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Verapamil for rhinosinusitis?

Chronic rhinosinusitis with nasal polyps is among our most challenging diagnoses to treat, because these patients essentially have chronic, lifelong inflammation that needs chronic, lifelong treatment, says Benjamin Bleier, a sinus surgeon at the Massachusetts Eye and Ear Hospital and an assistant professor of otolaryngology at Harvard Medical School.

Some of the inflammation in chronic rhinosinusitis with nasal polyps seems to arise when the nasal lining overexpresses P-glycoprotein (a protein pump), leading to over-secretion of inflammatory cytokines. Verapamil blocks P-glycoprotein and, in some patients with chronic rhinosinusitis and nasal polyps, dramatically improves symptom scores, according to a new study.

While the study involving 18 patients is too small to confirm efficacy, the improvement in several outcome measures suggest that verapamil should be assessed further at a higher dose. “We observed no significant side-effects at the doses we used, and we were very encouraged by the results of this first step,” says Dr Bleier.

(J Allergy Clin Immunol DOI: 10.1016/j.jaci.2016.11.014)

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