Comparative Efficacy of Isotonic Saline (0.9% NaCl) and Sea Salt Water Mineral Nasal Spray on Nasal Mucosal Eosinophil Cytology in Patients with Moderate-to-Severe Persistent Allergic Rhinitis
Keywords:
Laryngopharyngeal Reflux, Zinc, Proton Pump Inhibitor, Reflux Symptom Index, Reflux Finding ScoreAbstract
Background and aim: Nasal irrigation is a foundational adjuvant therapy for allergic rhinitis (AR). While 0.9% NaCl (isotonic saline) is conventional, sea salt water (SSW) mineral sprays enriched with complex trace elements are hypothesized to provide superior anti-inflammatory modulation. This study compared the efficacy of 0.9% NaCl and SSW mineral nasal spray on nasal mucosal eosinophil counts and clinical symptoms in patients with moderate-to-severe persistent AR.
Methods: In this prospective cohort study, 30 patients with moderate-to-severe persistent AR were allocated into two groups (n=15 each): one group received 0.9% NaCl irrigation (20 mL twice daily), and the other received SSW mineral spray (0.15 mL twice daily). Clinical symptoms were evaluated using the Visual Analog Scale (VAS) at baseline, week 2, and week 4. Objective nasal mucosal eosinophil counts were assessed via nasal scraping and Papanicolaou staining at baseline and week 4.
Results: Both groups exhibited significant reductions in nasal eosinophil counts and VAS scores by week 4 (p<0.001). Notably, the SSW group demonstrated significantly accelerated clinical improvement in rhinorrhea, sneezing, and ocular symptoms at week 2 compared to the 0.9% NaCl group (p<0.001). By week 4, no significant differences were observed between the two groups in the magnitude of eosinophil reduction (p=0.423) or final total VAS scores.
Conclusion: Both 0.9% NaCl and SSW mineral nasal spray are equally effective for sustained symptomatic and inflammatory control in persistent AR. However, SSW mineral spray offers a distinct clinical advantage through accelerated symptomatic relief during the early phase of treatment.
References
1. Bousquet J, Anto JM, Bachert C, et al. Allergic rhinitis. Nat Rev Dis Primers. 2020;6(1):95. doi:10.1038/s41572-020-00227-0
2. Bousquet J, Schünemann HJ, Togias A, et al. Next-generation Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines for allergic rhinitis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and real-world evidence. Journal of Allergy and Clinical Immunology. 2020;145(1):70-80.e3. doi:10.1016/j.jaci.2019.06.049
3. Vandenplas O, Vinnikov D, Blanc PD, et al. Impact of Rhinitis on Work Productivity: A Systematic Review. J Allergy Clin Immunol Pract. 2018;6(4):1274-1286.e9. doi:10.1016/j.jaip.2017.09.002
4. Soegiarto G, Abdullah MS, Damayanti LA, Suseno A, Effendi C. The prevalence of allergic diseases in school children of metropolitan city in Indonesia shows a similar pattern to that of developed countries. Asia Pac Allergy. 2019;9(2):e17. doi:10.5415/apallergy.2019.9.e17
5. Lombardi C, Berti A, Cottini M. The emerging roles of eosinophils: Implications for the targeted treatment of eosinophilic-associated inflammatory conditions. Curr Res Immunol. 2022;3:42-53. doi:10.1016/j.crimmu.2022.03.002
6. Song Y, Zhang X, Li J, Zhang L, Zhang Y. The role of nasal cytology in the diagnosis and treatment of Allergic rhinitis. Expert Rev Clin Immunol. 2025;21(8):1073-1082. doi:10.1080/1744666X.2025.2534060
7. Güner Atayoğlu A, Bayar Muluk N, Koca R, et al. Investigation of the Effectiveness of Nasal Sprays in Allergic Rhinitis. Ear Nose Throat J. 2024;103(3_suppl):144S-151S. doi:10.1177/01455613241287298
8. Huang S, Constant S, De Servi B, et al. Is a diluted seawater-based solution safe and effective on human nasal epithelium? Eur Arch Otorhinolaryngol. 2021;278(8):2837-2842. doi:10.1007/s00405-020-06527-1
9. Di Cara G, Carelli A, Latini A, et al. Severity of allergic rhinitis and asthma development in children. World Allergy Organ J. 2015;8(1):13. doi:10.1186/s40413-015-0061-4
10. Sudiro M, Madiadipoera THS, Purwanto B. Eosinofil Kerokan Mukosa Hidung Sebagai Diagnostik Rinitis Alergi. mkb. 2010;42(1):6-11. doi:10.15395/mkb.v42n1.2
11. Gunawan Y. Correlation Between the Number of Natural Mucosa Eosinophils and Blood Eosinophils in Persistent Allergic Rhinitis. Andalas University; 2017. http://scholar.unand.ac.id/26249/
12. Lee VS, Chiu RG, Dick AI, et al. Biological sex differences in rhinitis prevalence among adults in the United States: An “All of Us” Research Program database analysis. J Allergy Clin Immunol Pract. 2025;13(4):950-952.e1. doi:10.1016/j.jaip.2024.12.032
13. Yim Y, Jo H, Park S, et al. Sex-Specific and Long-Term Trends of Asthma, Allergic Rhinitis, and Atopic Dermatitis in South Korea, 2007-2022: A Nationwide Representative Study. Int Arch Allergy Immunol. 2025;186(2):166-183. doi:10.1159/000540928
14. Zhang X, Zhang M, Sui H, et al. Prevalence and risk factors of allergic rhinitis among Chinese adults: A nationwide representative cross-sectional study. World Allergy Organ J. 2023;16(3):100744. doi:10.1016/j.waojou.2023.100744
15. Diyanah FQ, Haitamy MN, Kusumawati A, Kadarullah O. Perbandingan Terapi Topikal Natrium Klorida 0,9% dengan Minyak Biji Jintan Hitam (Nigella sativa) terhadap Waktu Transpor Mukosilliar Hidung Penderita Rinitis Alergi. HMJ. 2019;2(2):1. doi:10.30595/hmj.v2i2.3089
How to Cite
Issue
Section
License
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.
How to Cite
