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      Nasal irrigation as an adjunctive treatment in allergic rhinitis: A systematic review and meta-analysis

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          Abstract

          Background:

          Saline nasal irrigation (SNI) is often recommended as additional nonpharmacologic treatment, having proven its efficacy in acute and chronic rhinosinusitis and for therapy after sinonasal surgery. To date, however, no systematic review or meta-analysis exists showing the influence of SNI on allergic rhinitis (AR). This study aimed to establish the impact of SNI on symptoms of AR in different patient groups.

          Methods:

          We conducted a systematic search of Medline, Embase, Cochrane Central Register of Controlled Trials, and ISI Web of Science databases for literature published from 1994 to 2010 on SNI in AR. Prospective, randomized, controlled trials that assessed the effects of SNI on four different outcome parameters were included. The evaluation focused on primary (symptom score) and secondary parameters (medicine consumption, mucociliary clearance, and quality of life).

          Results:

          Three independent reviewers chose 10 originals that satisfied the inclusion criteria (>400 participants total) from 50 relevant trials. SNI performed regularly over a limited period of up to 7 weeks was observed to have a positive effect on all investigated outcome parameters in adults and children with AR. SNI produced a 27.66% improvement in nasal symptoms, a 62.1% reduction in medicine consumption, a 31.19% acceleration of mucociliary clearance time, and a 27.88% improvement in quality of life.

          Conclusion:

          SNI using isotonic solution can be recommended as complementary therapy in AR. It is well tolerated, inexpensive, easy to use, and there is no evidence showing that regular, daily SNI adversely affects the patient's health or causes unexpected side effects.

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          Most cited references25

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          Prevalence and rate of diagnosis of allergic rhinitis in Europe.

          To measure the prevalence of allergic rhinitis among European adults and the proportion of undiagnosed subjects, a two-step, cross-sectional, population-based survey in Belgium, France, Germany, Italy, Spain, and the UK was undertaken. Step one of the study involved screening for allergic rhinitis by telephone interview, based on history of symptoms and/or self-awareness of the condition. Step two undertook confirmation of allergic rhinitis in a subset of the subjects screened positive; this was performed by a clinical diagnosis conducted in three to five clinical centres per country, including specific immunoglobulin E tests and a disease-specific questionnaire. A total of 9,646 telephone interviews were conducted between February and April 2001. Self-awareness of allergic rhinitis was reported by 19% of the subjects. Physician-based diagnosis of allergic rhinitis was reported by 13% of the subjects. In step two, 725 clinical assessments were conducted between May and August 2001. A total of 411 of patients, who underwent step two, had investigator-confirmed allergic rhinitis. Among patients with investigator-confirmed allergic rhinitis, 45% had not reported a previous diagnosis by a physician. Prevalence of subjects with clinically confirmable allergic rhinitis estimated by combining step one and step two data ranged from 17% in Italy to 29% in Belgium with an overall value of 23%. This large-scale study confirms that allergic rhinitis has a high prevalence in western Europe and is frequently undiagnosed.
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            Interrater reliability of the modified Jadad quality scale for systematic reviews of Alzheimer's disease drug trials.

            Drug therapies for Alzheimer's disease (AD) have been evaluated in clinical trials over the past 2 decades. Systematic reviews of AD drug trials can shed more light on the efficacy of pharmaceutical interventions. The modified Jadad scale can be used to assess the quality of trial reports that are candidates for inclusion in these systematic reviews. The interrater reliability of the modified Jadad scale was examined during such a review. Three blinded reviewers rated the quality of 42 AD drug trial reports: the intraclass correlation coefficient was 0.90. The modified Jadad scale appears to be a useful tool for AD research because of the very good interrater reliability. Also, it is composed of items that are well suited to the specific disease characteristics of AD. Further research should focus on the validity of this instrument. Copyright 2001 S. Karger AG, Basel.
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              Mucociliary clearance and buffered hypertonic saline solution.

              Nasal irrigations have been used for centuries without any scientific data to determine efficacy. For 10 years, the senior author has used buffered hypertonic saline nasal irrigation for patients with acute/chronic sinusitis and for those having undergone sinus surgery. A simple study was undertaken using volunteers without any significant sinonasal disease. Patients served as their own control using a saccharin clearance test before any nasal irrigation was used. Patients then used one of two solutions to irrigate their nose-buffered normal saline or buffered hypertonic saline-and were then retested. On a separate day, the control test was repeated, followed by irrigation with the alternate solution and a second saccharin clearance test. The outcome showed buffered hypertonic saline nasal irrigation to improve mucociliary transit times of saccharin, while buffered normal saline had no such effect.
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                Author and article information

                Journal
                Am J Rhinol Allergy
                Am J Rhinol Allergy
                rhinol
                American Journal of Rhinology & Allergy
                OceanSide Publications, Inc. (Providence, RIUSA )
                1945-8924
                1945-8932
                Sep-Oct 2012
                : 26
                : 5
                : e119-e125
                Affiliations
                [1]From the 1Department of Otorhinolaryngology, Division of Sinus and Skull Base Surgery and Traumatology, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany, and
                [2] 2Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
                Author notes
                Address correspondence and reprint requests to Rainer Weber, M.D., Rhinology Center Marburg, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, UKGM Baldinger Straße, D-35043 Marburg, Germany E-mail address: rainer.weber@ 123456uk-gm.de
                Article
                AJRA409-11
                10.2500/ajra.2012.26.3787
                3904042
                23168142
                57ac5196-96ec-4124-9a93-8499ad321a69
                Copyright © 2012, OceanSide Publications, Inc., U.S.A.

                This publication is provided under the terms of the Creative Commons Public License ("CCPL" or "License"), in attribution 3.0 unported, further described at http://creativecommons.org/license/by/3.0/legalcode. The work is protected by copyright and/or other applicable law. Any use of the work other then as authorized under this license or copyright law is prohibited

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                Immunology
                adjunctive treatment,allergic rhinitis,hypertonic saline solution,isotonic saline solution,nasal douche,nasal lavage,nasal obstruction,pollinosis,saline nasal irrigation,sneezing

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