Review Article

The Effectiveness of the Bacteria Derived Extremolyte Ectoine for the Treatment of Allergic Rhinitis

Table 1

Details on the selected studies. ACT: asthma control test; AE: adverse event; AR: allergic rhinitis; ASIT: allergen-specific immunotherapy; IAR: intermittent allergic rhinitis; INS: intranasal steroids; SAE: serious adverse event; TNNSS: total nonnasal symptom score; TNSS: total nasal symptom score; TOSS: total ocular symptom score.

Authors, year, study location [reference]Indication of studyComparatorStudy design of patients (total and by groups)Patient population, age (years) of participantsInclusion criteria/exclusion criteria (only AR-specific criteria listed)Treatment duration, dosage, and number of visitsOutcome parametersReported side effectsJadad scale (criteria)

Minaeva and Shiryaeva, 2015, Russia [50]Allergic rhinitisOral antihistamineR, C, OLTotal: 50
: 30 antihistamine alone: 20
Children & adolescents
Age range: 3-17
Mean age: 10.6
Inclusion: diagnosis of seasonal AR, sensitization to tree pollen, received an antihistamine product
Exclusion: taking INS
21-day (3 weeks) treatment
Ectoine: 3-4 times daily
Antihistamine: age-appropriate dose
3 visits
Nasal congestion, rhinorrhea, itching, sneezingNo AE reported3 (A, B, E)
Abdulkerimov et al., 2016, Russia [46]Allergic rhinitisIntranasal glucocorticoidR, C, OLTotal: 90
Ectoine alone: 30
INS alone: 30
: 30
Adults
Age range: 18-65
Mean age: not assessed
Inclusion: diagnosed intermittent AR, during a period of exacerbation of symptoms, admissible accompanying pharmacotherapy
Exclusion: pregnant and nursing women, intolerance to one of the substances, usage of other antiallergy agents, nose surgery within 6 weeks before the study, signs of bacterial disease, flu, antibacterial treatment, stomatic disease
60-day treatment
Ectoine: 1-2 sprays 3 times a day
INS: 2 doses once a day
4 visits
Sneezing, itching, rhinorrhea, nasal congestion, dry mucosa, cough, fatigue, eosinophils, unpleasant smell in the rhinopharynx, rhinoscopy status, video endoscopic investigation status of the nasal cavity, cytological investigation status of the nasal secretionNo AE reported for the ectoine treatment, 4 patients from the INS-alone group reported increased dryness of the nasal mucosa2 (A, B)
Kayb et al., 2016, Russia [51]Allergic rhinitisAnti-inflammatory therapy (standard of care)C, OLTotal: 60
therapy: 30
Anti-inflammatory therapy alone: 30
Children & adolescents
Age range: 5-17
Mean age: not assessed
Inclusion: diagnosed seasonal allergic rhinitis,
Exclusion: AR flare-ups associated with an acute respiratory disease with increased body temperature, as well as children with an AR flare-up, atopic dermatitis, and bronchial asthma
28-day treatment (4 weeks)
Ectoine: as prescribed
Anti-inflammatory: as prescribed
4 visits
Rhinorrhea, paroxysmal sneezing, nasal congestion clinical manifestations of the flare-ups and the severity of AR in the courseNo AE reported1 (E)
Bardenikova et al., 2016, Russia [52]Allergic rhinitisINSOL, CTotal: 30
Ectoine: 17
: 13
Children & adolescents
Age range: 7-17
Mean age: 12.4
Inclusion: diagnosis of all year-round AR (mild and moderate severity) with clinically significant sensitization to house allergens. The patients were enrolled while experiencing exacerbation of persistent AR, with a total score for nasal symptoms (TNSS) of 2 points or more
Exclusion: seasonal exacerbations caused by associated pollinosis
21-day treatment
Ectoine: 2 doses per nostril, 3 times per day
INS: as prescribed
