Capsaicin may be a treatment option for patients with idiopathic non-allergic rhinitis, concluded study authors from the Cochrane Ears, Nose and Throat Group. 

Symptoms of non-allergic rhinitis include nasal congestion, blockage or obstruction, clear rhinorrhea, sneezing, and sometime nasal itching that can be debilitating. Current treatments include oral or topical nasal antihistamines, intranasal or systemic (rare) corticosteroids, and anticholinergics. Researchers set out to compare the efficacy of capsaicin, an active component of chili peppers, vs. no therapy, placebo, or other topical or systemic medications, or ≥2 combination therapies, or different capsaicin regimens, in the management of non-allergic rhinitis

The team included randomized controlled trials in adults with on-allergic rhinitis by searching the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials; PubMed and additional sources. Four studies were included in the analysis (n=302) that evaluated adults with moderately severe, idiopathic non-allergic rhinitis between the ages of 16–65. 

One study that compared capsaicin vs. placebo showed that capsaicin led to an improvement of overall nasal symptoms measured on a visual analog scale (VAS). A mean difference of -3.34 (9% CI: -5.24 to -1.44), -3.73 (95% CI: -5.45 to -2.01) and -3.52 (95% CI: -5.55 to -1.48) were seen at 2, 12, and 36 weeks after treatment, respectively. Another study showed capsaicin was more likely to resolve overall symptoms at 4 weeks after treatment vs. placebo (RR 3.17, 95% CI: 1.38 to 7.29).

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A study that compared capsaicin vs. budesonide showed that capsaicin led to better overall symptom score vs. budesonide (2.50, 95%CI: 1.06-3.94); no differences in the individual symptom scores (headache, postnasal drip, rhinorrhea, nasal blockage, sneezing, sore throat) were seen during the final 3 days of a 4-week treatment. When comparing two different capsaicin regimens (5 treatments/day vs. 5 treatments every 2–3 days for 2 weeks), significant improvement in symptom scores for rhinorrhea were seen in patients treated 5 times/day; no improvements in other outcomes (rhinorrhea, nasal obstruction, sneezing, overall nasal symptoms) were seen. The final study, which compared three doses of capsaicin vs. placebo, showed the 1mcg/puff dose of capsaicin had a worse daily record chart overall symptom score resolution than the 4mcg/puff (RR 0.63, 95% CI: 0.34 to 1.16).

Study findings suggest capsaicin seems beneficial for overall nasal symptoms up to 36 weeks post-treatment. More robust randomized-controlled trials are needed to further understand the efficacy of capsaicin in non-allergic rhinitis of different types and severity.

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