Self-Prepared Hypertonic Saline Nasal Irrigation as an Effective Adjuctive Treatment in Allergic Rhinitis along with Intranasal Steroids and Oral Antihistaminics: A Randomized Controlled Trial
- 1. Assistant Professor, Department of ENT, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai
- 2. Junior Resident, Department of ENT, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai
- 3. Professor & HOD, Department of ENT, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai
Description
Background: Allergic rhinitis is a global health problem, and the symptoms deeply affect a patient’s quality of life (QoL). The current treatment protocols consist of antihistamines and nasal steroids as mainstay. In any setting, AR usually requires chronic treatment, which raises safety concerns about long term drug usage and also its economic burden. Nasal irrigation with saline appears to be useful adjunctive tool improving nasal symptoms and QoL, and also decreasing drug consumption in a cost-efficient manner. Methods: A hospital based, open label, randomized controlled trial was conducted with 100 patients to assess the adjuvant effect of nasal irrigation in cases of allergic rhinitis undergoing regular treatment with oral anti-histaminic and intranasal steroids. 100 patients of AR were randomized into two groups – one receiving oral antihistaminic and intranasal steroid and the other group additionally also received nasal irrigation with self-prepared hypertonic saline for a period of 3 weeks with follow up at 6 weeks. Both the groups were compared on the basis of total symptom score and Rhino-conjunctivitis Quality of Life Questionnaire (RQLQ). Results: The study group was superior to the control group in terms of total symptom score and QoL (both P<0.001). Conclusion: Hypertonic Saline nasal irrigation when combined with Intranasal corticosteroids and oral antihistaminic demonstrates superior efficacy in managing symptoms and improving QoL. It also decreases drug dependence and is safe, easy to prepare and cost effective. Hence it is a worthy adjunctive tool to be considered in AR.
Abstract (English)
Background: Allergic rhinitis is a global health problem, and the symptoms deeply affect a patient’s quality of life (QoL). The current treatment protocols consist of antihistamines and nasal steroids as mainstay. In any setting, AR usually requires chronic treatment, which raises safety concerns about long term drug usage and also its economic burden. Nasal irrigation with saline appears to be useful adjunctive tool improving nasal symptoms and QoL, and also decreasing drug consumption in a cost-efficient manner. Methods: A hospital based, open label, randomized controlled trial was conducted with 100 patients to assess the adjuvant effect of nasal irrigation in cases of allergic rhinitis undergoing regular treatment with oral anti-histaminic and intranasal steroids. 100 patients of AR were randomized into two groups – one receiving oral antihistaminic and intranasal steroid and the other group additionally also received nasal irrigation with self-prepared hypertonic saline for a period of 3 weeks with follow up at 6 weeks. Both the groups were compared on the basis of total symptom score and Rhino-conjunctivitis Quality of Life Questionnaire (RQLQ). Results: The study group was superior to the control group in terms of total symptom score and QoL (both P<0.001). Conclusion: Hypertonic Saline nasal irrigation when combined with Intranasal corticosteroids and oral antihistaminic demonstrates superior efficacy in managing symptoms and improving QoL. It also decreases drug dependence and is safe, easy to prepare and cost effective. Hence it is a worthy adjunctive tool to be considered in AR.
