The acceptability and tolerability of nasal douching in children with allergic rhinitis: A systematic review

Gutiérrez-Cardona, Nelson; Sands, Paula; Roberts, Graham; Lucas, Jane S.; Walker, Woolf; Salib, Rami J.; Burgess, Andrea; Ismail-Koch, Hasnaa

doi:10.1016/j.ijporl.2017.04.040

Cited by 15 publications

(6 citation statements)

References 31 publications

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“…2,7,8 A strong belief that table salt should be avoided while making homemade saline solutions is described in the literature, as these solutions contain additives that are suspected to harm the sinonasal mucosa. [7][8][9][10] However, we could not find any evidence to support this claim in the English medical literature. Therefore, this study in healthy volunteers was conducted to assess the effect of hypertonic saline containing iodized table salt on the nasal mucosa by assessing changes in mucociliary clearance (MCC) with saccharine clearance time (SCT); these changes were compared to those obtained by using conventionally prescribed hypertonic nasal irrigation solutions containing noniodized salt.…”

Section: Introductioncontrasting

confidence: 72%

Impact of Nasal Irrigation With Iodized Table Salt Solution on Mucociliary Clearance: Proof-of-Concept Randomized Control Trial

Sumaily

Alarifi

Alsuwaidan

et al. 2019

Am J Rhinol�Allergy

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Introduction Saline nasal irrigation is a common recommendation shared between the majority of clinical guidelines for sinusitis and rhinitis in adults and children. Studies involving homemade saline have typically involved the use of noniodized salt. However, the literature does not contain any descriptions for the use of iodized table salt in homemade saline solutions. Objectives To study the usefulness of iodized salt in homemade saline and its impact on mucociliary clearance (MCC). Methods Only healthy volunteers were enrolled in this randomized controlled trial. The sinonasal outcome test (SNOT)-22 and rhinoscopy were used to rule out any clinical evidence of sinusitis or rhinitis in the enrolled subjects. The saccharine clearance time (SCT) was used to evaluate MCC at baseline. Each candidate received 2 different nasal wash solutions—one containing iodized salt and the other containing noniodized salt—on different days. Visual analog scale pain scores were recorded while using each type of nasal wash. The SCT was assessed after each wash. Results Thirty-eight healthy candidates (18 men and 20 women) were enrolled in the study. All subjects were in their 30s. The mean baseline SCT was 10.92 minutes. The use of the noniodized salt solution led to a nonsignificant change ( P = .139) in mean SCT (9.68 min). In contrast, a significant change ( P = .035) was observed in mean SCT after the use of the iodized salt solution (9.06 min). However, the mean postirrigation SCT was not significantly different between solutions ( P = .31). No significant differences were observed in pain/discomfort experience between solutions. Conclusion MCC improved with both solutions. Interestingly, the improvement was significant, when the iodized salt nasal irrigation solution was used. This finding contradicts the conventional recommendation against the use of iodized salt in nasal rinse solution. Moreover, this solution was well tolerated. Further studies regarding the long-term safety are recommended.

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Section: Introductioncontrasting

confidence: 72%

Impact of Nasal Irrigation With Iodized Table Salt Solution on Mucociliary Clearance: Proof-of-Concept Randomized Control Trial

Sumaily

Alarifi

Alsuwaidan

et al. 2019

Am J Rhinol�Allergy

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“…Our results correspond with those of earlier studies in which symptom scores and need for medicines such as intranasal corticosteroids and antihistamines decreased after NSI in children with AR. [22][23][24][25][26] In a prospective Chinese study, patients aged 2-15 years with AR who received combination treatment of NSI and intranasal corticosteroids for 12 weeks showed significant improvement of AR symptoms and reduced intranasal corticosteroid dose compared to those who used intranasal corticosteroids alone. 23 A randomized double-blind study in Thailand reported that nasal symptom scores and antihistamine consumption significantly decreased after 4 weeks of hypertonic nasal irrigation.…”

