The Beneficial Effects of Hydrogen-Rich Saline Irrigation on Chronic Rhinitis: A Randomized, Double-Blind Clinical Trial

Abstract

Purpose Chronic rhinitis (CR) is a common chronic inflammation of the nasal mucosa. Nasal saline irrigation has been demonstrated to be an effective treatment for CR. In this study, we investigated the beneficial effects of hydrogen-rich saline irrigation as an anti-inflammatory irrigation therapy for CR and compared its effectiveness over saline irrigation. Hydrogen-rich saline (HRS) was investigated due to its antioxidant and anti-inflammatory properties. Methods A total of 120 patients with CR were randomly divided into two groups, patients irrigated with HR (HRS group) and the control group irrigated with saline (NS group). A randomized, double-blind control study was performed. The main observation index in this study was the total score of nasal symptoms (TNSS). In addition, eosinophilic protein (ECP) of the nasal secretions, nasal nitric oxide (nNO) levels, and levels of regulatory T cells (Treg) and regulatory B cells (Breg) were also compared between the two groups. Furthermore, patients with allergic rhinitis (AR) and non-allergic rhinitis (NAR) were also evaluated based on serum-specific IgE positivity. Results After treatment, TNSS and nasal ECP in the two groups decreased significantly (P<0.05), with patients in the HRS group showing significantly lower levels compared to the NS group (P<0.05). There were no significant differences in Treg and Breg levels between the two groups. Subgroup analysis showed that TNSS in the AR-HRS group showed a more significant reduction compared to the AR-NS group (P<0.05); however, there were no significant differences for the other inflammatory biomarkers (P>0.05). ECP levels were reduced significantly in the NAR subgroup compared to NS irrigation (P<0.05). There were no obvious adverse events observed in patients during the entire treatment period. Conclusion Compared to saline irrigation, HRS nasal irrigation was found to improve CR clinical symptoms, especially in patients with AR. HRS could effectively be used for the clinical treatment of patients with CR.

Research Progress of Hydrogen on Chronic Nasal Inflammation

“…Subgroup analysis found that AR patients had more significant treatment effects, so it is believed that HRS can be effectively used in the clinical treatment of CR patients. 56 There are also clinical studies on other AR treatment methods, such as a 2021 meta-analysis that summarized 56 clinical studies on "phototherapy" for AR. 57 Although this therapy has a positive effect on AR, there are still shortcomings such as a small sample size, lack of summary on long-term side effects, and a high risk of research bias.…”

“…Jin et al 56 conducted a pilot study on a small sample of AR patients and found that hydrogen-rich normal saline nasal irrigation can significantly improve the nasal mucosal physiological function of AR patients. Based on this, the sample size was further expanded, and a total of 120 CR patients, including AR and NAR, were randomly divided into two groups, hydrogen-rich normal saline group and normal saline group, for a double-blind controlled study.…”

“…Subgroup analysis found that AR patients had more significant treatment effects, so it is believed that HRS can be effectively used in the clinical treatment of CR patients. 56 …”

Application of nasal irrigation in the treatment of chronic rhinosinusitis

“…In recent years, there have been basic studies on the use of hydrogen-rich saline to improve chronic inflammation in the nasal mucosa, and it was found that hydrogen-rich saline achieved antioxidant effects by directly neutralizing free radicals and indirectly increasing superoxide dismutase levels [ 79 ], and also reduced the transcription and expression of inflammatory factors IL-4 and IL-13 in the nasal mucosa of experimental guinea pigs, reducing inflammation and promoting the recovery of nasal mucosa physiological functions [ 80 ]. On this basis, clinical studies have been conducted on the use of hydrogen-rich saline for chronic rhinitis [ 81 ] and CRS, with the hope that it will become another effective alternative to NI for CRS.…”

Up-regulation of systemic and local BDNF in non-allergic Nasal Polyps in China

“…11 Non-allergic rhinitis and allergic rhinitis exhibited comparable levels of ECP and other inflammatory biomarkers. 12 Recombinant Keratin 5 (KRT5), also recognized as Cytokeratins 5 (CK5), is expressed in a highly specific manner in epithelial cells where it plays a crucial role in the integrity and mechanical stability of the cells. 13 Epithelial dysfunction in NPs exhibits some morphological changes, including squamous metaplasia, basal cell proliferation, goblet cell hyperplasia and the loss of differentiation of ciliated cells.…”