Saline irrigation for allergic rhinitis

Abstract

Background Allergic rhinitis is a common condition affecting both adults and children. Patients experience symptoms of nasal obstruction, rhinorrhoea, sneezing and nasal itching, which may affect their quality of life. Nasal irrigation with saline (salty 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 nebuliser or with gravity-based pressure in which the person instils 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. Objectives To evaluate the effects of nasal saline irrigation in people with allergic rhinitis. Search methods The Cochrane ENT Information Specialist searched the ENT Trials Register; CENTRAL; Ovid MEDLINE; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 23 November 2017. Selection criteria Randomised controlled trials (RCTs) comparing nasal saline irrigation, delivered by any means and with any volume, tonicity and alkalinity, with (a) no nasal saline irrigation or (b) other pharmacological treatments in adults and children with allergic rhinitis. We included studies comparing nasal saline versus no saline, where all participants also received pharmacological treatment (intranasal corticosteroids or oral antihistamines). Data collection and analysis We used the standard methodological procedures expected by Cochrane. Primary outcomes were patient-reported disease severity and a common adverse effect-epistaxis. Secondary outcomes were 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. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics.

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

“…Studies have shown their efficacy in AR and sinusitis, and meta-analyses support their use [11,29], with hypertonic solutions (e.g. 2.3% NaCl) being apparently more effective than normal saline solutions [8,9,30].…”

“…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].…”

“…Its mechanisms of action include direct mechanical cleansing of the mucosa from allergens or other particles, decrease of inflammatory and/or allergic mediators, and increase of mucociliary clearance. Meta-analyses suggest that NI can be used as add-on to medical treatment [11]. However, in children, NI is not yet part of the guideline recommendations, probably due to insufficient evidence of its pediatric effectiveness.…”

What role for saline nasal irrigation?

“…A Cochrane review published in 2018 included 14 trials and 747 participants 22. Saline volumes ranged from very low to high, with either hypertonic or isotonic saline solution.…”

Evidence of orofacial myofunctional therapy patients with asthma and rhinitis: a systematic review

“…Patients with asthma and rhinitis may present respiratory impairment, resulting in unbalance and adaptations in the musculature and/or orofacial structures and stomatognathic functions, due to the presence of nasal obstruction and consequent mouth breathing (1) . The consequences of this unbalance can be observed in the short or long term, such as facial and vocal quality changes, inadequate occlusion, and body posture alterations (2,3) . In addition, mouth breathing exposes the lower airways to the penetration of allergens, irritants and bacterial agents, increasing the risk of asthma exacerbations (4) .…”