An antifungal nasal spray is prescribed for topical treatment of infections in the nasal passages and sinuses. Fungal infections can lead to chronic sinusitis with nasal congestion, runny nose, and difficulty breathing.  Individuals with compromised immune systems are more susceptible to fungal infections that can progress to a serious condition. Those who have had to live in environments with mold sometimes develop biotoxin illness, which can require multiple treatment methods to eradicate including topical antifungal therapy.

While multiple types of fungi are always present in the nasal passages, it’s when some of these cause allergic reactions that problems develop. An allergic reaction to a fungus can cause inflammation of the nasal passages and sinuses. An antifungal nasal spray can help relieve the inflammation that is causing symptoms.

Fungal Rhino sinusitis in Immunocompromised Individuals

Fungal rhinosinusitis, a type of chronic sinusitis, often occurs in patients with immunocompromised states that result from conditions like diabetes. It can be a serious condition if it is allowed to progress and can require surgical removal of the fungus and tissue that is diseased. After surgery, a systemic corticosteroid is usually prescribed to reduce inflammation of the mucous membrane. The inflammation that comes from the fungal infection is the main cause of the symptoms of chronic sinusitis.

When antifungal drugs are given systemically they do not achieve high enough levels in the mucous of the nasal passages to kill the fungus. A nasal spray is therefore the preferred method of administration for antifungals.  When the topically applied antifungal nasal spray is used, it reduces the fungi in the nasal passages, which decreases the allergic response that is causing inflammation.

If a patient who has been using antifungal nasal spray for about three months is showing improvement, then the treatment is usually continued in order to prevent re-colonization of the nasal passages. Since patients who have had a fungal infection are likely to have a recurrence, the continued use of a preventative therapy is necessary.

Biotoxin Illness from Mold Exposure

Mold is most often found in buildings that are water-damaged. A variety of health problems can develop in individuals who live in moldy environments including fungal rhinosinusitis, respiratory infections, chronic fatigue, central and peripheral neuropathy, and more. Together the effects of mold on health are sometimes referred to as “biotoxin illness.” There are different protocols and treatment theories for treating biotoxin illness from mold exposure. Many of them involve the use of an antifungal nasal spray to clear infections from the nasal passages.

Biotoxin illness is usually treated with a combination of cholestyramine and topical nasal sprays. Cholestyramine is used to bind and remove toxins from the body.  Topical nasal sprays are used to eliminate infections in the nasal passages and sinuses and can include antibiotics, antifungals, and cheaters.  Mycotoxins from mold can be harbored beneath a biofilm that makes infections persist for long periods of time. In order to eliminate the mold, it is necessary to first use a chelator like EDTA to remove the biofilm. Then a topical antifungal like amphotericin B or voriconazole can be used to eliminate the infection.

Besides the advantage of being able to target the infection directly, an antifungal nasal spray does not have systemic effects. When antifungals are taken orally they can have multiple systemic side effects, which may be especially harmful for individuals who are already coping with chronic illness.

Types of Antifungal Nasal Spray

The nasal therapies available from a compounding pharmacy are available in customized formulations for each individual patient’s needs. There are two main antifungals that are prescribed in a nasal spray or with an atomizer:

Amphotericin B – This antifungal has been the most frequently prescribed for treating fungal infections and is considered the standard treatment for biotoxin illness. This medication is only compounded in capsules or powder for reconstitution for use with an atomizer or nasal irrigation.

Voriconazole – While amphotericin B has been the standard antifungal therapy for many years, voriconazole has shown promise as an alternative with fewer side effects. Commercially available voriconazole is limited to oral and intravenous forms. Intranasal delivery with a voriconazole solution is only available from a compounding pharmacy.

Atomization of Antifungals

One of the most effective ways to deliver topical antifungals to the nasal passages is with an atomizer. An atomizer is a battery-powered device that sends small particles deep into the nasal passages and sinuses to topically treat fungal infections. Many doctors and patients have found this to be the best way to deliver topical sinus medications. The Rhino Clear Sprint atomizer can be purchased with a patient’s first prescription from our pharmacy then used for all subsequent refills of antibiotic or antifungal solutions.