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

Abstract

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.

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