Here Comes Spring … And Seasonal Allergies

Spring is upon us, and that brings popping tulips, blooming buds, and, for some, horrible seasonal allergies.  My daughter’s allergy symptoms include swollen and itchy eyes, wheezing, headaches, and general aches, so Spring often means several days of misery for us.  But last Spring we used an electronic neti pot to wash out her nasal passages, and her symptoms improved.  What’s the science behind nasal irrigation, and does it really work? Surprisingly, this is one subject where the data are consistent: nasal irrigation is known to decrease allergy symptoms, decrease the need for allergy medications, and to decrease histamine concentrations in the nose.  All positive things when dealing with a major case of seasonal allergies. 

What the research says:

I’ve always suffered from seasonal allergies, but my suffering is minor compared to my daughter’s.  I sneeze repeatedly and have itchy eyes, but that’s the extent of it.  My daughter’s symptoms, on the other hand, include swollen and itchy eyes, wheezing, nasal congestion, headaches, and general malaise.  So Spring is often a mixed blessing for us; we look forward to the popping of tulips and the blooming of buds, but we worry about the pollen count and whether or not she’ll be able to go outside during recess. 

Last year, while perusing the allergy medicine section of our local pharmacy, the pharmacist recommended nasal irrigation for our daughter.  I’d never heard of it, but was intrigued when she said it had eased her daughter’s allergies dramatically.  We purchased a motorized neti pot and began flushing our daughter’s nose morning and night.  And it did help.  It helped quite a bit. Her symptoms improved, she was able to play outside, and we could miss an allergy pill or two without causing a flare up.  But afterwards, I wondered if that her improvement had been happenstance.  Was it really happenstance, or should I dust off the neti pot to prepare for this Spring’s arrival?  What’s the latest research on nasal irrigation, and does it really work?

What is nasal irrigation?

First, let’s start with some definitions from Wikipedia:

Nasal irrigation is the practice in which the nasal cavity is flushed with saline to remove excess mucus and debris from the nose and sinuses.

Allergic rhinitis is the medical term for inflammation in the nasal cavity caused by allergens such as pollen or dander. 

To put it very simply, allergies are caused by allergens, and nasal irrigation helps wash the allergens out of your nose. Your nose is responsible for clearing out allergens and other things using mucus and cilia. Pollen, dust and dander are “trapped on the thin mucus blanket that covers the nasal respiratory epithelium and then slowly moved by rapidly beating cilia to the back of the nose, to be swallowed” [14].  The jury is still out as to how exactly irrigation works, as studies point to nasal irrigation enhancing both the movement of mucus and the beating of the cilia.  But no matter the exact mechanism, nasal irrigation does help ease your body’s response to allergens.  Or at least that’s what the studies show.

What do the studies show?

Reviewing the clinical results is simple for nasal irrigation, as a relatively small number of studies have been done and their results have been very consistent.  Studies have persistently found that nasal irrigation is beneficial when used for allergic rhinitis.  These benefits include:

  • Decreased allergy symptoms [1, 2,3,5,7,8,10,11,12,13]:  The symptoms of allergic rhinitis include runny nose, stuffy nose, itchy nose, sneezing, itchy eyes and head and facial pain, and these symptoms are improved with nasal irrigation [1, 2,3,5,7,8,10,11,12,13].   Symptoms usually improve within 2-4 weeks after the start of nasal irrigation. 
  • Decrease consumption of allergy medications [1,3,5,7,13].  “The duration of oral antihistamines was significantly lower” when comparing children using nasal irrigation to those who did not [1], and similar results were obtained in other studies.
  • Decreased histamine concentration in the nose [13]. “Patients given nasal irrigation through a modified Water Pik® device had lower concentrations of nasal histamine (compared with baseline) immediately following treatment and at 2, 4, and 6 hours after treatment” [13].  Because histamine receptors are the receptors primarily involved in allergic rhinitis symptoms, having decreased histamine concentrations is believed to lead to decreased allergic symptoms.

Nasal irrigation is typically used as an adjunct therapy, or in addition to other treatments, such as antihistamines. However, results point to the effectiveness of nasal irrigation to alleviate allergy symptoms even when used alone.  For example, Tomooka et al. reported the following:

“Although there was a trend toward greater improvement in patients who used additional medications, no statistically significant differences were identified between these two patient groups” [12]

So the improvement in symptoms was similar for those who used nasal irrigation only versus those who used nasal irrigation along with other treatments. 

