Hypertonic Saline is More Effective Than Normal Saline in Seasonal Allergic Rhinitis in Children

Abstract

Allergic rhinitis (AR) is a very common childhood disease that is associated with a significant reduction in the patients' quality of life. Its treatment combines educating the patients and their parents, immunotherapy and drug administration. However, even the best approach does not relieve the symptoms of a number of patients. Alternative therapies are particularly needed for children because the fear of adverse events frequently reduces parental compliance to the prescribed drugs, and immunotherapy is less easy to administer than in adults. In this prospective investigator-blinded study we evaluated whether children, with a documented history of seasonal grass pollen-related AR, benefit from nasal irrigation by assessing the effects on nasal signs and symptoms, on middle ear effusion and on adenoidal hypertrophy. We randomized children aged 5 to 9 years (median age 82 months) to normal saline or hypertonic saline (a 2.7% sodium chloride solution), administered twice-daily using a disposable 20 ml syringe, or no treatment. Nasal symptoms (rhinorrhea, itching, sneezing, nasal obstruction), swelling of turbinates, adenoid hypertrophy or middle ear effusion were assessed at baseline and after 4 weeks of treatment. Two hundred and twenty children (normal saline: 80; hypertonic saline: 80; no treatment: 60) completed the study. After four weeks, all the considered items were significantly reduced in the group receiving hypertonic saline (P <0.0001), whereas in the group receiving normal saline only rhinorrhea (P = 0.0002) and sneezing (P = 0.002) were significantly reduced. There was no significant change in any of the items in the control group. The duration of oral antihistamines was significantly lower in the children receiving hypertonic saline than in those treated with normal saline or in controls. No adverse events were reported and parental satisfaction and compliance with the procedure were globally very good, regardless of the solution used. Using our procedure, hypertonic saline is effective, inexpensive, safe, well tolerated and easily accepted by children with seasonal grass pollen-related AR and their parents. Our data suggest that nasal irrigation with hypertonic saline might be included in the wide spectrum of therapies recommended for grass-pollen AR.

Nasal saline irrigation in preschool children: a survey of attitudes and prescribing habits of primary care pediatricians working in northern Italy

“…[12] found that family physicians in Wisconsin included children aged <7 years among the subjects eligible for NSI. The opinion of these physicians concerning the tolerability of NSI is similar to that of the primary care pediatricians enrolled in this study, and is supported by the data collected in other studies evaluating the effect of NSI on children [3-8]. The incidence of adverse events following NSI was usually very low, and most of the studies highlighted the fact that they were not severe enough to preclude continuing treatment.…”

“…A number of recent studies have shown that nasal saline irrigation (NSI), a practice widely used to treat upper respiratory tract diseases in adults [1,2], can also be effective in children with infectious and/or allergic respiratory problems not only as adjunctive treatment, but also alone [3-8]. NSI significantly reduces nasal secretions/post-nasal drip in children with chronic rhinosinusitis, and considerably improves radiographic signs of disease [3]; it also reduces the need for surgery even in patients resistant to medical treatment with antibiotics and nasal corticosteroids [4,5].…”

“…[7] and Marchisio et al . [8] have found that it reduces signs and symptoms of seasonal allergic rhinitis and limits the need for antihistamines. All of these studies showed that NSI is safe and well tolerated because there were no severe adverse events and only a minority of children had to discontinue the treatment because of poor tolerance [3-8].…”

“…[8] have found that it reduces signs and symptoms of seasonal allergic rhinitis and limits the need for antihistamines. All of these studies showed that NSI is safe and well tolerated because there were no severe adverse events and only a minority of children had to discontinue the treatment because of poor tolerance [3-8]. It has also been shown that the procedure is quite inexpensive and reduces the use of prescription and over-the-counter medications, and therefore have a substantial impact not only on medical costs, but also on antibiotic pressure and the associated antibiotic resistance [9].…”

Efficacy of Buffered Hypertonic Saline Nasal Irrigation for Nasal Symptoms in Children with Seasonal Allergic Rhinitis: A Randomized Controlled Trial

“…It is known that hypertonicity can reduce mucosal oedema due to osmotic pressure-induced water transport through the epithelial membrane, improving mucociliary clearance [19]. Previous data reported the efficacy of nasal irrigation with hypertonic saline solution in children with AR [20,21].…”