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Ovid MEDLINE; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials.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.

A multicenter survey on the effectiveness of nasal irrigation devices in rhinosinusitis patients

“…The patient questionnaire was developed based on the available literature 13‐17 and expert opinion and consisted of questions regarding general personal information, devices used, saline solution concentration, and effectiveness scores ranging from 0 to 10 (0 = strongly disagree, 10 = strongly agree) that covered disease severity, convenience of use, learning curve, and device satisfaction. For patients who had used more than one device, their opinions regarding the device they most recently used were collected.…”

Nasal saline irrigation: prescribing habits and attitudes of physicians and pharmacists

“…Many over-the-counter treatments claim to alleviate nasal symptoms, but their efficacy remains largely unproven [4]. In nasal saline irrigation (NSI) the patient rinses nasal cavities by instilling either isotonic or hypertonic saline solution into one nostril and allows it to drain out from the other nostril [5][6][7][8]. Some believe it is an efficient, cheap and safe alternative treatment [9].…”

Cochrane Corner: Saline irrigation: a cheap and effective treatment for allergic rhinitis

“…2 CliniCal boTTom line: This Cochrane review showed that people who suffer from allergic rhinitis benefitted from using saline irrigation both in the short and long-term. 3 No adverse effects were reportedly associated with the use of saline irrigation but it is unclear how competently the studies carried out this assessment. 3 There was no evidence to suggest that saline irrigation was less effective than nasal corticosteroids or antihistamines but this may have been due to a lack of available evidence.…”

“…3 No adverse effects were reportedly associated with the use of saline irrigation but it is unclear how competently the studies carried out this assessment. 3 There was no evidence to suggest that saline irrigation was less effective than nasal corticosteroids or antihistamines but this may have been due to a lack of available evidence. 3 No harms with respect to saline irrigation were identified.…”

“…3 There was no evidence to suggest that saline irrigation was less effective than nasal corticosteroids or antihistamines but this may have been due to a lack of available evidence. 3 No harms with respect to saline irrigation were identified.…”