Section: Discussionmentioning

confidence: 99%

Beneficial effect of nasal saline irrigation in children with allergic rhinitis and asthma: A randomized clinical trial

Jung

Lee

Ryu

et al. 2020

Asian Pac J Allergy Immunol

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Background: Asthma and allergic rhinitis (AR) are chronic inflammatory diseases of airway and affect the disease severity each other.Objective: We performed this study to examine whether nasal saline irrigation (NSI) improves bronchial hyperresponsiveness and clinical parameters in children with asthma and allergic rhinitis (AR). Methods:We enrolled 20 children with AR and asthma aged between 6-18 years. Patients were randomized into two groups: irrigation group (8 boys and 2 girls) and control group (8 boys and 2 girls). The irrigation group performed daily NSI. All patients received 12-week treatment with montelukast, levocetirizine, and inhaled glucocorticoids. Provocative concentrations of methacholine causing a 20% decrease in FEV 1 (PC 20 ), Asthma Control Test (ACT), the Questionnaire for Quality-of-Life Specific to Allergic Rhinitis in Korean Children (QQOL-ARK) and exhaled nitric oxide (FE NO ) were compared before and after the study. Results:The PC 20 at week 12 was higher than baseline measurements in the irrigation group (P = 0.017), while there was no difference in PC 20 before and after treatment in the control group (P = 0.333). ACT score increased after 12 weeks of NSI (P = 0.007), while QQOL-ARK score decreased compared to baseline scores (P = 0.028) in the irrigation group. No differences in ACT and QQOL-ARK were found between weeks 0 and 12 in the control group. No differences were found in the median value of changes in PC 20 , ACT, QQOL-ARK and FE NO between the irrigation and control groups.Conclusions: Our results suggest that NSI is beneficial for treatment of asthma and AR in children.

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“…Nasal saline solution irrigation (NSSI) has recently gained popularity in selected settings (34). An Italian survey among primary care pediatricians showed that most of them prescribe NSSI for both the prophylaxis and treatment of upper respiratory tract problems (35).…”

Section: Nasal Saline Solution Irrigationmentioning

confidence: 99%

Wet Cough and Nasal Symptoms in Children: Can We Do Better?

Benedictis

Carloni²,

Comberiati

et al. 2019

Front. Pediatr.

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The causes of chronic cough in children are mainly dependent on the setting and age of the child. Protracted bacterial bronchitis is a frequent cause of morbidity in childhood, and antibiotic treatment is beneficial. Prompt recognition and early treatment is important both to prevent inappropriate use of asthma medications and also progression to bronchiectasis, but the diagnosis should not be made uncritically, because chronic wet cough is not necessarily due to lower airway disease. Upper Airway Cough Syndrome (UACS) is considered by some to cause chronic cough in childhood. Underlying UACS are many common conditions, including allergic rhinitis, adenoiditis and rhinosinusitis. Diagnosis relies on a combination of clinical criteria that are relatively sensitive but non-specific. The role of nasal endoscopy in children with chronic cough and signs suggesting UACS is unclear. Nasal saline solution irrigation is commonly used in UACS, but most studies have methodological biases, and efficacy data are scanty. Randomized controlled trials are urgently required. However, if saline washes, rather than oral antibiotics, can effectively treat some children with wet cough associated with upper airway conditions, antibiotic resistance could potentially be reduced. There is a need to further study wet cough and not to assume it to be equivalent to lower airway infection in all children.

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The acceptability and tolerability of nasal douching in children with allergic rhinitis: A systematic review

Cited by 15 publications

References 31 publications

Impact of Nasal Irrigation With Iodized Table Salt Solution on Mucociliary Clearance: Proof-of-Concept Randomized Control Trial

Impact of Nasal Irrigation With Iodized Table Salt Solution on Mucociliary Clearance: Proof-of-Concept Randomized Control Trial

Beneficial effect of nasal saline irrigation in children with allergic rhinitis and asthma: A randomized clinical trial

Wet Cough and Nasal Symptoms in Children: Can We Do Better?

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