Hypertonic Saline Helps Allergic Rhinitis, Not Superior to Isotonic

A meta-analysis showed that 3% hypertonic saline nasal irrigation significantly reduced nasal symptoms and lowered antihistamine use in patients with allergic rhinitis compared with controls.1 However, hypertonic saline nasal irrigation did not show a significant advantage over isotonic saline.

“From a practical standpoint, [hypertonic saline nasal irrigation] is inexpensive, safe, and easily accessible, making it especially valuable in low-resource settings or for individuals who cannot tolerate pharmacologic therapies,” study investigator Nishtha Singh, MD, MBBS, from the department of respiratory medicine at Asthma Bhawan in India, and colleagues wrote.1 “Nevertheless, in view of its comparable impact on antihistamine usage relative to [isotonic saline nasal irrigation], a universal preference for [hypertonic saline nasal irrigation] cannot be currently endorsed.”

Isotonic saline nasal irrigation is often recommended as an adjunct treatment for allergic rhinitis since it helps flush out allergens and mucus from the nasal lining, easing local inflammation and reducing symptom severity.1 Regular rinsing provides relief and improves nasal hygiene. Various concentrations of saline are used in practice, though no single formulation has displayed superiority.

Multiple studies have demonstrated the clinical benefits of 0.9% isotonic saline nasal irrigation, leading to its inclusion as a complementary therapy in the 2018 allergic rhinitis guidelines.2 Evidence shows that consistent use of saline irrigation improves symptom scores and quality of life in both adults and children with allergic rhinitis. Both isotonic and hypertonic solutions enhance mucociliary clearance, though hypertonic solutions may offer additional anti-inflammatory effects on the nasal lining.1

Investigators conducted a systematic review and meta-analysis to assess the efficacy of 3% hypertonic saline nasal irrigation for adults and children with allergic rhinitis. The analysis compared nasal symptom scores in patients on hypertonic saline nasal irrigation vs controls (isotonic saline or no saline).1

The team searched PubMed, Scopus, and Cochrane Central from inception to May 8, 2024, for randomized clinical trials comparing 3% hypertonic saline nasal irrigation with controls. In total, 9 trials met eligibility criteria, resulting in a sample of 645 patients. Adults and children had mean ages of 35.49 years and 9.3 years, respectively. The trials’ follow-up ranged from 4 weeks to 2 months.1

The analysis showed that hypertonic saline nasal irrigation significantly reduced nasal symptom scores compared with adult (MD = −2.09; 95% confidence interval [CI], −3.86 to −0.33; P =.02) and children MD = −0.97; 95% CI, −1.51 to −0.44; P =.000) controls. Moreover, antihistamine use was lower with hypertonic saline nasal irrigation than controls (OR = 0.39; 95% CI, 0.21 to 0.70; P =.002), but investigators observed no significant difference between hypertonic saline nasal irrigation and isotonic saline alone (OR, 0.69; 95% CI, 0.41 to 1.16; P =.16).1

“Although there was a trend toward reduced antihistamine use, [hypertonic saline nasal irrigation] did not significantly outperform [isotonic saline nasal irrigation] in this regard,” investigators wrote.1 “This raises relevant clinical concerns about its ability to decrease medication reliance, particularly pertinent in pediatric patients and those pursuing steroid-sparing strategies. The lack of significant reduction in pharmaco-logic use suggests that while [hypertonic saline nasal irrigation] enhances symptom control, its utility in minimizing medication burden remains unproven.”

Overall, hypertonic saline nasal irrigation appeared effective in reducing symptoms and medication use in adults and children with allergic rhinitis, but not better than isotonic saline nasal irrigation.

“Future research should aim to address these gaps by investigating whether [hypertonic saline nasal irrigation] contributes to reduced medication dependence, improves patient-reported outcomes, or modifies disease progression,” investigators concluded.1 “While current evidence supports [hypertonic saline nasal irrigation] as a safe and effective adjunct with consistent symptomatic benefits, its precise clinical positioning—particularly in comparison to [isotonic saline nasal irrigation]—requires further elucidation through robust, well-designed studies.”

References

1. Singh N, Singh S, Sharma AK, Singh U, Bhatnagar V, Singh V. Efficacy of hypertonic saline nasal irrigation in allergic rhinitis: A systematic review and meta-analysis. Allergol Immunopathol (Madr). 2025;53(5):164-178. Published 2025 Sep 1. doi:10.15586/aei.v53i5.1409

2. Wise SK, Damask C, Roland LT, et al. International consensus statement on allergy and rhinology: Allergic rhinitis - 2023. Int Forum Allergy Rhinol. 2023;13(4):293-859. doi:10.1002/alr.23090