In Reply We thank Radulesco et al for their interest in our article and their letter in response. We agree that it would be beneficial to explore the utility of other topical additives in prevention and treatment of respiratory viruses, such as severe acute respiratory syndrome coronavirus 2. Regarding the potential use of copper, it is certainly encouraging to note its antiviral efficacy. The literature is particularly supportive of its use as an antimicrobial coating for surfaces. However, there is not yet strong evidence regarding the safety of copper as an additive for nasal saline irrigations. As the authors address, 1 preliminary study performed by Huang et al does note the safety of a nasal solution enriched with copper, among other additives. However, the product evaluated in that study reports only that it is enriched with coppe r and does not further specify the concentration or form of copper used. Though the aforementioned study notes safety of a nasal solution enriched with copper, animal studies of nasally applied copper salts and nanoparticles have demonstrated the potential toxic effects of copper, resulting in direct olfactory neuron damage or intracranial translocation, resulting in neurologic damage. These concerns were further described in a recent review of copper toxicology, which notes concern for copper-induced cell damage through the release of reactive oxygen species.
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