Ganciclovir for refractory allergic rhinitis: a case series and literature review

BACKGROUND: Allergic rhinitis (AR) is a prevalent nasal allergic disorder, with approximately 15%-20% of patients exhibiting persistent symptoms and poor disease control despite standard anti-allergic treatment management. Ganciclovir (GCV), a synthetic guanine nucleoside analog, is widely used for prophylaxis and treatment of Herpesvirus infections (e.g., cytomegalovirus, herpes simplex virus) via inhibition of viral DNA synthesis. CASE PRESENTATION: We present five cases (three adults, two children) of refractory AR characterized by well-documented allergen sensitization, disease duration of 4–11 years, and suboptimal response to conventional therapies (e.g., intranasal corticosteroids, oral antihistamines). Following informed consent, all patients received oral ganciclovir (250 mg or 500 mg, twice daily) for 14 days. Remarkably, all five cases exhibited significant improvement in nasal symptoms, with substantial reductions in both Visual Analog Scale (VAS) and Total Nasal Symptom Score (TNSS) values, without treatment-related adverse events. Long-term follow-up revealed sustained symptom control, reduced AR exacerbation frequency, and maintained low VAS/TNSS scores. Occasional breakthrough symptoms responded effectively to rescue therapy with standard allergenic medications. CONCLUSION: Ganciclovir demonstrates potential as a therapeutic option for patients with refractory AR unresponsive to standard treatments, providing both rapid symptom relief and long-term control. However, large-scale randomized controlled trials and mechanistic investigations are warranted to validate efficacy and clarify its mechanisms of action beyond antiviral pathways.