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Review
. 2012 Sep-Oct;26(5):e119-25.
doi: 10.2500/ajra.2012.26.3787.

Nasal irrigation as an adjunctive treatment in allergic rhinitis: a systematic review and meta-analysis

Kristina E Hermelingmeier  1 , Rainer K Weber, Martin Hellmich, Christine P Heubach, Ralph Mösges
Affiliations
Review

Nasal irrigation as an adjunctive treatment in allergic rhinitis: a systematic review and meta-analysis

Kristina E Hermelingmeier et al. Am J Rhinol Allergy. 2012 Sep-Oct.

Abstract

Background: Saline nasal irrigation (SNI) is often recommended as additional nonpharmacologic treatment, having proven its efficacy in acute and chronic rhinosinusitis and for therapy after sinonasal surgery. To date, however, no systematic review or meta-analysis exists showing the influence of SNI on allergic rhinitis (AR). This study aimed to establish the impact of SNI on symptoms of AR in different patient groups.

Methods: We conducted a systematic search of Medline, Embase, Cochrane Central Register of Controlled Trials, and ISI Web of Science databases for literature published from 1994 to 2010 on SNI in AR. Prospective, randomized, controlled trials that assessed the effects of SNI on four different outcome parameters were included. The evaluation focused on primary (symptom score) and secondary parameters (medicine consumption, mucociliary clearance, and quality of life).

Results: Three independent reviewers chose 10 originals that satisfied the inclusion criteria (>400 participants total) from 50 relevant trials. SNI performed regularly over a limited period of up to 7 weeks was observed to have a positive effect on all investigated outcome parameters in adults and children with AR. SNI produced a 27.66% improvement in nasal symptoms, a 62.1% reduction in medicine consumption, a 31.19% acceleration of mucociliary clearance time, and a 27.88% improvement in quality of life.

Conclusion: SNI using isotonic solution can be recommended as complementary therapy in AR. It is well tolerated, inexpensive, easy to use, and there is no evidence showing that regular, daily SNI adversely affects the patient's health or causes unexpected side effects.

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Figures

Figure 1.
Figure 1.
Flowchart of study selection.
Figure 2.
Figure 2.
Absolute improvements in symptom scores (assessment of heterogeneity: irrigation, q = 194.2, df(Q) = 5, p < 0.001, I2 = 97.4, τ2 ≥ 522.3; spray, q = 59.7, df(Q) = 2, p < 0.001, I2 = 96.7, τ2 = 372.1; overall, q = 385.5, df(Q) = 8, p < 0.001, I2 = 97.9, τ2 = 586.2).
Figure 3.
Figure 3.
Absolute improvements in medicine consumption (assessment of heterogeneity: irrigation, q = 25.3, df(Q) = 2, p < 0.000, I2 = 92.1, τ2 = 4214.9; overall, q = 25.3, df(Q) = 2, p < 0.000, I2 = 92.1, τ2 = 4214.9).
Figure 4.
Figure 4.
Absolute improvements in MCT (assessment of heterogeneity: spray, q = 0.4, df(Q) = 1, p < 0.542, I2 = 0.000, τ2 = 0.000; overall, q = 0.4, df(Q) = 1, p < 0.542, I2 = 0.000 τ2 = 0.000).
Figure 5.
Figure 5.
Absolute improvements in quality of life (assessment of heterogeneity: irrigation, q = 0.0, df(Q) = 0, p < 1.000, I2 = 0.0, τ2 = 0.0; spray, q = 0.000, df(Q) = 0, p < 1.000, I2 = 0.0, τ = 0.0; overall, q = 1.1, df(Q) = 1, p < 0.297, I2 = 7.7, τ2 = 1.5).
Figure 6.
Figure 6.
Relative improvements in symptom scores when comparing SNI users/nonusers (assessment of heterogeneity: q = 51.8, df(Q) = 3, p < 0.000, I2 = 94.2, τ2 = 631.8).
Figure 7.
Figure 7.
Relative improvements in medicine consumption when comparing SNI users/nonusers (assessment of heterogeneity: qe = 2.3, df(Q) = 2, p < 0.315, I2 = 13.4, τ2 = 128.3)/.
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