Hay fever options

An interesting article written by a number of academics promises to give some relief to the 15% of Australians who experience hay fever, or allergic rhinitis.
Predictably, they list oral and nasal decongestants, antihistamines, nasal steroid sprays and immunotherapy as the best medical options.

I was therefore surprised to note the absence of isotonic saline as a clinically proven complementary therapy in allergic rhinitis.

The American Journal of Rhinology and Allergy published a study in 2012 which came to the conclusion that “nasal irrigation with normal saline in allergic rhinitis results in the improvement of symptoms, quality of life, and mucocilary clearance time” – this being a measure of proper/improper nasal mucosa function.

The conclusion continues: “The consumption of antiallergenic medication can also be decreased. Nasal irrigation represents a safe and inexpensive, non-pharmacological form of treatment.”

Another important consideration in today’s environment of cluttered categories is that isotonic rinsing is generally preferred to the hypertonic version. The reason for this recommendation is that optimal mucocilary transport can only be ensured at a neutral pH.

The use of a hypertonic solution in this research resulted in mild worsening of mucocilary clearance time in patients with allergic rhinitis, in contrast to the application in healthy subjects with chronic rhinosinusitis.

When comparing the results of adult patients and children, it became apparent that in children less than 15 years of age, improvement reaches a maximum of 20%, and it is up to 45.5% in adults.

The spectrum of what is called “nasal irrigation” is broad, reaching from applying a nasal spray to rinsing the nose with 250ml of saline solution. It seems obvious that this makes a difference in the subsequent effects.

The mechanism of action is still unknown. It has been assumed that mucosal function improves because of:

  • Direct physical cleansing by flushing out thick mucous, crusts, debris, allergens, air pollutants, etc.

  • The removal of inflammatory mediators.

  • Better mucociliary clearance by improving ciliary beat frequency.

My patients are fed up with ineffective remedies, in spite of superb marketing claims.

Make a real difference by recommending the addition of a strictly isotonic saline irrigation, based on evidence – not marketing.

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