: 10.1111/j.1399-3038.2012.01319.x.

Fokkens WJ, Lund VJ, Mullol J et al. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. Rhinology. 2012 Mar;50(1):1-12. doi: 10.4193/Rhino50E2.

Inanli S, Oztürk O, Korkmaz M, Tutkun A, Batman C. The effects of topical agents of fluticasone propionate, oxymetazoline, and 3% and 0.9% sodium chloride solutions on mucociliary clearance in the therapy of acute bacterial rhinosinusitis in vivo. Laryngoscope. 2002 Feb;112(2):320-5. doi: 10.1097/00005537-200202000-00022.

Ji Y, Liu Y, Yang N. Pediatric rhinitis risk factors. Exp Ther Med. 2016 Oct;12(4):2383-2386.

Juhn YJ. Risks for infection in patients with asthma (or other atopic conditions): is asthma more than a chronic airway disease? J Allergy Clin Immunol. 2014 Aug;134(2):247-57; quiz 258-9. doi: 10.1016/j.jaci.2014.04.024.

Kurukulaaratchy RJ, Zhang H, Patil V, et al. Identifying the heterogeneity of young adult rhinitis through cluster analysis in the Isle of Wight birth cohort. J Allergy Clin Immunol. 2015 Jan;135(1):143-50. doi: 10.1016/j.jaci.2014.06.017.

Lee RJ, Chen B, Redding KM, Margolskee RF, Cohen NA. Mouse nasal epithelial innate immune responses to Pseudomonas aeruginosa quorum-sensing molecules require taste signaling components. Innate Immun. 2014 Aug;20(6):606-17. doi: 10.1177/1753425913503386.

Liu W, Zhou L, Zeng Q, Luo R. Combination of mometasone furoate and oxymetazoline for the treatment of adenoid hypertrophy concomitant with allergic rhinitis: A randomized controlled trial. Sci Rep. 2017 Jan 18;7:40425. doi: 10.1038/srep40425.

Mortuaire G, de Gabory L, François M, et al. Rebound congestion and rhinitis medicamentosa: nasal decongestants in clinical practice. Critical review of the literature by a medical panel. Eur Ann Otorhinolaryngol Head Neck Dis. 2013 Jun;130(3):137-44. doi: 10.1016/j.anorl.2012.09.005.

Nocon CC, Baroody FM. Acute rhinosinusitis in children. Curr Allergy Asthma Rep. 2014 Jun;14(6):443. doi: 10.1007/s11882-014-0443-7.

Passàli D, Salerni L, Passàli GC, Passàli FM, Bellussi L. Nasal decongestants in the treatment of chronic nasal obstruction: efficacy and safety of use. Expert Opin Drug Saf. 2006 Nov;5(6):783-90. doi: 10.1517/14740338.5.6.783.

Pritchard S, Glover M, Guthrie G, et al. Effectiveness of 0.05% oxymetazoline (Vicks Sinex Micromist(R)) nasal spray in the treatment of objective nasal congestion demonstrated to 12 h post-administration by magnetic resonance imaging. Pulm Pharmacol Ther. 2014 Feb;27(1):121-6. doi: 10.1016/j.pupt.2013.08.002.

Shaikh N, Wald ER, Pi M. Decongestants, antihistamines and nasal irrigation for acute sinusitis in children. Cochrane Database Syst Rev. 2012 Sep 12;(9):CD007909. doi: 10.1002/14651858.CD007909.pub3.

Snidvongs K, Thanaviratananich S. Update on Intranasal Medications in Rhinosinusitis. Curr Allergy Asthma Rep. 2017 Jul;17(7):47. doi: 10.1007/s11882-017-0720-3.

Tengroth L, Millrud CR, Kvarnhammar AM, Kumlien Georén S, Latif L, Cardell LO. Functional effects of Toll-like receptor (TLR)3, 7, 9, RIG-I and MDA-5 stimulation in nasal epithelial cells. PLoS One. 2014 Jun 2;9(6):e98239. doi: 10.1371/journal.pone.0098239.

Thongngarm T, Assanasen P, Pradubpongsa P, Tantilipikorn P. The effectiveness of oxymetazoline plus intranasal steroid in the treatment of chronic rhinitis: A randomised controlled trial. Asian Pac J Allergy Immunol. 2016 Mar;34(1):30-7. doi: 10.12932/AP0649.34.1.2016.

Toppila-Salmi S, van Drunen CM, Fokkens WJ, et al. Molecular mechanisms of nasal epithelium in rhinitis and rhinosinusitis. Curr Allergy Asthma Rep. 2015 Feb;15(2):495. doi: 10.1007/s11882-014-0495-8.

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