Inter-societal Delphi Consensus on the topical nasal treatments in Italy

Inter-societal Delphi Consensus on the topical nasal treatments in Italy

Authors

  • Attilio Varricchio Department of Otolaryngology, University of Molise, Campobasso, Italy
  • Livio Presutti ENT Department, University of Bologna, Italy
  • Ignazio La Mantia ENT Department, University of Bologna, Italy
  • Giorgio Ciprandi Casa di Cura Villa Montallegro http://orcid.org/0000-0001-7016-8421

Keywords:

topical nasal therapy, device, upper respiratory diseases

Abstract

Topical nasal therapy is widely used in clinical practice by different specialists. However, it is multifaceted and still controversial. Namely, there is no consensus about the many aspects, and there needs to be specific guidelines.

Four independent experts involved 14 Italian scientific societies (concerning ENT, allergy, and pediatrics areas) to participate in generating an Intersocietal Delphi Consensus on this matter. Three iterative rounds collected experts (4 in the first round, 20 in the second round, and 45 in the third round) designed by the scientific societies based on their clinical expertise and documented scientific value. Thirty-four statements were discussed and voted on. At the second round, all statements accomplished a very high consensus grade (>95%). At the third round, many statements reached a high or very high grade of consensus (>70%). However, some statements did not obtain sufficient agreement. Consequently, there is a need to implement knowledge about this issue through educational initiatives and new studies conducted with a robust methodology.

In conclusion, topical nasal therapy deserves adequate knowledge as it is widespread and fruitful in managing upper respiratory diseases.

References

Wise SK, Damask C, Greenhawt M, Oppenheimer J, Roland LT, Shaker MS, et al. A Synopsis of Guidance for Allergic Rhinitis Diagnosis and Management From ICAR 2023. J Allergy Clin Immunol Pract. 2023;11(3):773-796

Xavier R. Overview of Nasal Airway and Nasal Breathing Evaluation. Facial Plast Surg. 2024;40(3):268-274

Hellings PW, Lau S, Scadding GK, Bjermer L, Backer V, Chaker AM, et al. EUFOREA summit in Brussels 2023: inspiring the future of allergy & respiratory care. Front Allergy. 2023;4:1236977

Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology 2020;Suppl. 29:1-464

El Feghaly RE, Nedved A, Katz SE, Frost HM. New insights into the treatment of acute otitis media. Expert Rev Anti Infect Ther. 2023;21(5):523-534

Ciprandi G, Tosca MA. Turbinate Hypertrophy, Allergic Rhinitis, and Otitis Media. Curr Allergy Asthma Rep. 2021;21(9):44

Eccles R. Common cold. Front Allergy. 2023;4:1224988

Bansil R, Turner BS. The biology of mucus: composition, synthesis and organization. Adv Drug Deliv Rev 2018;124:3-15

Harvey RJ, Roland LT, Schlosser RJ, Pfaar O. Chief Complaint: Nasal Congestion. J Allergy Clin Immunol Pract. 2024 Jun;12(6):1462-1471

Karkouli G, Douros K, Moriki D, Moutsatsou P, Giannopoulou I, Maratou E, et al. Dysfunctional Breathing in Children: A Literature Review. Children (Basel). 2024;11(5):556

Taherali F, Varum F, Basit AW. A slippery slope: On the origine, role and physiology of mucus. Adv Drug Deliv Rev 2018;124:16-33

Keicho N, Hijikata M, Miyabayashi A, Wakabayashi K, Yamada H, Ito M, et al. Impact of primary ciliary dyskinesia: Beyond sinobronchial syndrome in Japan. Respir Investig 2024;62(1):179-186

Ciprandi G, Cirillo I The lower airway pathology of Rhinitis. Update Review J Allergy Clin Immunol 2006; 118:1105-1109

Ciprandi G, Gelardi M. Open and clean: the healthy nose. Acta Biomed 2019;90(2-S):4-6

Jones J, Hunter D. Consensus methods for medical and health services research. BMJ 1995;311(7001):376–380

Martínez-Serrano A, Martínez-Campos P, Seijoso-González L, Ruiz-Rojo H. Literature review of nasal lavage technique in paediatrics. Enferm Clin (Engl Ed). 2021;31(3):189-194

Brożek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision. J Allergy Clin Immunol 2017;140(4):950-958

Bousquet J, Schünemann HJ, Togias A, Bachert C, Erhola M, Hellings PW, 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. J Allergy Clin Immunol 2020;145(1):70-80.e3

Dykewicz MS, Wallace DV, Amrol DJ, Baroody FM, Bernstein JA, CraigTJ, et al. Rhinitis 2020: A practice parameter update. J Allergy Clin Immunol 2020;146(4):721-767

Meltzer EO, Bachert C, Staudinger H. Treating acute rhinosinusitis: comparing efficacy and safety of mometasone furoate nasal spray, amoxicillin, and placebo. J Allergy Clin Immunol 2005;116(6):1289-1295

Varricchio A, Brunese FP, La Mantia I, Ascione E, Ciprandi G. Choosing nasal devices: a dilemma in clinical practice. Acta Biomed 2023;94(1):e2023034

Varricchio A, De Lucia A, Varricchio AM, Della Volpe A, Mansi N, Pastore V, et al. Sinuclean Nebules treatment in children suffering from otitis media with effusion. Int J Pediatr Otorhinolaryngol 2017:94:30-35

