Therapy of allergic rhinitis using ribavirin spray to clear nasal commensal viruses

Much attention has focused on commensal bacteria in health and disease, but the role of commensal viruses is largely unexplored, especially in the nose that directly contacts outer environment. Here, we focused on nasal commensal viruses in the development of allergic rhinitis (AR), and found that clearance of nasal commensal viruses using ribavirin alleviated AR symptoms, suggesting that nasal commensal viruses promote AR etiology. Mechanistically, nasal commensal viruses, recognized by innate sensors, initiated the production of type I interferon, generating interferon-induced neutrophils and releasing NETs to promote AR. We then performed a randomized, double-blind, placebo-controlled, phase 2 clinical trial (www.chictr.org.cn ChiCTR2400082642) to explore the efficacy and safety of ribavirin spray in treating AR patients, and found that the patients of ribavirin group experienced significantly reduced nasal commensal viruses and alleviated symptoms as compared to placebo. Thus, we suggest a new mechanism for AR and a new approach for the treatment.