Is Sinupret (herbal supplement) effective for treating allergies in patients with allergic rhinitis?

Is Sinupret Effective for Allergies?

Sinupret is NOT recommended for treating allergic rhinitis, as there is no evidence supporting its use for this indication; it is studied only for rhinosinusitis (sinus infections), not allergies. 1, 2, 3

Why Sinupret Should Not Be Used for Allergies

The 2015 American Academy of Otolaryngology-Head and Neck Surgery clinical practice guideline explicitly states that no recommendation is provided regarding the use of herbal therapy for patients with allergic rhinitis due to lack of evidence. 1

• Major international guidelines on allergic rhinitis treatment (2007-2017) make no mention of Sinupret as a treatment option for allergies 1
• Sinupret's evidence base is exclusively for rhinosinusitis (acute and chronic sinus infections), not allergic rhinitis 2, 4
• Even for rhinosinusitis, the evidence is limited: a large 929-patient trial failed to meet its primary endpoint, with benefits only seen in post-hoc subgroup analysis 2, 4

What Actually Works for Allergic Rhinitis

Intranasal corticosteroids are the most effective first-line treatment for moderate to severe allergic rhinitis. 1, 3, 5

First-Line Treatment Algorithm:

• Start with intranasal corticosteroid (e.g., fluticasone, mometasone) used daily and continuously, not intermittently 3, 5
• Direct spray away from nasal septum to prevent irritation and bleeding 5
• Evaluate response after 2-4 weeks of continuous use 5

If Inadequate Response After 2-4 Weeks:

• Add intranasal antihistamine (azelastine) to the intranasal corticosteroid for moderate to severe symptoms 1, 3
• This combination provides 37.9% symptom reduction versus 29.1% for intranasal corticosteroid alone 1, 5
• The 2017 Joint Task Force on Practice Parameters specifically recommends this combination for initial treatment of moderate to severe seasonal allergic rhinitis in patients ≥12 years 1

Alternative or Additional Options:

• Second-generation oral antihistamines (cetirizine, fexofenadine, loratadine) are less effective than intranasal corticosteroids but useful for mild symptoms 3
• Intranasal anticholinergics (ipratropium) specifically target rhinorrhea when combined with intranasal corticosteroids 3, 5
• Leukotriene receptor antagonists (montelukast) are less effective than intranasal corticosteroids and should not be used as primary therapy 1, 3

Critical Pitfalls to Avoid

• Never use intranasal decongestants for more than 3 days - risk of rhinitis medicamentosa (rebound congestion) 3, 5
• Never use oral corticosteroids routinely - contraindicated due to long-term systemic adverse effects 3, 5
• Do not add oral antihistamines to intranasal corticosteroids - multiple trials show no additional benefit 3
• Do not use intranasal corticosteroids intermittently - they require daily continuous use for optimal efficacy 5

When to Consider Immunotherapy

Refer to allergist for immunotherapy (subcutaneous or sublingual) if inadequate response to pharmacotherapy after 2-4 weeks of optimal treatment. 1, 3, 5

• Immunotherapy is the only treatment that modifies the natural history of allergic rhinitis 3, 5
• It can prevent new allergen sensitizations and reduce risk of developing asthma 3, 5
• Benefits may persist years after discontinuation 3