Assessing Subjective and Clinical Response to Flunisolide and Saline Nasal Irrigation In Patients With Allergic Rhinitis
DOI:
https://doi.org/10.51253/pafmj.v76iSUPPL-5.11710Keywords:
Allergic rhinitis, Flunisolide nasal spray, Saline nasal irrigationAbstract
Objective: To assess subjective and clinical response to flunisolide and saline irrigation in patients with allergic rhinitis.
Study Design: Quasi-experimental study.
Place and Duration of Study: Combined Military Hospital (CMH), Rawalpindi, Pakistan, from Feb 2023 to Jan 2024.
Methodology: With consecutive sampling technique, 116 participants were included in the study. Those patients who were prescribed flunisolide nasal spray were labeled as the “exposed group” whereas patients receiving normal saline irrigation constituted the “unexposed/ control group”. After 3 months, every patient had a thorough evaluation which included an endoscopic nasal examination, and a review of Sinonasal Outcome Test-22 (SNOT-22) questionnaire.
Results: Study included 81(69.80%) males and 35(30.20%) females. Mean age of the participants was 33.18±7.96 years. The change in median SNOT score after treatment was 37 in exposed group as compared to 14 in unexposed group which was statistically significant (p < 0.001). Individually, 16 out of 22 symptoms checked by SNOT questionnaire (all except dizziness, ear pain, facial pain, difficulty falling asleep, lack of good night sleep and fatigue) showed statistically significant improvement (p < 0.001) when flunisolide nasal spray was used instead of saline nasal irrigation.
Conclusion: Flunisolide is more effective in controlling symptoms of allergic rhinitis (AR) as compared to normal saline after a period of 3 months. These findings allow the therapy of allergic rhinitis to be tailored depending upon the specific symptoms of each patient.
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1. Öçal R, Bayar Muluk N, Mullol J. Epidemiology of allergic rhinitis. In: All Around the Nose: Basic Science, Diseases and Surgical Management. Cham: Springer; 2020. p. 297-301. https://doi.org/10.1007/978-3-030-21217-9_33
2. Liva GA, Karatzanis AD, Prokopakis EP. Review of rhinitis: classification, types, pathophysiology. J Clin Med. 2021; 10(14): 3183. https://doi.org/10.3390/jcm10143183
3. Komnos ID, Michali MC, Asimakopoulos AD, Basiari LV, Kastanioudakis IG. The effect of allergic rhinitis on quality of life in patients suffering from the disease: a case control study. Int J Otolaryngol Head Neck Surg. 2019; 8(4): 121-131. https://doi.org/10.4236/ijohns.2019.84014
4. Bousquet J, Toumi M, Sousa-Pinto B, Anto JM, Bedbrook A, Czarlewski W, et al. The allergic rhinitis and its impact on asthma (ARIA) approach of value-added medicines: as-needed treatment in allergic rhinitis. J Allergy Clin Immunol Pract. 2022; 10(11): 2878-2888. https://doi.org/10.1016/j.jaip.2022.07.020
5. Watts AM, Cripps AW, West NP, Cox AJ. Modulation of allergic inflammation in the nasal mucosa of allergic rhinitis sufferers with topical pharmaceutical agents. Front Pharmacol. 2019; 10: 294. https://doi.org/10.3389/fphar.2019.00294
6. Daley-Yates PT, Larenas-Linnemann D, Bhargave C, Verma M. Intranasal corticosteroids: topical potency, systemic activity and therapeutic index. J Asthma Allergy. 2021; 14: 1093-1104. https://doi.org/10.2147/JAA.S321332
7. Wang Y, Jin L, Liu SX, Fan K, Qin ML, Yu SQ. Role of nasal saline irrigation in the treatment of allergic rhinitis in children and adults: a systematic analysis. Allergol Immunopathol. 2020; 48(4): 360-367. https://doi.org/10.1016/j.aller.2020.01.002
8. Sy RK. Flunisolide intranasal spray in the treatment of perennial rhinitis. Arch Otolaryngol. 1979; 105(11): 649-653. https://doi.org/10.1001/archotol.1979.00790230019004
9. Dean AG, Sullivan KM, Soe MM. OpenEpi: Open Source Epidemiologic Statistics for Public Health 2013 [Internet]. Version 3.01. Available from: https://www.openepi.com/SampleSize/SSCohort.html
10. Kang TW, Chung JH, Cho SH, Lee SH, Kim KR, Jeong JH. The effectiveness of budesonide nasal irrigation after endoscopic sinus surgery in chronic rhinosinusitis with asthma. Clin Exp Otorhinolaryngol. 2017; 10(1): 91-96. https://doi.org/10.21053/ceo.2016.00220
11. Hopkins C, Gillett S, Slack R, Lund VJ, Browne JP. Psychometric validity of the 22-item Sinonasal Outcome Test. Clin Otolaryngol. 2009; 34(5): 447-454.
