Thank you for your recent inquiry.
For your convenience, I have copied below a recent response to a similar question that was posted on our website in May 2008. As you can see from this previous posting, there has been no random controlled trials, there are no guidelines for administering a "sinus cocktail," and evidence supporting the use of "sinus cocktails" is sparse.
Thank you again for your inquiry, and we hope this response is helpful to you.
Question from May 2008:
I am a pharmacist that has tried to find the rationale for the use of "sinus cocktail shots". These cocktails generally consist of a combination of a steroid, an antihistamine and sometimes an antibiotic. Several family practice physicians in the community give these to patients with acute allergic rhinitis and I feel better prophylaxis is needed. Is there any clinical literature to support the use of these injections or does the AAAAI have a position on this topic?
Response from Dr. Lieberman, May 2008:
I am very familiar with the use of "the sinus cocktail" for the treatment of upper respiratory tract infections. There are 392,000 references to this on "Google," but no pertinent references found to this term through "PubMed" and The Journal of Allergy, Asthma & Clinical Immunology. This gives some indication as to the specific documentation of the role of "sinus cocktails" in the treatment of upper respiratory tract symptoms.
To my knowledge there are no studies investigating the efficacy of this practice, and no official position statement from the AAAAI in this regard.
As you know, each ingredient found in the "sinus cocktail injection" can be administered separately by mouth. I know of no study comparing these routes of administration.
Thus, in summary, there are no data of which I am aware dealing with this issue, and there is no official position statement that I could find from our professional organizations mentioning it.
However, to solicit another opinion in this regard, I have requested Dr. Eli Meltzer, who is an internationally known expert in diseases of the sinuses, to give us his thoughts on the issue. In the meantime, I am sending you this letter in lieu of receipt of his response. When I do hear from him, I will forward his response to you as well.
Thank you again for your inquiry, and I hope this response has been of help to you.
Phil Lieberman, MD
Response from Dr. Meltzer, May 2008:
The tune you are singing is very familiar.
We, too, in clinical practice, frequently see the preschool, often in day care child, with what we diagnose as chronic rhinosinusitis. The symptoms include nasal congestion, rhinorrhea, often of a discolored mucoid quality, and a moist cough. The child usually presents from late September through the end of March, with the late spring and summer a period of lessening problems.
Evaluations for Cystic Fibrosis, immune deficiency and ciliary abnormalities are typically WNL. Microbiological and cytological specimens are sometimes indicative of a specific pathogen or underlying allergic disease but more often also unremarkable. Imaging by X Ray (by Waters View) is confusing because of overlying structures and to get a CT in the young child usually requires anesthesia and, therefore, is often not obtained. Without a history of snoring or middle ear disease it is unlikely the adenoids are involved as the pathogenic source
Typical treatments include saline lavage (sometime helpful if the child will accept it), short courses of antibiotics (variably helpful and need to be individualized) chronic low dose antibiotics (variably helpful and need to be individualized) a short oral course of prednisone (a medical adenoidectomy) if the adenoids are prominent (however, without a history of snoring or middle ear disease it is unlikely the adenoids are involved as the pathogenic source) and a lot of TLC. A surgical adenoidectomy without the previously mentioned issues rarely is beneficial. Removing the child from the source of the infections (day care) can be the best "medicine."
Reassurances that the child will, in all likelihood, cease and desist from this pattern as they age and through the summer are important. I also certainly agree with you that monitoring for other comorbidities, and general well being, and growth and development are necessary but interventions that have more risk than benefit (e.g., sinus surgery) are definitely unnecessary.
Eli O. Meltzer, MD
Allergy and Asthma Medical Group and Research Center
Phil Lieberman, M.D.