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

Abstract

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)

Efficacy and Safety of Sea Salt-Derived Physiological Saline Nasal Spray as Add-On Therapy in Patients with Acute Upper Respiratory Infection: A Multicenter Retrospective Cohort Study

“…Multiple reports assessing nasal irrigation have demonstrated its effectiveness in treating seasonal allergic rhinitis in adult and pediatric patients [ 24 – 26 ]. Seawater nasal irrigation, as utilized in the present trial, represents a simple method with high reproducibility and facile execution.…”

New concepts in pediatric rhinitis

“…126 Recently, a real-life study in children showed significant improvement of AR symptoms and reduction in medications, as these were assessed by VAS and CARAT when nasal irrigation was added to standard treatment. 127 Use of nasal filters in AR adults with grass allergy during a natural in-season exposure demonstrated significant efficacy by means of an improved nasal symptom score, while their safety and usability were also documented. 128 It is, however, uncertain whether such intervention may be tolerable in children.…”

Digital Health Europe (DHE) Twinning on severe asthma—kick-off meeting report

“…MASK is based on:  An App for rhinitis and asthma developed by the MACVIA-France EIP on AHA reference site (Allergy Diary, now MASK-air ® ), available in 27 countries and fully validated (1);  An interoperable electronic clinical decision support system (CDSS) (6);  A n i n t e r o p e r a b l e w e b -b a s e d p h y s i c i a n 's questionnaire (7) and  An EIT Health project POLLAR (Impact of air POLLution on Asthma and Rhinitis) which predicts alerts for pollen and pollution peaks (8). MASK has led to:  A better understanding of rhinitis in terms of phenotypes and management (1,9);  A better understanding of the links between allergy and pollution (10,11);  A proof-of-concept on the digital transformation of health and care to sustain Planetary Health (12);  Clinical trials (13,14).…”