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

Jung, Minyoung; Lee, Ji Young; Ryu, Gwanghui; Lee, Jun Young; Hong, Sang Duk; Choi, Jaehee; Kim, Soyoung; Ahn, Kangmo; Dhong, Hun‐Jong; Chung, Seung‐Kyu; Kim, Jihyun; Kim, Hyo Yeol

doi:10.12932/ap-070918-0403

Cited by 8 publications

(13 citation statements)

References 27 publications

(40 reference statements)

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“…Many devices (spray, atomizer device, or large-volume syringe) provided beneficial effects. Minor adverse events, such as otalgia, ear fullness, and epistaxis, occurred in 30% of the patients who used a large-volume device 15 but none in very low and low-volume devices. 17 , 19 - 21 …”

Section: Resultsmentioning

confidence: 99%

“…Eleven RCTs assessed adult AR, 4 - 14 and 8 RCTs assessed pediatric AR. 15 - 22 Three meta-analyses pooled the data from adult and pediatric AR, 1 , 3 , 23 and 1 meta-analysis examined data only from children. 24 …”

Section: Resultsmentioning

confidence: 99%

“…In pediatric AR, 6 RCTs compared the effects of saline treatment with no-saline treatment. 15 , 17 , 19 - 22 All RCTs reported benefits of nasal saline treatment over control. Decreases in symptom score and antihistamine usage favored the nasal saline treatment at 4 weeks.…”

Section: Resultsmentioning

confidence: 99%

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Optimal Device and Regimen of Nasal Saline Treatment for Sinonasal Diseases: Systematic Review

et al. 2022

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Objective This review aimed to systematically determine the optimal nasal saline regimen for different types of sinonasal diseases. Data Sources PubMed, Embase, SCOPUS, Cochrane Library, Web of Science, ClinicalTrials.gov. The last search was on December 6, 2021. Review Methods Study selection was done by 2 independent authors. Randomized controlled trials and meta-analyses were included. The effects of nasal saline treatment through various devices, saline tonicities, and buffer statuses were evaluated in patients with allergic and nonallergic rhinitis, acute and chronic rhinosinusitis (CRS), CRS with cystic fibrosis, and postoperative care, including septoplasty/turbinoplasty and endoscopic sinus surgery. Results Sixty-nine studies were included: 10 meta-analyses and 59 randomized controlled trials. For allergic rhinitis, large-volume devices (≥60 mL) were effective for treating adults, while low-volume devices (5-59 mL) were effective for children. Isotonic saline was preferred over hypertonic saline due to fewer adverse events. For acute rhinosinusitis, saline irrigation was beneficial in children, but it was an option for adults. Large-volume devices were more effective, especially in the common cold subgroup. For CRS, large-volume devices were effective for adults, but saline drop was the only regimen that had available data in children. Buffered isotonic saline was more tolerable than nonbuffered or hypertonic saline. The data for CRS with cystic fibrosis and nonallergic rhinitis were limited. For postoperative care, buffered isotonic saline delivered by large-volume devices was effective. Conclusion Nasal saline treatment is recommended for treating most sinonasal diseases. Optimal delivery methods for each condition should be considered to achieve therapeutic effects of saline treatment.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Optimal Device and Regimen of Nasal Saline Treatment for Sinonasal Diseases: Systematic Review

et al. 2022

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“…Topical medications with intranasal drug delivery devices (IDDD) have been widely indicated as possible therapeutics, 16 especially among patients with rhinitis (allergic or not), allergic rhinoconjunctivitis, rhinosinusitis, and nasal polyposis. In the specific case of rhinitis, glucocorticoids have been mentioned as the gold standard in improving patients' quality of life.…”

Section: Intranasal Drug Delivery Devices Are a Potential Contaminatimentioning

confidence: 99%

Intranasal drug delivery devices are a potential contamination source of airways

Pereira¹,

Soares²,

Innocencio³

et al. 2019

Brazilian Journal of Allergy and Immunology (BJAI)