https://doi.org/10.1111/j.1749-4486.2009.01995.x
12. Piccirillo JF, Edwards D, Haiduk A, Yonan C, Thawley SE. Psychometric and clinimetric validity of the 31-item rhinosinusitis outcome measure (RSOM-31). Am J Rhinol. 1995; 9(6): 297-308. https://doi.org/10.2500/105065895781808711
13. Al-Digheari A, Mahboub B, Tarraf H, Yucel T, Annesi-Maesano I, Doble A, et al. The clinical burden of allergic rhinitis in five Middle Eastern countries: results of the SNAPSHOT program. Allergy Asthma Clin Immunol. 2018; 14: 63. https://doi.org/10.1186/s13223-018-0298-x
14. Bjermer L, Westman M, Holmström M, Wickman M. The complex pathophysiology of allergic rhinitis: scientific rationale for the development of an alternative treatment option. Allergy Asthma Clin Immunol. 2019; 15: 24.
https://doi.org/10.1186/s13223-018-0314-1
15. Feuille EJ, Phipatanakul W, Permaul P. Conventional medications for the treatment of allergic rhinitis and conjunctivitis. In: Boguniewicz M,-editor. Allergic and Immunologic Diseases. London: Elsevier; 2022. p. 1077-1109.
https://doi.org/10.1016/B978-0-323-95061-9.00038-2
16. Anolik R. Clinical benefits of combination treatment with mometasone furoate nasal spray and loratadine vs monotherapy with mometasone furoate in the treatment of seasonal allergic rhinitis. Ann Allergy Asthma Immunol. 2008; 100(3): 264-71. https://doi.org/10.1016/S1081-1206(10)60452-8
17. Ishak MN, Md Shukri N, Ramli RR. The effectiveness of budesonide nasal irrigation in patients with allergic rhinitis. Malays J Med Sci. 2022; 29(1): 34-42.
https://doi.org/10.21315/mjms2022.29.1.4
18. Hermelingmeier KE, Weber RK, Hellmich M, Heubach CP, Mösges R. Nasal irrigation as an adjunctive treatment in allergic rhinitis: a systematic review and meta-analysis. Am J Rhinol Allergy. 2012; 26(5): e119-125. https://doi.org/10.2500/ajra.2012.26.3787
19. Satdhabudha A, Poachanukoon O. Efficacy of buffered hypertonic saline nasal irrigation in children with symptomatic allergic rhinitis: a randomized double-blind study. Int J Pediatr Otorhinolaryngol. 2012; 76(4): 583-588. doi: https://doi.org/10.1016/j.ijporl.2012.01.022
20. Yata K, Srivanitchapoom C. The comparison of nasal irrigation outcome between 3% NaCl and 0.9% NaCl in adults majority with intermittent allergic rhinitis: a randomized double-blind study. Asian Pac J Allergy Immunol. 2021; 39(1): 9-14. https://doi.org/10.12932/AP-140520-0844
21. Segboer C, Gevorgyan A, Avdeeva K, Chusakul S, Kanjanaumporn J, Aeumjaturapat S, et al. Intranasal corticosteroids for non-allergic rhinitis. Cochrane Database Syst Rev. 2019;11:CD010592.
https://doi.org/10.1002/14651858.CD010592.pub2
22. Tran NP, Vickery J, Blaiss MS. Management of rhinitis: allergic and non-allergic. Allergy Asthma Immunol Res. 2011; 3(3): 148-156. https://doi.org/10.4168/aair.2011.3.3.148
23. Scadding GK. Corticosteroids in the treatment of pediatric allergic rhinitis. J Allergy Clin Immunol. 2001; 108(1 Suppl): S59-64. https://doi.org/10.1067/mai.2001.115568
24. Periasamy N, Pujary K, Bhandarkar AM, Bhandarkar ND, Ramaswamy B. Budesonide vs saline nasal irrigation in allergic rhinitis: a randomized placebo-controlled trial. Otolaryngol Head Neck Surg. 2020; 162(6): 979-984. https://doi.org/10.1177/0194599820919363
25. Afridi AU, Khan RZ, Wahab U, Nasir A, Ahmed Z, Iqbal S. Using intranasal corticosteroids and oral antihistamines to treat allergic rhinitis: a comparison of the mean total nasal symptom score. Ann Punjab Med Coll. 2023; 17(3): 358-360. https://doi.org/10.29054/apmc/2023.1449
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