Files
IJPCR,Vol15,Issue1,Article153.pdf
Files
(400.7 kB)
| Name | Size | Download all |
|---|---|---|
|
md5:8febe33f1c15893bc848cab71bf68640
|
400.7 kB | Preview Download |
Additional details
Dates
- Accepted
-
2023-01-20
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/15/IJPCR,Vol15,Issue1,Article153.pdf
- Development Status
- Active
References
- 1. Cibella F, Ferrante G, Cuttitta G, Bucchieri S, Melis MR, La Grutta S, Viegi G: The burden of rhinitis and rhino conjunctivitis in adolescents. Allergy Asthma Immunol Res 2015;7: 44–50. 2. Passalacqua G, Bousquet PJ, Carlsen KH, Kemp J, Lockey RF, Nigge- mann B, et al. ARIA update: I-systematic review of complementary and alternative medicine for rhinitis and asthma. J Allergy Clin Immunol. 2006;117(5):1054–62. 3. Over-the-counter Nasal Products for Sinus Congestion: a review of the clinical effectiveness. Ottawa: Canadian agency for drugs and technologies in health; 2016. https://cadth.ca/over-counternasal-products-sinus -congestion-reviewclinical-effectiveness. 4. Head K, Snidvongs K, Glew S, Scadding G, Schilder AG, Philpott C, et al. Saline irrigation for allergic rhinitis. Cochrane Database Syst Rev. 2018;6:CD012597 5. Jones NS, Carney AS, and Davis A. The prevalence of allergic rhinosinusitis: A review. J Laryngol Otol 112:1019–1030, 1998. 6. Röder E, Berger MY, Hop WC, de Groot H, Gerth van Wijk R: The relevance of patient reported outcomes in a grass pollen immunotherapy trial in children and adolescents with rhinoconjunctivitis. Pediatr Allergy Immunol 2013; 24:39– 48. 7. Zeiger R, and Shatz M. Chronic rhinitis: A practical approach to diagnosis and treatment part II: Treatment. Immunol Allergy Pract 4:26–36, 1982. 8. Talbot AR, Herr TM, and Parsons DS. Mucociliary clearance and buffered hypertonic saline solution. Laryngoscope 107:500–503, 1997. 9. Keojampa BK, Nguyen MH, Ryan MW. Efects of bufered saline solution on nasal mucociliary clearance and nasal airway patency. Otolaryngol Head Neck Surg. 2004;131(5):679–82. 10. Marchisio P, Varricchio A, Baggi E, Bianchini S, Capasso ME, Torretta S, Capaccio P, Gasparini C, Patria F, Esposito S, Principi N. Hypertonic saline is more effective than normal saline in seasonal allergic rhinitis in children. International journal of immunopathology and pharmacology. 2012 Jul; 25(3):721-30. 11. Suslu, M. Bajin, A. Suslu, Effects of buffered 2.3%, buffered 0.9%, and nonbuffered 0.9% irrigation solutions on nasal mucosa after septoplasty, Eur. Arch. Otorhinolaryngol. 2009; 226: 685– 689. 12. Satdhabudha A, Poachanukoon O. Efficacy of buffered hypertonic saline nasal irrigation in children with symptomatic allergic rhinitis. Int J Pediatr Otorhinolaryngol. 2012; 76:583-8 13. Park KH, Cho JS, Lee KH, Shin SY, Moon JH, Cha CI. Rhino conjunctivitis Quality of Life Questionnaire (RQLQ) as an Evaluator of Perennial Allergic Rhinitis Patients-The First Report-. Korean Journal of OtorhinolaryngologyHead and Neck Surgery. 2002 Mar 1;45(3):254-62. 14. J. Teeratakulpisarn, S. Wiangnon, P. Kosalaraksa, S. Heng, Surveying the prevalence of asthma, allergic rhinitis and eczema in school-children in Khon Kaen, Northeastern Thailand using the ISAAC questionnaire: phase 3, Asian Pac. J. Allergy Immunol. 2004; 22 (4): 175–181 15. D. Rabago, A. Zgierska, Saline nasal irrigation for upper respiratory conditions, Am. Fam. Physician. 2009; 1117–1119. 16. Rogkakou A, Guerra L, Massacane P, Baiardini I, Baena-Cagnani R. Effects on symptoms and quality of life of hypertonic saline nasal spray added to antihistamine in persistent allergic rhinitis-: A randomized controlled study. European annals of allergy and clinical immunology. 2005;37(9):353-6. 17. Cordray S, Harjo JB, Miner L. Comparison of intranasal hypertonic dead sea saline spray and intranasal aqueous triamcinolone spray in seasonal allergic rhinitis. Ear, nose & throat journal. 2005 Jul;84(7):426-30. 18. Li H, Sha Q, Zuo K, Jiang H, Cheng L, Shi J, Xu G. Nasal saline irrigation facilitates control of allergic rhinitis by topical steroid in children. Orl. 2009;71(1):50-5.