Published in the _San Jose Mercury News_, March 16 2004

http://www.mercurynews.com/mld/mercurynews/living/health/8197610.htm

TREATING THE NOSE
MANY RINSING AWAY SYMPTOMS OF SPRING WITH NASAL WASHES

By April Lynch
Mercury News

Spring flowers mean pollen -- and, for a growing number of allergy
sufferers, a good spring cleaning for their noses.

Allergy patients, long used to popping pills or getting shots, are
also turning to nasal cleansers to ease their misery as this spring's
allergy season flares. These washes, whether squirted, snorted or
poured from something that resembles a teapot, can rinse
allergy-fueling pollen out of the nose and reduce allergy symptoms.

The idea, derived from traditional medicine from India and popular
with alternative health practitioners, is becoming an important part
of overall respiratory care. Numerous medical studies have found
lightly salted nasal rinses to be beneficial. Doctors ranging from
sinus surgeons to allergy specialists are recommending nasal washes --
often simple blends of salt, water and baking soda -- to patients.

Conventional and natural drugstores, building on the treatments'
popularity, are selling nose washes infused with everything from
sugars to herbs. Some patients, believing simpler is better, are
crafting their own rinses at home.

``It's really helpful,'' said Ellen DiNucci, 49, who is already in the
throes of spring sneezing and uses a homemade nasal wash that she
blends in her Belmont kitchen. Both she and her husband, mortgage
lending executive Mark Smith, rely on the wash during the spring
allergy season.

DiNucci works in both the worlds of conventional science and
alternative medicine, and relies on each for allergy relief. She is a
research coordinator at Stanford University's School of Medicine. She
also has a private health practice in which she helps cancer patients
and others using techniques such as relaxation and meditation.

For her allergies, she also uses over-the-counter pills and treatments
such as occasional acupuncture. But they don't stop her from reaching
for her bottle of nasal wash two to three times a day. ``It really
clears things up,'' she said. ``It just kind of speeds the healing
process.''

Nose washes, which can also help other nasal conditions such as the
flu or chronic sinus problems, won't cure all allergy problems,
especially for people with severe allergies or asthma.

Nor have the washes displaced traditional allergy drugs. It's unclear
at this point how big a piece of the allergy medicine market belongs
to nasal washes, as many of the companies that make such products are
small, privately held firms that don't release sales
figures. Americans spend more than $4 billion on allergy care a year,
according to industry estimates, but much of that goes for medicines
such as antihistamines.

Physicians, however, say the washes have a place alongside other
treatments. For patients with less severe but persistent symptoms, who
have had sinus surgery or are looking for ways to take less
medication, doctors say the washes can help.

`There's definitely been an increase in interest,'' said Dr. Andrew
Goldberg, a nose, sinus and throat specialist at the University of
California-San Francisco. ``There are people who swear by the use of
saline rinses for nasal hygiene. I have hundreds of patients who use
them.''

Nasal washing is also called nasal irrigation or lavage. By any name,
the practice can sound odd. Basic human breathing, after all, acts on
instincts of ``Air good, liquid bad.'' Water anywhere near the nose
usually means choking or coughing.

But the idea builds on one of the most basic concepts in medicine --
to help ailing tissues heal, soothe them and keep them clean.

Airborne pollens, dust and other allergens are inhaled as part of
breathing. In the nose, they can stick to the tiny hairs or tissue
that line the nasal passages. In people with seasonal allergies --
more than 10 percent of the U.S. population -- these allergens trigger
inflammation, with its accompanying swelling, sneezing and runny
mucus.

Flushing irritated nasal tissues with a mild wash, such as lightly
salted water, can reduce the inflammation. As the wash flows into the
nasal passages and drains back out, it removes irritants and
discharges with it. The rinses almost always contain salt -- plain
water can cause discomfort and pain inside the nose.

But how can anyone actually get liquid up there without choking? The
upper respiratory area, with its tubes and sinus cavities, is a bit of
a maze -- the two nostrils actually connect high at the back of the
nose, with other passages leading to the lungs or the back of the
throat.

In India, where practitioners of a traditional type of medicine called
ayurveda have long focused on preventing illness, healers figured out
how to clean this intricate system without aggravating it.

Ayurvedic healers developed a practice called jala neti, which relies
on an understanding of the nasal system and the body's fluid
balances. Lightly salted warm water, they found, matched the amount of
salt naturally found in the body's fluids and wouldn't further inflame
tissues. To get it into the nose, they created a device that looks a
lot like a small teapot.

The spouts of these neti pots go into one nostril. The user, bending
over, tips the head to one side and pours. With some practice, water
goes in one nostril, flows through the chamber connecting the two
nostrils and comes out the other.

It's trickier than it sounds. If you forget to breathe through your
mouth while pouring, you may inhale a little water. Some people don't
like any kind of salt water in their nose, saying it stings.

But for followers of ayurveda, neti is an important part of staying
healthy, especially as allergy season approaches. Some companies that
make neti pots, such as Minnesota-based Sinucleanse, are marketing the
pots more widely as a medical aid.

``Neti is used both ways, both as a prevention and a treatment,'' said
Dr. Shri Mishra, a neurology professor at the University of Southern
California's School of Medicine, who is also a trained ayurveda
practitioner. ``I personally believe in and practice neti for chronic
nasal allergy.''

Many Americans may not be ready to pour water through their nose. But
doctors have found enough merit in the idea to recommend more familiar
forms of nose washing.

``They're one of the multiple things we would use,'' said Dr. James
Orlowski, chief of allergy care at Santa Teresa Community
Hospital. ``They're good for prevention and early treatment.''

The same type of lightly salted water used in neti can also be
squirted into the nose with a nasal sprayer or any squirt bottle that
will get liquid up into the nose. DiNucci uses a bottle sold to hold
massage oil for her own blend of water, salt and baking soda.

More than a dozen drug companies are offering pre-packaged saline
rinses. A few smaller companies especially focused on nasal hygiene,
such as New Jersey-based Bradley Pharmaceuticals, sell everything from
single-use sprays to salts for blending your own wash.

Others are adding ingredients from sugar to herbs. The sugar-infused
products, such as one called Xlear, contain a sugar called xylitol
that has been found to inhibit bacterial growth. Other washes contain
infusions such as eucalyptus. Doctors say that while there's no
evidence such washes are harmful, they also may not have any medical
benefit.

``Some patients really have a preference,'' said UCSF's
Goldberg. ``With the herbal ones, some people love them and some
people hate them.''

DiNucci prefers knowing her home-brewed version doesn't contain extra
additives. And with the Bay Area spring allergy season heading toward
its usual peak season in April and May, she keeps the bottle at hand.

``I don't think the extra ingredients are necessary,'' she
said. ``Something simple really does the trick.''