There can be adverse reactions with this technique, however.  Some have reported irritation and discomfort [12] after using nasal irrigation.   However, the incidence of irritation and discomfort seem to be less when slightly basic [8], hypertonic [15], buffered saline solutions that are slightly warm are used.

What does this all mean?

I’ll rely on the conclusions of Papsin et al. to summarize these findings:  “Clinical evidence is mounting that nasal irrigation is an effective, inexpensive adjunct treatment for symptom relief of sinus discomfort and disease. The procedure has been used safely by both adults and children and has no documented serious adverse effects” [13].  There’s really not much I can add, except that I’m cleaning out our neti pot tonight in preparation for Spring. 

References:

  1. Hypertonic saline is more effective than normal saline in seasonal allergic rhinitis in children. Marchisio P, Varricchio A, Baggi E, Bianchini S, Capasso ME, Torretta S, Capaccio P, Gasparini C, Patria F, Esposito S, Principi N. Int J Immunopathol Pharmacol. 2012 Jul-Sep;25(3):721-30.
  2. Is nasal saline irrigation all it is cracked up to be? Khianey R, Oppenheimer J. Ann Allergy Asthma Immunol. 2012 Jul;109(1):20-8.
  3. Efficacy of buffered hypertonic saline nasal irrigation in children with symptomatic allergic rhinitis: a randomized double-blind study. Satdhabudha A, Poachanukoon O. Int J Pediatr Otorhinolaryngol. 2012 Apr;76(4):583-8.
  4. Effectiveness of Ischia thermal water nasal aerosol in children with seasonal allergic rhinitis: a randomized and controlled study. Miraglia Del Giudice M, Decimo F, Maiello N, Leonardi S, Parisi G, Golluccio M, Capasso M, Balestrieri U, Rocco A, Perrone L, Ciprandi G. Int J Immunopathol Pharmacol. 2011 Oct-Dec;24(4):1103-9.
  5. Nasal rinsing with hypertonic solution: an adjunctive treatment for pediatric seasonal allergic rhinoconjunctivitis. Garavello W, Di Berardino F, Romagnoli M, Sambataro G, Gaini RM. Int Arch Allergy Immunol. 2005 Aug;137(4):310-4.
  6. Is hypertonic saline better than normal saline for allergic rhinitis in children? Degirmencioglu H, Karadag A, Avci Z, Kurtaran H, Catal F. Pediatr Allergy Immunol. 2004 Apr;15(2):190.
  7. Hypersaline nasal irrigation in children with symptomatic seasonal allergic rhinitis: a randomized study. Garavello W, Romagnoli M, Sordo L, Gaini RM, Di Berardino C, Angrisano A. Pediatr Allergy Immunol. 2003 Apr;14(2):140-3.
  8. Comparison of buffered and nonbuffered nasal saline irrigations in treating allergic rhinitis.  Chusakul S, Warathanasin S, Suksangpanya N, Phannaso C, Ruxrungtham S, Snidvongs K, Aeumjaturapat S. Laryngoscope. 2013 Jan;123(1):53-6.
  9. Decongestants, antihistamines and nasal irrigation for acute sinusitis in children. Shaikh N, Wald ER, Pi M. Cochrane Database Syst Rev. 2012 Sep 12;9:CD007909.
  10. Nasal saline irrigation facilitates control of allergic rhinitis by topical steroid in children. Li H, Sha Q, Zuo K, Jiang H, Cheng L, Shi J, Xu G. ORL J Otorhinolaryngol Relat Spec. 2009;71(1):50-5.
  11. Nasal irrigation for chronic sinus symptoms in patients with allergic rhinitis, asthma, and nasal polyposis: a hypothesis generating study. Rabago D, Guerard E, Bukstein D. WMJ. 2008 Apr;107(2):69-75.
  12. Clinical study and literature review of nasal irrigation.  Tomooka LT, Murphy C, Davidson TM.  Laryngoscope. 2000 Jul;110(7):1189-93.
  13. Saline nasal irrigation: Its role as an adjunct treatment. Papsin B, McTavish A. Can Fam Physician. 2003 Feb;49:168-73. Review.
  14. An explanation for the seasonality of acute upper respiratory tract viral infections. Eccles R. Acta Otolaryngol. 2002 Mar;122(2):183-91.
  15. Nasal irrigations: good or bad? Brown CL, Graham SM. Curr Opin Otolaryngol Head Neck Surg. 2004 Feb;12(1):9-13.