Safya E Esmaeel, Reem Ibrahim S Alanazi, Osama Omar A Albladi, Rakan Faleh H Alharbi, Turki Abdullah S Alwasil, Daniya Sulaiman A Alanazi, Maisa Hassan B Almazyad, Abdullah Bader F Almutairi, Deem Saud K Alanazi, Baraah Abu Alsel, Manal S Fawzy, Eslam K Fahmy, Yehia Nabil
Nasal saline irrigation is an effective and safe intervention for children and adolescents with allergic rhinitis, offering clinically meaningful improvements in nasal symptoms and a significant medication-sparing effect. NSI can reasonably be considered as an adjunctive therapy alongside standard pharmacological care, with the choice of saline tonicity potentially tailored to the predominant symptom phenotype, although the predominance of high risk-of-bias evidence warrants confirmation in more rigorous trials.
PURPOSE: To critically evaluate and synthesize evidence from controlled trials regarding the efficacy and safety of nasal saline irrigation (NSI), utilizing both isotonic and hypertonic solutions, for the treatment of allergic rhinitis (AR) exclusively in children and adolescents aged 18 years or younger.
METHODS: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. A comprehensive search of PubMed/MEDLINE, Embase, Cochrane CENTRAL, Scopus, and Web of Science was performed for studies published up to May 2025. Eligibility criteria included randomized and non-randomized controlled trials comparing NSI (isotonic 0.9% or hypertonic >0.9%) against standard pharmacological care or no intervention in pediatric populations with physician-confirmed AR. Primary outcomes assessed were changes in nasal symptom scores, rescue antihistamine use, and disease control scores, with the certainty of evidence evaluated using the GRADE approach.
RESULTS: Seven studies involving a total of 462 participants met the inclusion criteria. The pooled analysis demonstrated that NSI resulted in a large and statistically significant reduction in nasal symptom scores compared with controls (Standardized Mean Difference [SMD] -1.29; 95% CI -1.98 to -0.60), supported by low-certainty evidence. Furthermore, NSI was associated with a significant decrease in rescue antihistamine use (SMD -1.38; 95% CI -2.50 to -0.26; very low certainty). Although a trend toward improved disease control was observed (SMD 0.53), it did not reach statistical significance (95% CI -0.03 to 1.08), and the evidence was graded as very low certainty. Adverse events were minor (e.g., nasal irritation) and infrequent, with no serious safety concerns reported.
CONCLUSION: Nasal saline irrigation is an effective and safe intervention for children and adolescents with allergic rhinitis, offering clinically meaningful improvements in nasal symptoms and a significant medication-sparing effect. NSI can reasonably be considered as an adjunctive therapy alongside standard pharmacological care, with the choice of saline tonicity potentially tailored to the predominant symptom phenotype, although the predominance of high risk-of-bias evidence warrants confirmation in more rigorous trials.