CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol
DOI: 10.1055/s-0042-1758219
Original Article

Glycyrrhizin and Mannitol Nasal Therapy: Cytological and Clinical Outcomes in Chronic Rhinitis

1   Otolaryngology University Unit, “S.M. Goretti Hospital”, Latina, Italy
2   Department of Sensorial Organs, ENT Section, “Sapienza” University of Rome, Rome, Italy
1   Otolaryngology University Unit, “S.M. Goretti Hospital”, Latina, Italy
3   Department of Adult and Development Age Human Pathology “Gaetano Barresi”, Otorhinolaryngology Unit, Messina, Italy
4   Otorhinolaryngology Unit, Pediatric Hospital “Bambino Gesù”, Roma, Italy
2   Department of Sensorial Organs, ENT Section, “Sapienza” University of Rome, Rome, Italy
2   Department of Sensorial Organs, ENT Section, “Sapienza” University of Rome, Rome, Italy
2   Department of Sensorial Organs, ENT Section, “Sapienza” University of Rome, Rome, Italy
› Author Affiliations
Funding The present study did not receive any funding from either private, public, or not-for-profit organizations.


Introduction Chronic rhinitis (CR) represents a widespread inflammation with a high incidence in the general population. Although it is generally considered a benign condition, CR has a relevant impact on quality of life and requires a specific treatment approach.

Objective The aim of the present study was to investigate the efficacy of glycyrrhizin and mannitol intranasal treatment on chronic rhinitis using cytological analysis and subjective evaluation of symptoms.

Methods A total of 55 patients suffering from chronic rhinitis were enrolled in the present study, 34 with allergic rhinitis (AR) and 21 with nonallergic rhinitis (NAR). The severity of four different nasal symptoms was determined by using a visual analogue scale (VAS). Specimens obtained by nasal scraping were collected for cytological analysis. Data were acquired before and after a 30-day treatment with glycyrrhizin and mannitol nasal spray. Statistical analyses were performed.

Results The VAS scores for all four nasal symptoms considered in the present study, as well as for neutrophil cells, reduced significantly after therapy in both allergic and nonallergic patients. The number of eosinophils was not significantly lower in nonallergic patients.

Conclusion A 30-day topical treatment with glycyrrhizin and mannitol may improve nasal symptoms and reduce inflammatory cells in the nasal mucosa in patients with chronic rhinitis without significant contraindications. Further studies could support our results and would better clarify all the aspects of this treatment.

