Saline irrigation reduces disease severity in allergic rhinitis

Saline irrigation may reduce patient-reported disease severity compared with no saline irrigation at up to three months in both adults and children with allergic rhinitis, with no reported adverse effects.

Karen Heads and his associates conducted a study to evaluate the effects of nasal saline irrigation in people with allergic rhinitis. Nasal irrigation with saline (salt water), also known as nasal douching, washing or lavage, is a procedure that rinses the nasal cavity with isotonic or hypertonic saline solutions. It can be performed with low positive pressure from a spray, pump or squirt bottle, with a nebulizer or with gravity-based pressure in which the person instills saline into one nostril and allows it to drain out of the other. Saline solutions are available over the counter and can be used alone or as an adjunct to other therapies.

The study included randomized controlled trials, involving cluster-randomized trials and quasi-randomized trials, and cross-over trials and patients were followed up for at least two weeks.

Exclusions covered non-allergic rhinitis, chronic rhinosinusitis, acute sinusitis, cystic fibrosis, immunotherapy started within the prior year, any alteration of allergic rhinitis-specific pharmacotherapy (antihistamines, intranasal corticosteroids, anti-leukotrienes) during the trial, aspirin-exacerbated respiratory disease, and surgery for turbinate reduction within three months prior to the study.

The authors included studies comparing nasal saline versus no saline, where all participants also received pharmacological treatment (intranasal corticosteroids or oral antihistamines).

Primary outcomes were patient-reported disease severity and a common adverse effect - epistaxis. Secondary outcomes were the disease-specific health-related quality of life (HRQL), individual symptom scores, general HRQL, the adverse effects of local irritation or discomfort, ear symptoms (pain or pressure) and nasal endoscopy scores.

Read Also: Antihistamines + LTRAs more effective than antihistamines alone in allergic rhinitis

Results were analyzed on the basis of following criteria:

• Nasal saline versus no saline treatment


• Nasal saline versus no saline with adjuvant use of intranasal steroids or oral antihistamines


• Nasal saline versus intranasal steroids

1.Nasal saline versus no saline treatment

Saline irrigation may improve patient-reported disease severity compared with no saline at up to four weeks and between four weeks and three months. Subgroup analysis showed the improvement in both adults and children.

Two studies (240 children) reported no adverse effects (epistaxis or local discomfort) in either group and three only reported no adverse effects in the saline group.

2. Nasal saline versus no saline with adjuvant use of intranasal steroids or oral antihistamines

Three studies (40 adults; 79 children) compared saline with intranasal steroids versus intranasal steroids alone. It is uncertain if there is a difference in patient-reported disease severity at up to four weeks or from four weeks to three months. Although none of the studies reported methods for recording adverse effects, three mentioned them: one study (40 adults; adjuvant intranasal steroids) reported no adverse effects (epistaxis or local discomfort) in either group; the other two only reported no adverse effects in the saline group.

It is uncertain if saline irrigation in addition to pharmacological treatment improved disease-specific HRQL at four weeks to three months, compared with pharmacological treatment alone.

3.Nasal saline versus intranasal steroids

It is uncertain if there was a difference in patient-reported disease severity between nasal saline and intranasal steroids at up to four weeks or between four weeks and three months Three studies reported no adverse effects (epistaxis or local discomfort) with saline, although one study reported that 27% of participants experienced local discomfort with steroid use.

Allergic rhinitis, also known as hay fever, is a type of inflammation in the nose which occurs when the immune system overreacts to allergens in the air.

For more reference log on to 10.1002/14651858.CD012597.pub2