Efficacy of buffered hypertonic saline nasal irrigation in children with symptomatic allergic rhinitis: a randomized double-blind study

Int J Pediatr Otorhinolaryngol. 2012 Apr;76(4):583-8. doi: 10.1016/j.ijporl.2012.01.022. Epub 2012 Feb 11.


Background: Nasal irrigation has been used as an adjunctive therapy of allergic rhinitis (AR). Available evidence suggested that buffered hypertonic saline (BHS) is superior to buffer normal saline (BNS) for relief nasal symptoms.

Objective: To evaluate the effectiveness of BHS nasal irrigation in the management of children with symptomatic AR.

Design: This was a randomized, prospective, double-blind placebo-controlled study.

Methods: The present study was a randomized prospective double-blind placebo-controlled study. Eighty-one children with symptomatic AR who had a total nasal symptom score (TNSS)≥4 were included in this study. Each participant was randomly treated with either normal saline (NSS) or BHS by a blinded investigator. Nasal saccharine clearance time (SCT) and TNSS were measured before and 10 min after nasal irrigation. Quality of life (QoL) was assessed using the questionnaire for Thai allergic rhinoconjunctivitis patients (Rcq-36). The 7-point Likert scale for satisfaction was also performed. All participants were assigned to perform nasal irrigation twice daily for the period of 4 weeks. During this period, they recorded TNSS, side effects and antihistamine use on daily diary card. A physical examination and subjective evaluation were performed at 2nd and 4th week visits, and daily diary cards were collected.

Results: Patients with BHS were significantly improved in SCT (39.2% versus 15.5%, P=0.009) and TNSS (82.7% versus 69.3%, P=0.006) compared to the NSS group. However, at 2nd and 4th week both groups had improvement in TNSS and QoL compared to baseline visit. There was a significant improvement in mean QoL score in BHS group at 2nd week visit compared to NSS group (P=0.04) but not at the 4th week. Nasal congestion but not TNSS was significantly improved in the BHS group (P=0.04). Moreover, a decreased use of oral antihistamine was observed in BHS group (P=0.04). There were few complaints reported, and side effects were seen equally in both groups.

Conclusion: Nasal irrigation with BHS causes an improvement in SCT, TNSS and QoL compare to NS in children with symptomatic AR.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Buffers
  • Child
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Mucociliary Clearance
  • Nasal Lavage*
  • Patient Satisfaction
  • Prospective Studies
  • Quality of Life
  • Rhinitis, Allergic, Seasonal / complications*
  • Rhinitis, Allergic, Seasonal / therapy*
  • Saline Solution, Hypertonic / administration & dosage*
  • Treatment Outcome


  • Buffers
  • Saline Solution, Hypertonic