Effectiveness of Saline Nasal Irrigation in the Treatment of Rhinosinusitis and Allergic Rhinitis in Pediatric Patients: A Systematic Review

Rhinosinusitis and allergic rhinitis are among the most common conditions of the upper airway in childhood, both presenting with nasal obstruction and rhinorrhea that can substantially impair quality of life.Alongside pharmacologic treatment, saline nasal irrigation has emerged as an inexpensive, accessible, and apparently well-tolerated nonpharmacologic measure, although its role in children remains incompletely defined.This systematic review aimed to evaluate the effectiveness of saline nasal irrigation in the treatment of rhinosinusitis and allergic rhinitis in the pediatric population.A systematic review was conducted in accordance with the PRISMA 2020 guidance.PubMed and the Cochrane Library were searched for randomized controlled trials and observational studies of saline nasal irrigation in children up to 18 years of age with rhinosinusitis or allergic rhinitis, compared with other effective medical therapy, published between 2014 and 2024 in English, Spanish, or Portuguese.Records were screened against predefined eligibility criteria, and data on study design, population, intervention, comparator, and outcomes were extracted.Of 50 records identified, 27 were removed for not meeting the PICO (population, intervention, comparator, and outcome) framework or for duplication, leaving 23 reports for full-text assessment; 21 were subsequently excluded, and two studies met all eligibility criteria.Both were prospective randomized controlled trials.The trial in acute sinusitis reported statistically significant between-group benefits favoring saline irrigation added to standard care, whereas the trial in allergic rhinitis and asthma reported significant within-group improvements in the irrigation group for several outcomes, without consistently significant between-group differences.In 60 children aged 3 to 12 years with acute sinusitis, all of whom completed the study, daily irrigation for three weeks significantly improved the nasal peak expiratory flow rate and pediatric rhinoconjunctivitis quality of life (p < 0.05), without a significant change in radiographic findings.In 20 children aged 6 to 18 years with allergic rhinitis and asthma, 12 weeks of twice-daily irrigation was associated with within-group improvements in bronchial hyperresponsiveness (PC20; p = 0.017), asthma control (p = 0.007), and disease-specific quality of life (p = 0.028) in the irrigation group, and reduced the proportion of moderate-to-severe persistent allergic rhinitis from 60% to 30% in that group (p = 0.003); the between-group difference in PC20 change was not statistically significant (p = 0.186), and forced expiratory volume in one second and fractional exhaled nitric oxide did not change significantly in either group.Reported adverse effects were minor and self-limited, including otalgia, aural fullness, and epistaxis, and did not compromise adherence.The available evidence indicates that adding saline nasal irrigation to standard treatment produces clinical and quality-of-life benefits in children with sinonasal disease, with a favorable safety profile.Given the small number of eligible studies and their methodological limitations, larger standardized trials are needed to consolidate these findings.