Targeting the pathophysiology of chronic rhinosinusitis with systemic enzyme therapy: a narrative review

• Published in: International Journal of Otorhinolaryngology and Head and Neck Surgery Vol. 8; no. 7; p. 621
• Main Authors: Srivastava, Amrita, Shukla, Vijay, Daftary, Gautam V.
• Format: Journal Article
• Language: English
• Published: 24.06.2022
• ISSN: 2454-5929; 2454-5937
• DOI: 10.18203/issn.2454-5929.ijohns20221569

Chronic rhinosinusitis (CRS) is a prevalent condition with significant impact on quality of life and increases the economic burden. Medical treatment modalities for CRS are limited. Most of the drugs, currently in use, target mainly the symptomatology, rather than the pathophysiology of CRS. As more and more information become available, there is better understanding of the underlying mechanisms leading to CRS pathology. This also allows us to identify targets for therapy. The enzyme-flavonoid combination of trypsin-bromelain-rutoside appears to have multiple relevant mechanisms of action to counter some of the known major pathophysiological pathways in CRS. Taken together, the anti-inflammatory, anti-edema, fibrinolytic, vasoprotective and antioxidant actions of the combination can be beneficial in the management of CRS. The literature evidence of these mechanisms, few relevant clinical studies and their potential to benefit CRS therapy has been discussed in this narrative review.