The effectiveness of nasal saline irrigation (seawater) in treatment of allergic rhinitis in children

BSACI guideline for the diagnosis and management of allergic and non‐allergic rhinitis (Revised Edition 2017; First edition 2007)

“…• Entopy (local allergic rhinitis), diagnosed by nasal allergen challenge is found in this age group (level D) 331,333 • Therapy of rhinitis in children is based on the same principles as in adults; however, it should take into account specific paediatric needs, such as acceptability, practicality for both children and parents and concern for potential side-effects ( Figure 8) • Nasal saline irrigation is effective in the treatment of AR in children 149,334 • Brief concomitant use (3 days) of topical decongestants can be helpful in children with significant nasal blockage to aid introduction of topical nasal steroid therapy • Recommendation for continuous use of intranasal steroids can often create anxiety in parents; intranasal steroids with low bioavailability have a better safety profile at recommended doses and should be used in preference (Figure 4) 335,336 • It is advisable to monitor growth in children, especially if they are receiving steroids by multiple routes 335 (see also This guideline is the revised edition for the management of allergic and non-allergic rhinitis. Adherence to this guideline does not constitute an automatic defence for negligence, and conversely nonadherence is not indicative of negligence.…”

“…Isotonic saline irrigation in both adults and children with allergic rhinitis was well tolerated, 148 inexpensive, easy to use with no evidence of adverse effect to health with regular use. 149,150 It has a small beneficial effect in symptom reduction and may reduce the amount of pharmacotherapy needed (Grade B).…”

“…• Entopy (local allergic rhinitis), diagnosed by nasal allergen challenge is found in this age group (level D) 331,333 • Therapy of rhinitis in children is based on the same principles as in adults; however, it should take into account specific paediatric needs, such as acceptability, practicality for both children and parents and concern for potential side-effects ( Figure 8) • Nasal saline irrigation is effective in the treatment of AR in children 149,334 • Brief concomitant use (3 days) of topical decongestants can be helpful in children with significant nasal blockage to aid introduction of topical nasal steroid therapy…”

Nasal Irrigation: An Imprecisely Defined Medical Procedure

“…In contrast, NI was only marginally effective: PNIF curves were not modified and the mean clinical symptom score was reduced by only 18%. Unsatisfactory results were also reported by Chen et al [39]. These authors compared nasal corticosteroids with NI and with a combination of nasal steroids and NI.…”

“…For example, in the study by Garavello et al in which children with allergic rhinitis were evaluated, NI consisted of 2.5 mL of solution delivered to each nostril three times a day for six weeks with a syringe [37]. Marchisio et al [38] and Chen et al [39], treating children with a similar mean age and the same disease, used 20 mL 2 times a day with a syringe for 4 weeks, and 4–6 sprays twice a day for 12 weeks, respectively. All of these studies showed that NI was effective but did not document the best way to perform NI.…”