2 visits
TNSS, rhinoscopy status, rhinocytogram status, tolerability, compliance, adverse effects, blood test, cytomorphology (cell count), pediatric ACT, eosinophilic cytosis3 AEs were reported. 2 increased sneezing immediately following application of the spray; 1 short nasal bleeding during the administration1 (E)
Skosarev et al., 2015, Kazakhstan [53]Allergic rhinitisStandard of careOL, CTotal: 36
Ectoine: 18
Standard of care: 18
Children & adolescents
Age range: not assessed
Mean age: not assessed
Inclusion: children with diagnosis of AR10-day treatment
Ectoine: as prescribed
Standard of care: as prescribed
Itchiness, periodic sneezing, coughing, voice changes, night snoring, emotional profilesNo information given0
Salapatek et al., 2011, Canada [43] (manuscript accepted for publication)Allergic rhinoconjunctivitisPlaceboR, CTotal: 46
Ectoine: 46
Placebo: 46
Adults
Age range: 18-65
Mean age:
Inclusion: history of seasonal AR, positive skin prick test, ,
Exclusion: usage of antiallergic medication before study start and throughout the study
14-day treatment per treatment type crossover after 7 days washout
Ectoine: 1 spray/nostril 3 times per day
Placebo: 1 spray/nostril 3 times per day
5 visits
Primary: TNSS (including sneezing, itchy nose, runny nose and nasal congestion) and TOSS (including watery eye, itchy eye, red eye)
Secondary: TNNSS (including watery eye, itchy eye, red eye, and itchy ear/palate), and acoustic rhinometry measurements
6 AEs reported during ectoine treatment. During placebo treatment, 5 AEs were reported. No SAEs occurred5 (A-E)
Sonnemann et al., 2014, Germany [47]Allergic rhinitisBeclomethasoneOL, NI, CTotal: 50
Ectoine: 25
Beclomethasone: 25
Adults
Age range: 18-65
Mean age: 33.3
Inclusion: 18-70 years, diagnosed seasonal allergic rhinitis,
Exclusion: not described
14-day treatment
Ectoine: 3 times daily,
Beclomethasone (0.05 mg): 2 times daily,
2 visits
Primary: nasal obstruction, rhinorrhea, nasal itching, sneezing
Secondary: itchy ear/palate, efficacy, tolerability
3 AEs, 2 in the ectoine group (not related), 1 in the beclomethasone group (probably related)1 (E)
Werkhäuser et al., 2014, Germany [49]Allergic rhinitisAzelastineOL, NI, CTotal: 48
Ectoine: 22
Azelastine: 26
Adults
Age range:18-65
Mean age: 35
Inclusion: patients aged 18-70, proven allergy in prick test, acute symptoms in nose and eyes
Exclusion: pregnant and nursing women, drug addicts, patients with intolerance against ingredients of treatments, previous eye or nose surgery
7-day treatment
Ectoine: one eye drop per eye and one puff of the nasal spray per nostril four times per day
Azelastine: One eye drop, one puff nasal spray, both twice per day
2 visits
Nasal obstruction, rhinorrhea, sneezing nasal itching, conjunctivitis, eye itching, tearing, palate itching8 AEs: 2 cases of burning of eyes and itching of the throat in the ectoine group, and 6 (4 cases of burning of eyes, 1 case of nausea, and 1 case of headache) in the azelastine group1 (E)
No SAE occurred
Werkhäuser et al., 2014, Germany [49]Allergic rhinitisCromoglicic acidOL, NI, CTotal: 50
Ectoine: 25
Cromoglicic acid: 25
Adults
Age range: 18-65
Mean age: 35
Inclusion: patients aged 18-70, proven allergy in prick test, acute symptoms in the nose and eyes
Exclusion: pregnant and nursing women, drug addicts, patients with intolerance against ingredients of treatments, previous eye or nose surgery
14-day treatment crossover after 7 days
Ectoine: 5 times per day, cromoglicic acid (20 mg/ml): nasal spray 4 times per day
