Nasal Nourishment: Xylitol’s Extra Kick in Fighting Sniffles

Written by:

Diordan Glenn R. De Lemos, MD, DPSMID

The potential for respiratory viruses to create pandemics, like the 1918 Spanish flu, the 2019 Coronavirus illness, and most recently the Respiratory Syncytial Virus (RSV) in pediatric populations, has drawn a lot of attention to their emergence. According to data released by the Department of Health (DOH), there were 151,375 occurrences of influenza-like illness (ILI), also known as the flu, nationwide between October 9 and October 13 of this year. By comparison, this is a 45% rise from the same time previous year. September was the start of the surge, with 26% more ILI instances than the same month the previous year. In a statement issued on October 18, the DOH stated, "The higher number of cases in 2023 compared to the previous year is observed in most diseases under surveillance, which could be attributed to the efforts to strengthen surveillance for other diseases as we shift our focus from COVID-19."

The flu brought about by SARS- COV-2 virus, Influenza virus and Respiratory Syncytial Virus (RSV) are highly contagious that spread easily into the environment. Important to note is the possibility for a person to be infected with multiple viruses at the same time. People who cough or sneeze with the virus might easily spread the illness to others. Airborne contaminants can cause irritation of the nasal mucosa, which can impair nasal function and cause symptoms including congestion, colds, and sneezing. In addition to increasing risk of infection or allergic reaction, the inability to eliminate unpleasant stimuli from the upper respiratory system has been related to long-term, chronic lung and other organ problems. Therefore, it is important to keep the nose functioning effectively to control diseases of the lungs and support overall health.

One study conducted by Santoro et al. mentioned the benefits of using saline nasal drops and nasal spray. Nasal sprays containing sodium chloride alone, 2 sprays in each nostril 3-4 times daily or as needed, are currently recommended as an adjunct therapy for post nasal drip, sinonasal diseases, such as rhinosinusitis, acute rhinitis, and upper respiratory tract infections including pharyngitis, tonsillitis, and laryngitis. Evidence suggests that nasal sprays effectively reach the nasal cavity; this is important when targeting the nasal mucosa. On the other hand, a little amount of saline (less than 5 mL per nostril) 2 - 4 drops 3 to 4 times daily that deliver a thin mist or jet of saline into the nose, are frequently recommended for use with young children. Saline nasal irrigation may improve nasal mucosa function through several physiologic effects, including directcleansing; removal of inflammatory mediators; and improved mucociliary function. Nasal saline sprays are easy to use, convenient, and acceptable, all of which are likely to increase compliance.

Regular saline has been the most commonly used nasal irrigation solution up to this point. The literature compares a wide range of nasal irrigation treatments with different ingredients including xylitol-containing solutions. Changes in the amounts of salt in the airway surface liquid (ASL) have an effect on antimicrobial factors. Reduced ASL salt concentration increases the bactericidal action of xylitol. Furthermore, it prevents the formation of crust by lowering mucus viscosity due to its a moisturizing activity.

According to scientific research, the addition of a simple adjunctive substance such as xylitol in nasal drops were found to be very useful. Xylitol, a naturally occurring compound, is a 5-carbon sugar alcohol under alditol class. Application of nasal drops composed of saline and xylitol, 2 to 4 drops in each nostril 3 to 4 times daily, reduces congestion, thins secretions, moisturizes, and washes away allergens and irritants. Xylitol has been demonstrated to have significant impacts on microbiota and immunological modulation, in addition to its antibacterial and anti-inflammatory qualities, making it an excellent treatment for chronic rhinitis. Moreover, xylitol in a saline solution serves as a supportive therapy to prevents nasopharyngeal congestion, irritation, and inflammation as well as sinusitis and otitis media.

The benefits of xylitol-containing nasal drops are increasing including its use for healthcare professionals who are required to wear an N95 respirators, as it helps ease nasal airway irritation and facilitates breathing. Patients diagnosed with mild obstructive sleep apnea can also potentially benefit from using xylitol, either on alone or in conjunction with a continuous positive airway pressure (CPAP) machine. Patients who also underwent endoscopic sinus surgery (ESS) for chronic rhinosinusitis with or without nasal polyps are present, nasal irrigation is advised, to eliminate infectious debris and crusts, hasten mucosal healing, enhance sinonasal drainage, and improve mucociliary clearance.

Interestingly, it has recently been demonstrated that xylitol deactivates SARS-CoV-2, the virus that can cause COVID-19 infection, according to research by Cannon et al. In patients who have recovered from COVID-19, use of xylitol may be crucial in preventing long-lasting nasal or even taste problems.

As an Infectious Disease Specialist, I prefer the use of saline nasal sprays or drops for mild and acute upper respiratory tract infections while combination of saline and xylitol nasal drops are more beneficial to patients with acute and chronic sinonasal infections to alleviate nasal stuffiness, decongest sinuses, and reduce tissue swelling from pollen, pollution, contaminants, and other irritants crusting in dry climates. Overall, the immune system is effectively stimulated and modulated by both nasal products, which improves quality of life.


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