Publication History

Received: 18 May 2022

Accepted: 19 July 2022

Article published online:
03 March 2023

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  • References

  • 1 Meltzer EO. Allergic Rhinitis: Burden of Illness, Quality of Life, Comorbidities, and Control. Immunol Allergy Clin North Am 2016; 36 (02) 235-248
  • 2 Gelardi M, Maselli Del Giudice A, Fiorella ML. et al. Quality of life in non-allergic rhinitis depends on the predominant inflammatory cell type. J Biol Regul Homeost Agents 2008; 22 (01) 73-81
  • 3 Gelardi M, Iannuzzi L, Tafuri S, Passalacqua G, Quaranta N. Allergic and non-allergic rhinitis: relationship with nasal polyposis, asthma and family history. Acta Otorhinolaryngol Ital 2014; 34 (01) 36-41
  • 4 Segboer C, Gevorgyan A, Avdeeva K. et al. Intranasal corticosteroids for non-allergic rhinitis. Cochrane Database Syst Rev 2019; Nov 2; 2019: CD010592
  • 5 Juel-Berg N, Darling P, Bolvig J. et al. Intranasal corticosteroids compared with oral antihistamines in allergic rhinitis: A systematic review and meta-analysis. Am J Rhinol Allergy 2017; 31 (01) 19-28
  • 6 Mansi N, D'Agostino G, Scirè AS. et al. Allergic Rhinitis in Children: A Randomized Clinical Trial Targeted at Symptoms. Indian J Otolaryngol Head Neck Surg 2014; 66 (04) 386-393
  • 7 Gelardi M, Fiorella ML, Russo C, Fiorella R, Ciprandi G. Role of nasal cytology. Int J Immunopathol Pharmacol 2010; 23 (1, Suppl) 45-49
  • 8 Wallace DV, Dykewicz MS, Bernstein DI. et al; Joint Task Force on Practice, American Academy of Allergy, Asthma & Immunology, American College of Allergy, Asthma and Immunology, Joint Council of Allergy, Asthma and Immunology. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol 2008; 122 (2, Suppl) S1-S84
  • 9 Heinzerling L, Mari A, Bergmann KC. et al. The skin prick test - European standards. Clin Transl Allergy 2013; 3 (01) 3
  • 10 Klimek L, Bergmann KC, Biedermann T. et al. Visual analogue scales (VAS): Measuring instruments for the documentation of symptoms and therapy monitoring in cases of allergic rhinitis in everyday health care: Position Paper of the German Society of Allergology (AeDA) and the German Society of Allergy and Clinical Immunology (DGAKI), ENT Section, in collaboration with the working group on Clinical Immunology, Allergology and Environmental Medicine of the German Society of Otorhinolaryngology, Head and Neck Surgery (DGHNOKHC). Allergo J Int 2017; 26 (01) 16-24
  • 11 Gelardi M, Iannuzzi L, Quaranta N, Landi M, Passalacqua G. NASAL cytology: practical aspects and clinical relevance. Clin Exp Allergy 2016; 46 (06) 785-792
  • 12 Bellussi LM, Cocca S, Chen L, Passali FM, Sarafoleanu C, Passali D. Rhinosinusal Inflammation and High Mobility Group Box 1 Protein: A New Target for Therapy. ORL J Otorhinolaryngol Relat Spec 2016; 78 (02) 77-85
  • 13 Chen D, Bellussi LM, Cocca S. et al. Glycyrrhetinic acid suppressed hmgb1 release by up-regulation of Sirt6 in nasal inflammation. J Biol Regul Homeost Agents 2017; 31 (02) 269-277
  • 14 Cavone L, Cuppari C, Manti S. et al. Increase in the Level of Proinflammatory Cytokine HMGB1 in Nasal Fluids of Patients With Rhinitis and its Sequestration by Glycyrrhizin Induces Eosinophil Cell Death. Clin Exp Otorhinolaryngol 2015; 8 (02) 123-128
  • 15 Salpietro C, Cuppari C, Grasso L. et al. Nasal high-mobility group box-1 protein in children with allergic rhinitis. Int Arch Allergy Immunol 2013; 161 (02) 116-121
  • 16 Passali D, Cappello C, Passali GC, Cingi C, Sarafoleanu C, Bellussi LM. Nasal Muco-ciliary transport time alteration: efficacy of 18 B Glycyrrhetinic acid. Multidiscip Respir Med 2017; 12: 29
  • 17 Passali D, Bellussi LM, Gregori D, Lauriello M, Passali FM, Passali GC. Gip Stop Study Group. Nasal obstruction as a key symptom in allergic rhinitis: efficacy and safety of a medical device in children. Otolaryngol Pol 2012; 66 (04) 249-253
  • 18 Rosato C, Pagliuca G, Martellucci S. et al. Effect of Radiofrequency Thermal Ablation Treatment on Nasal Ciliary Motility: A Study with Phase-Contrast Microscopy. Otolaryngol Head Neck Surg 2016; 154 (04) 754-758
  • 19 Gelardi M, Incorvaia C, Fiorella ML. et al; Italian Academy of Nasal Cytology. The clinical stage of allergic rhinitis is correlated to inflammation as detected by nasal cytology. Inflamm Allergy Drug Targets 2011; 10 (06) 472-476
  • 20 Ciprandi G, Gelardi M. Trattamento delle riniti allergiche e vasomotorie: il ruolo del beclometasone dipropionato e dell'acido ialuronico (ad alto peso molecolare) [Treatment of allergic and vasomotor rhinitis: the role of beclomethasone dipropionate and hyaluronic acid (with high molecular weight)]. Recenti Prog Med 2018 Apr;109(4):257e–265e. Italian
  • 21 Ciofalo A, Zambetti G, Altissimi G. et al. Pathological and cytological changes of the nasal mucosa in acute rhinosinusitis: the role of hyaluronic acid as supportive therapy. Eur Rev Med Pharmacol Sci 2017; 21 (19) 4411-4418
  • 22 Gelardi M, Taliente S, Fiorella ML. et al. Ancillary therapy of intranasal T-LysYal® for patients with allergic, non-allergic, and mixed rhinitis. J Biol Regul Homeost Agents 2016; 30 (01) 255-262
  • 23 Wu EL, Harris WC, Babcock CM, Alexander BH, Riley CA, McCoul ED. Epistaxis Risk Associated with Intranasal Corticosteroid Sprays: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2019; 161 (01) 18-27
  • 24 Bellussi LM, Cocca S, Passali GC, Passali D. HMGB1 in the Pathogenesis of Nasal Inflammatory Diseases and its Inhibition as New Therapeutic Approach: A Review from the Literature. Int Arch Otorhinolaryngol 2017; 21 (04) 390-398
  • 25 Damiani V, Camaioni A, Viti C, Scirè AS, Morpurgo G, Gregori D. A single-centre, before-after study of the short- and long-term efficacy of Narivent(®) in the treatment of nasal congestion. J Int Med Res 2012; 40 (05) 1931-1941
  • 26 Gelardi M, Cavaliere C, Jannuzzi L. Nasal cytology. J Biol Regul Homeost Agents 2018; 32 (1, Suppl. 1) 37-40
  • 27 Pagliuca G, Rosato C, Martellucci S. et al. Cytologic and functional alterations of nasal mucosa in smokers: temporary or permanent damage?. Otolaryngol Head Neck Surg 2015; 152 (04) 740-745