3 visits
Nasal obstruction, rhinorrhea, sneezing nasal itching, conjunctivitis, eye itching, tearing, palate itchingDuring the study, no SAE occurred1 (E)
No AEs were observed for ectoine containing nasal spray; 15 AEs were recorded for the cromoglicic acid nasal spray
Kryuchko et al., 2014, Ukraine [55]Allergic rhinitisSea salt solutionOL, NI, CTotal: 60
Ectoine: 38
Sea salt solution: 22
Children & adolescents
Age range: 6-14
Mean age: not assessed
Inclusion: sensitized to pollen allergens, sufficient compliance, patients applying antihistamines on demand
Exclusion: not described
14-day treatment
Ectoine: as prescribed
Control: as prescribed
5 visits
Activity, sleep, nasal symptoms, ocular symptoms, emotionsNo adverse effects reported0
Ryabova et al., 2019, Russia [54]Allergic rhinitisNoneOLTotal: 45
Group persistent allergic rhinitis: 25
Group intermittent allergic rhinitis: 20
Pregnant women
Age range: 18-40
Mean age:
Inclusion: pregnancy, proven case of AR at the time of examination, aged 18 to 40 years, presence of 2 or more typical signs of AR, bright-red mucosa in aggravated seasonal allergic rhinitis, cyanotic or gray mucosa in perennial allergic rhinitis, the mucosa spotting (“marbling”) (Voyachek’s symptom)
Exclusion: present infectious diseases, history of alcohol or drug abuse, problems that may limit the patient’s ability to follow the protocol requirements, participation in another clinical trial during the three months preceding the screening visit, any other conditions that make it difficult to participate in the study
All patients received 1-2 doses of ectoine 3-4 times a day or for 10 days before contact with allergensRhinoscopy status, laboratory tests, mucociliary clearanceNone reported1 (E)
Kamaev and Трусоbа, 2015, Russia [48]Allergic rhinitisNoneOLTotal: 50
: 22
: 28
Children & adolescents
Age range: not assessed
Mean age: not assessed
Inclusion: diagnosis of persistent AR, domestic or epidermal sensitization, exacerbation of the disease at the first visit
Exclusion criteria not described
4 weeks of treatment
Treatments as prescribed
3 visits
Rhinocytogram status, eosinophil count (laboratory test), result of the anterior rhinoscopy, result of the TNSSAEs reported during the study were resolved completely by days 8 to 15 of administration0
Mokronosova et al., 2017, Russia [45]Allergic rhinitisNoneOL, NITotal: 34
Ectoine: 34
Adults
Age range: 20-45
Mean age: not assessed
Inclusion: confirmed mono allergy to tree pollen, mild-moderate IAR, two courses of ASIT
Exclusion: severe IAR, noncompliance, nose surgery, use of antiallergic drugs
Max. 37-day treatment
Ectoine: 1-2 sprays 3-4 times daily (or as necessary)
2 visits
Nasal obstruction, sneezing, nasal itching, skin test, laboratory test with specific serum IgE antibodies, cytological analysis of nasal secretions, otorhinolaryngological examinationNo AE reported1 (E)
Mokronosova et al., 2019, Russia [44]Allergic rhinitisNoneOL, NITotal: 30
Ectoine: 30
Adults
Age range: 18-60
Mean age: not assessed
Inclusion: tree pollen sensitization confirmed positive test for IgE antibodies
Exclusion: severe IAR, noncompliance, nose surgery, use of antiallergic drug
7-day treatment
Ectoine: 1-2 sprays 3-4 times daily (or as necessary)
2 visits
Nasal obstruction, sneezing, nasal itching, skin test, laboratory test with specific serum IgE antibodies, cytological analysis of nasal secretions, otorhinolaryngological examinationNo AE reported0

Study design: randomized (R); controlled (C); open-label (OL); noninterventional (NI).