General Medicine · Medical Literature
Diet, Nutrition, and Rhinosinusitis: A Systematic Review of Dietary Interventions and Exposures.
Abstract
Background/Objectives: Rhinosinusitis (RS) is a prevalent inflammatory condition with substantial morbidity and variable response to standard therapies. Diet is a modifiable determinant of systemic inflammation, yet its role in sinonasal disease remains incompletely defined. Methods: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, Cochrane Library, and Web of Science were searched from inception through 28 June 2026. Studies assessing dietary exposures or interventions in RS were included using predefined criteria. Risk of bias was assessed using ROBINS-I and Joanna Briggs Institute tools. Due to heterogeneity in study design and outcomes, findings were synthesized narratively. Results: Ten studies met inclusion criteria (5 adult, 4 pediatric, 1 mixed), including interventional and observational designs. Anti-inflammatory dietary patterns were associated with improved sinonasal outcomes. In children, Mediterranean diet adherence reduced recurrent inflammatory episodes, and reduced sugar intake improved sinus infection scores with decreased TNF-α concentrations. In adults, both allergen-guided elimination diets and a low-arachidonic acid, low-salicylate, high-fiber dietary intervention improved symptom severity, with accompanying improvements in endoscopic outcomes. Observational studies demonstrated that higher fruit intake was associated with lower RS prevalence, whereas higher fat intake, caloric intake, Dietary Inflammatory Index scores, frequent meals prepared away from home, and ultra-processed food intake were associated with increased disease risk or sinonasal symptom burden. Phenotype-specific associations included increased dietary salicylate sensitivity and food-triggered symptom exacerbation among patients with nasal polyposis. Conclusions: Dietary patterns and specific nutritional exposures are associated with RS outcomes across age groups. Anti-inflammatory dietary profiles demonstrate potential protective effects, whereas pro-inflammatory dietary patterns are associated with increased disease burden. However, the predominance of observational data and study heterogeneity limit causal inference. Well-designed prospective and randomized studies are needed to define the therapeutic role of dietary modification in RS.
Clinical relevance
Rhinosinusitis affects a substantial proportion of the general population and frequently demonstrates variable or incomplete response to standard pharmacologic and surgical therapies, creating an unmet need for adjunctive management strategies. This systematic review addresses a critical evidence gap by synthesizing the emerging role of diet—a modifiable determinant of systemic inflammation—in sinonasal disease across both pediatric and adult populations. As interest in lifestyle medicine grows and patients increasingly seek non-pharmacologic interventions, clinicians across primary care, otolaryngology, and allergy/immunology need a foundational understanding of the diet–rhinosinusitis relationship to counsel patients appropriately.
Key findings
1. Ten studies met inclusion criteria (5 adult, 4 pediatric, 1 mixed), encompassing both interventional and observational designs; heterogeneity precluded meta-analysis, and findings were synthesized narratively. 2. In the pediatric population, adherence to a Mediterranean dietary pattern was associated with reduced recurrent inflammatory sinonasal episodes, and reduced dietary sugar intake was associated with improved sinus infection scores alongside decreased TNF-α concentrations (specific effect sizes not reported in the abstract). 3. In adults, allergen-guided elimination diets improved symptom severity, and a combined low-arachidonic acid, low-salicylate, high-fiber dietary intervention improved both symptom severity scores and endoscopic outcomes (quantitative effect sizes not available from the abstract). 4. Observational data demonstrated that higher fruit intake was associated with lower rhinosinusitis prevalence, while higher fat intake, higher caloric intake, elevated Dietary Inflammatory Index (DII) scores, frequent consumption of meals prepared away from home, and higher ultra-processed food intake were each independently associated with increased disease risk or greater sinonasal symptom burden. 5. Phenotype-specific associations were identified: patients with nasal polyposis demonstrated increased dietary salicylate sensitivity and food-triggered symptom exacerbation, suggesting that dietary phenotyping may be relevant to subgroup-specific management. 6. The overall body of evidence is limited by a predominance of observational study designs, heterogeneity in outcome measures and dietary assessment tools, and risk of bias assessed via ROBINS-I and Joanna Briggs Institute instruments, collectively precluding causal inference.
Practice implications
Clinicians managing patients with chronic or recurrent rhinosinusitis—particularly those with inadequate response to standard therapy—should consider incorporating dietary counseling into their management approach, with emphasis on anti-inflammatory dietary patterns (e.g., Mediterranean-style diet, increased fruit and fiber intake, reduced ultra-processed and high-fat food consumption) as a low-risk adjunctive strategy. In the subpopulation with nasal polyposis, screening for salicylate sensitivity and food-triggered exacerbations is warranted, and an allergen-guided or low-arachidonic acid/low-salicylate elimination diet may be considered in conjunction with standard care. Given the current predominance of observational data and study heterogeneity, dietary modification should be framed to patients as a promising but not yet definitively proven intervention, pending well-designed prospective and randomized controlled trials.