Steroid-sparing nasal irrigation for allergic rhinitis?

Jala Neti (saline nasal irrigation) involves using a special “neti pot” filled with warm, slightly salted water.

Researchers from Nanjing Medical University, in China report, “It permitted the use of less topical steroids for controlling allergic rhinitis in children.”

First, the details.

• 26 children with allergic rhinitis were divided into 3 treatment groups.
  • Nasal saline irrigation + topical steroid
  • Nasal saline irrigation alone
  • Topical steroid alone
• The dose of topical steroids was tapered at weeks 8 and 12.
• Symptoms and signs of allergic rhinitis and mucociliary clearance (removal of mucus from the airways) were evaluated.
• The concentration of soluble intercellular adhesion molecule (sICAM)-1 in nasal secretions was measured.
  • ICAM-1 levels increase in patients with allergic rhinitis following exposure to an allergen.

And, the results.

• In children treated with irrigation + steroids, tapering the dose of topical steroid at week 8 and week 12 was associated with a significant improvement in symptoms and signs.
  • It’s not sated if this was tried in the steroid only group for comparative purposes.
• Mucociliary clearance and concentrations of sICAM-1 in nasal secretions significantly decreased.

The bottom line?
The authors concluded, “Nasal saline irrigation can be viewed as a good adjunctive treatment option for allergic rhinitis. It permitted the use of less topical steroids for controlling allergic rhinitis in children, which will contribute to fewer side effects and less economic burden.”

This is the first study to report a steroid-sparing effect of the neti pot.

Contrary to this, a Cochrane review from 2007 concluded, “Saline is not as effective as an intranasal steroid.” Although they did agree that saline was beneficial to treat the symptoms of chronic rhinosinusitis when used alone and when added to other treatments.

Here’s a video demonstrating the correct technique for using the neti pot. And MayoClinic.com has instructions for making the solution.

4/15/09 10:34 JR