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Saline Nasal Irrigation May Provide Symptom Relief in Patients with Seasonal Allergic Rhinitis

Question

  • In pediatric patients with seasonal allergic rhinitis, is nasal irrigation with hypertonic saline an effective adjunct therapy in qualitatively reducing rhinitis symptoms in comparison to patients who use standard medical therapy (i.e. antihistamines) alone?

Clinical Bottom Lines
  1. May recommend using saline nasal irrigation as an adjunct to antihistamine therapy due to minimal side effects, well-tolerated profile, but still very limited evidence that it is effective.


Summary of Key Evidence
1. Patients ages 6-12 years old enrolled with a specific allergy to a hayfever-inducing plant. 2. Exclusion criteria included absence of asthma symptoms, urticaria/eczema, and any other clinically significant allergens.
3. Over 6-week course, symptoms of rhinitis decreased qualitatively using a rhinitis score questionnaire, but clinical significance of the rhinitis score remains unknown.
4. Use of oral antihistamines was also decreased in the treatment group over same 6-week period, but baseline oral antihistamine use not recorded, and antihistamine use was not standardized to determine if nasal irrigation was truly functioning as an adjunct therapy.
5. More studies needed to determine frequency of optimal daily usage, and to compare hypertonic (3%) versus isotonic (0.9%) saline.
6. Hypertonic saline nasal irrigation was well tolerated with minimal/no adverse effects.
7. Results are only partially valid because patients were randomized, but the study was not blinded. Results are also partially valid because of a very small sample size and extremely narrow selection of patients, much narrower than our typical patient population, that were chosen to participate in the study.

Additional Comments

  • • “Randomized” does not mean a quality study – this was not blinded, and the sample size was only ten patients per arm.
    • There are other studies, better designed than this one, that do show some benefit to adults and children with allergic rhinitis, sinusitis, or upper respiratory symptoms. However, there is no consensus in solution concentration and frequency of use for optimal benefit.
    • One of the reasons a study like this was published was due to the minimal side effect profile and low cost to intervention. Otherwise, the study had an insufficient sample size to generate power, excluded real world patients (with allergies and asthma, for example), and had a symptom score card that was not validated to show clinical significance, among other things.

Citation

  1. Garavello W, Romagnoli M, Sordo L, Gaini RM, Di Berardino C, Angrisano A. “Hypersaline nasal irrigation in children with symptomatic seasonal allergic rhinitis: A randomized study.” Pediatr Allergy Immunol 2003: 14:140-143.
CAT Author: Smriti Mohan, MD

CAT Appraisers: James Gurney, PhD

Date appraised: <January 14, 2009

Last updated June 15, 2009
Department of Pediatrics and Communicable Diseases
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