Popular Nasal Decongestants Associated with Birth Defects

Researchers have discovered that there is a very small, but significant association between birth defects and use of nasal decongestants in the first trimester of pregnancy. Unfortunately, decongestants (ie sudafed, afrin, etc) are also one of the most popular medications purchased over-the-counter to treat symptoms of nasal congestion, runny nose, and allergies.

In particular, three strong associations were found:

• Phenylephrine and endocardial cushion defects
• Phenylpropanolamine and ear defects
• Phenylpropanolamine and pyloric stenosis

Although these associations were related to ORAL decongestant use and first trimester intake, it was also found that intra-nasal decongestant use during the first trimester was associated with pyloric stenosis and tracheo-esophageal fistula.

Taken in summary, it is perhaps ideal that women in their first trimester of pregnancy avoid decongestant use due to a possible association between birth defects and medication usage. This association accounts for a VERY small percentage increase in birth defects and as such more study is needed.

For example, the baseline prevalence of endocardial cushion defect is 0.34 per 1,000 live births. Phenylephrine exposure increases this risk 8-fold resulting in 2.7 per 1,000 live births. That's an overall increased risk of only 0.27%.

Keep in mind that all these over-the-counter products contain a decongestant ingredient:

• Afrin
• Sudafed
• Tylenol Cold Multi-Symptom Nighttime
• Alka-Seltzer Plus Cold
• Delsym Night Time Multi-Symptom
• Tylenol Cold Multi-Symptom Severe
• Tylenol Cold & Flu Severe
• Vicks Dayquil Cold & Flu Relief
• Benadryl Allergy Plus Sinus Headache
• Theraflu Warming Relief Nighttime Severe Cold & Cough
• Vicks Nyquil Sinus
• Acutrim
• Dexatrim
• Afrin
• Zicam
etc, etc, etc

So what is a pregnant woman to do if her nose gets all stuffed up and wants to avoid decongestant medications to eliminate any possible risk of birth defects? Click here for some suggestions.

Source:
Use of Decongestants During Pregnancy and the Risk of Birth Defects. Am. J. Epidemiol. (2013) doi: 10.1093/aje/kws427

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Xylitol Nasal Flushes Helps Prevent Chronic Sinusitis

Image by Aikhan from German Wikipedia

Over the years, there has been much about how beneficial a safe food additive called xylitolis in preventing infections. This naturally-occurring plant-based sugar substitute apparently has all sorts of anti-bacterial as well as anti-fungal properties. Given these properties, daily xylitol gum chewingor xylitol nasal sprayuse has been shown to help prevent recurrent acute ear infections and sinus infections... safe for use even in infants.

How may this occur? Toronto researchers figured out that xylitol inhibits the adherence of germs (burkholderia in the study) to airway linings thereby helping to prevent recurrent infections.

Another beneficial practice found to be helpful in preventing sinus infections are saline flushes to the nose. For those who don't realize the difference, saline flushes are different from saline nasal sprays in the volume of irrigation performed (think garden hose versus squirt bottle). Nasopurenasal flushes is being shown in the picture above (there are many different stylesbut all basically do the same thing).

Now what if we combine saline flushes with xylitol for those who suffer from particularly difficult chronic sinus infections???

Stanford University researchers conducted a small study (20 subjects) to see whether xylitol flushes (rather than nasal spray) to nose works even better than plain saline flushes to the nose. In spite of its small size, it was a prospective, randomized, double-blinded, controlled crossover pilot study.

What they found, at least in the short term, is that xylitol nasal irrigations resulted in greater improvement of chronic rhinosinusitis symptoms as compared to saline irrigations.


Reference:
Xylitol nasal irrigation in the management of chronic rhinosinusitis: A pilot study. The Laryngoscope Volume 121, Issue 11, pages 2468–2472, November 2011

A novel model to study bacterial adherence to the transplanted airway: inhibition of Burkholderia cepacia adherence to human airway by dextran and xylitol. J Heart Lung Transplant. 2004 Dec;23(12):1382-91.

A Story About a Sugar: The X-Factor. Blog by Dr. Faust

Xylitol as a prophylaxis for acute otitis media: systematic review. Int J Audiol. 2010 Oct;49(10):754-61.

A novel use of xylitol sugar in preventing acute otitis media. Pediatrics. 1998 Oct;102(4 Pt 1):879-84.

Xylitol chewing gum in prevention of acute otitis media: double blind randomised trial. BMJ. 1996 Nov 9;313(7066):1180-4.

Failure of xylitol given three times a day for preventing acute otitis media. Pediatr Infect Dis J. 2007 May;26(5):423-7.

Xylitol administered only during respiratory infections failed to prevent acute otitis media. Pediatrics. 2002 Feb;109(2):E19.

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