Cochrane for Clinicians

Putting Evidence into Practice

Saline Irrigation for Allergic Rhinitis


Am Fam Physician. 2019 May 1;99(9):544-545.

Author disclosure: No relevant financial affiliations.

Clinical Question

Is nasal saline irrigation an effective treatment for allergic rhinitis?

Evidence-Based Answer

Nasal saline irrigation reduces the severity of allergy symptoms for up to eight weeks vs. no treatment. It is uncertain if adding nasal saline to pharmacologic treatment further improves symptoms over pharmacologic treatment alone. It is also unclear whether there is any difference in symptom outcomes when comparing the use of nasal saline and intranasal corticosteroids. Nasal saline is well tolerated.1 (Strength of Recommendation: B, recommendation based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Allergic rhinitis is an immunoglobulin E–mediated nasal hypersensitivity to allergens. It often presents as rhinorrhea, sneezing, and nasal itching and may include other symptoms such as conjunctivitis and ear pain or fullness. Patients with allergic rhinitis can also have impaired sleep and social interactions, leading to a decreased quality of life. The prevalence of allergic rhinitis in the United States currently varies between 10% and 30% for adults and up to 40% for children, making this a common condition encountered by the family physician.2

This Cochrane review included 14 studies with a total of 747 participants (seven randomized controlled trials [RCTs], 260 adults; seven RCTs, 487 children) from China, Italy, Thailand, Turkey, and the United States.1 All of the studies were parallel-group RCTs; only two studies were described as single-blinded and the remaining 12 were nonblinded. The volume of saline used in the studies varied from less than 5 mL per nostril per application to more than 60 mL per nostril per application. The type of saline varied as well, ranging from hypertonic to isotonic. Treatment duration was one to 12 weeks across the different comparisons.

Primary outcomes included disease severity as measured by patient-reported symptom scores, including the Total Nasal Symptom Score (a five-item questionnaire

Author disclosure: No relevant financial affiliations.


1. Head K, Snidvongs K, Glew S, et al. Saline irrigation for allergic rhinitis Cochrane Database Syst Rev. 2018;(6):CD012597.

2. Mims JW. Epidemiology of allergic rhinitis. Int Forum Allergy Rhinol. 2014;4(S2):S18–S20.

3. Brożek JL, Bousquet J, Agache I, et al. Allergic rhinitis and its impact on asthma (ARIA) guidelines—2016 revision. J Allergy Clin Immunol. 2017;140(4):950–958.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at



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