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Background: The use of intranasal drug delivery devices (IDDD) for the treatment of allergic rhinitis (AR) is frequent because they are simple, efficient, and safe, and mainly because they are perceived as low-risk. However, it is speculated that contact between the nasal mucosa and an IDDD may give rise to infections once the nose is colonized by bacteria, and there are currently no proper instructions for IDDD sanitization. The objective of this study was to evaluate the possibility of contamination of an IDDD for topical medication after simulating use in healthy individuals. Methods: The in vitro study consisted of 14 healthy individuals of both sexes, between the ages of 18 and 24 years. Samples were collected immediately after the opening of each IDDD and after simulating use by the subjects. Afterwards, the samples were deposited in tubes and kept in an incubator at 37 °C. After 48 hours, the samples were inoculated on Müller-Hinton agar. Qualitative analyses of the appearance of the samples were performed after 24 and 48 hours, and after 72 hours the presence or absence of bacteria was evaluated macroscopically. Results: After 24 hours of incubation, 21.4% (n = 3) of the samples presented with a turbid appearance and after 48h, 71% (n = 10) of the samples presented with a turbid appearance and positive bacterial growth. Conclusion: The results suggest that IDDDs for topical medications may be important sources of contamination or recontamination of the nasal mucosa of individuals who are being treated for upper respiratory tract conditions. A better understanding of the risks of re-using IDDDs after previous contact with the nasal mucosa will improve guidelines on hygiene procedures and prevention of related risks.

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“…Symptomatic treatment consists of antihistamines and nasal steroids, while allergen immunotherapy is usually performed in more severe/persistent cases [3,4]-in any case, AR usually requires chronic treatment, which raises safety Page 2 of 11 Mitsias et al Clin Transl Allergy (2020) 10:9 concerns about protracted drug usage, leading to the quest for non-pharmacological approaches [5,6]. Among add-on treatments, nasal irrigation (NI) with saline solutions appears to be useful [7][8][9][10][11], as it does not need medical prescription and is considered safe for long-term use [7]. Normal saline is primarily used, although studies have shown increased effectiveness with hypertonic solutions [8,9].…”

Section: Introductionmentioning

confidence: 99%

Effect of nasal irrigation on allergic rhinitis control in children; complementarity between CARAT and MASK outcomes

Mitsias

Dimou

Lakoumentas

et al. 2020

Clin Transl Allergy

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Background: Nasal irrigations (NI) are increasingly used as an over-the-counter adjunctive treatment for allergic rhinitis (AR), but clinical studies on their effectiveness are limited.Methods: An open-label, controlled, non-randomized, real-life study was conducted to evaluate the effectiveness of NI with a new hypertonic solution as add-on treatment for AR. Children and adolescents with AR were prescribed symptomatic treatment. The active group also received an additional sea-water NI solution supplemented with algae extracts. The primary endpoint was symptom control, assessed by the control of allergic rhinitis and asthma test (CARAT) questionnaires. Moreover, the MASK/Allergy Diary was used to track symptoms and daily medication use that were combined in a novel total symptom/medication score (TSMS). Results:We assessed 76 patients. Overall, there was a significant improvement of CARAT results (median Z-score change of 1.1 in the active/NI group vs. 0.4 in the control group; p = 0.035). Among patients > 12 years old (n = 51), there was a significant improvement in CARAT10 results among participants receiving NI (21.0 to 25.5; p < 0.001), but not in the regular treatment group (21.5 to 24.0; p = 0.100). For children < 12 years old (n = 25), the ΝΙ group had significantly improved symptom control (CARATKids results: 5.0 to 2.0; p = 0.002), in contrast to the control group (4.0 to 2.5; p = 0.057). MASK data on allergic symptoms were comparable between groups. However, the NI group had lower TSMS, more days with < 20% symptoms and fewer days using symptomatic treatment (26.9% vs. 43.5%; p = 0.005). Conclusion:Addition of NI with a sea-water solution to regular treatment improved AR symptom control. CARAT questionnaires and MASK application can be useful outcome tools in real-life studies. Active (n: 55) Control (n: 23) p-value * Percentage (%) of days on treatment 0.005 Median (25-75 percentile) 26.9 (19.1-40.7) 43.5 (31.0-61.2) Medication score a 0.006 Median (25-75 percentile) 16.7 (10.7-25.0) 25.7 (17.3-35.7)

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

Cited by 8 publications

References 27 publications

Optimal Device and Regimen of Nasal Saline Treatment for Sinonasal Diseases: Systematic Review

Optimal Device and Regimen of Nasal Saline Treatment for Sinonasal Diseases: Systematic Review

Intranasal drug delivery devices are a potential contamination source of airways

Effect of nasal irrigation on allergic rhinitis control in children; complementarity between CARAT and MASK outcomes

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