Varricchio A, Capasso M, Di Gioacchino M, Ciprandi G. Inhaled thiamphenicol and acetylcysteine in children with acute bacterial rhinopharyngitis. Int J Immunopathol Pharmacol 2008;21(3):625-629

Varricchio A, Capasso M, Avvisati F, Varricchio AM, De Lucia A, Brunese FP, et al. Inhaled hyaluronic acid as ancillary treatment in children with bacterial acute rhinopharyngitis. J Biol Regul Homeost Agents 2014;28(3):537-43

Djupesland PG. Nasal drug delivery devices: characteristics and performance in a clinical perspective. Drug Deliv Trans Res 2013;3(1):42-62

Xi J, Si X, Kim JW, BerlinskiA. Simulation of airflow and aerosol deposition in the nasal cavity of a 5-year-old child. J Aerosol Sci 2011;42(3):156-173

Kimbell JS, Segal RA, Asgharian B, Wong BA, Schroeter JD, Southall JD, et al. Characterization of deposition from nasal spray devices using a computational fluid dynamics model of the human nasal passages. J Aerosol Med 2007;20(1):59-74

Berlinski A. Pediatric Aerosol Therapy. Respir Care. 2017;62(6):662-677

Ocak E, Mulazimoglu S, Kocaoz D, Mirici E, Dagli E, Acar A. Effect of adjunctive sodium hyaluronate versus surfactant nasal irrigation on mucociliary clearance in allergic rhinitis: a single-blind, randomised, controlled study. J Laryngol Otol 2021;135(6):529-532

Ural A, Oktemer TK, Kizil Y, Ileri F, Uslu S. Impact of isotonic and hypertonic saline solutions on mucociliary activity in various nasal pathologies: clinical study. J Laryngol Otol 2009;123(5):517-21

Donaldson SH, Bennett WD, Zeman KL, Knowles MR, Tarran R, Boucher RC. Mucus clearance and lung function in cystic fibrosis with hypertonic saline. N Engl J Med 2006 Jan 19;354(3):241-50

Hermelingmeier KE, Weber RK, Hellmich M, Heubach CP. Nasal irrigation as an adjunctive treatment in allergic rhinitis: a systematic review and meta-analysis. Am J Rhinol Allergy 2012;26(5):e119-25

Jung M, Lee JY, Ryu G, Lee KE, Hong SD, Choi J, et al. Beneficial effect of nasal saline irrigation in children with allergic rhinitis and asthma: A randomized clinical trial. Asian Pac J Allergy Immunol 2020;38(4):251-257

Nguyen SA, Psaltis AJ, Schlosser RJ. Isotonic saline nasal irrigation is an effective adjunctive therapy to intranasal corticosteroid spray in allergic rhinitis. Am J Rhinol Allergy 2014;28(4):308-311

Salib RJ, Talpallikar S, Uppal S, Nair SB. A prospective randomised single-blinded clinical trial comparing the efficacy and tolerability of the nasal douching products Sterimar™ and Sinus Rinse™ following functional endoscopic sinus surgery. Clin Otolaryngol 2013;38(4):297-305

Gelardi M, Mezzoli A, Fiorella ML, Carbonara M, Di Gioacchino M, Ciprandi G. Nasal irrigation with Lavonase as ancillary treatment of acute rhinosinusitis: a pilot study. J Biol Reg 2009;23:79-84

Gelardi M, Taliente S, Piccininni K, Silvestre G, Quaranta N, Ciprandi G. Nasal irrigation with Nasir® in children: a preliminary experience on nasal cytology. J Biol Reg 2016;30:1125-30

Frank DO, Kimbell JS, Pawar S, Rhee JS. Effects of anatomy and particle size on nasal sprays and nebulizers. Otolaryngol Head Neck Surg 2012;146(2):313-319

Keeler JA, Patki A, Woodard CR, Do F-I. A Computational Study of Nasal Spray Deposition Pattern in Four Ethnic Groups. J Aerosol Med Pulm Drug Deliv 2016;29(2):153-166

Stjärne P, Blomgren K, Cayé-Thomasen P, Salo S, Søderstrøm T. The efficacy and safety of once-daily mometasone furoate nasal spray in nasal polyposis: a randomized, double-blind, placebo-controlled study. Acta Otolaryngol 2006;126(6):606-612

Campbell RG. Risks and management of long-term corticosteroid use in chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg 2018;26(1):1-7

Antunes MB, Feldman MD, Cohen NA, Chiu Dose-dependent effects of topical tobramycin in an animal model of Pseudomonas sinusitis. Am J Rhinol 2007;21(4):423-7

Lim M, Citardi MJ, Leong J-L. Topical antimicrobials in the management of chronic rhinosinusitis: a systematic review. Am J Rhinol 2008;22(4):381-389

Liebermann P. Management of allergic rhinitis with a combination antihistamine/anti-inflammatory agent. J Allergy Clin Immunol 1999;103(3 Pt 2):S400-404

Klimek L, Mullol J, Ellis AK, Izquierdo-Dominguez A, Hagemann J, Casper I, et al. Current management of allergic rhinitis. J Allergy Clin Immunol Pract 2024;12:1399-1412

Feng S, Fan Y, Liang Z, Ma R, Cao W. Concomitant corticosteroid nasal spray plus antihistamine (oral or local spray) for the symptomatic management of allergic rhinitis. Eur Arch Otorhinolaryngol 2016;273(11):3477-3486

Golden S, Teets SJ, Lehman EB, Mauger EA, Chinchilli V, Berlin JM, et al. Effect of topical nasal azelastine on the symptoms of rhinitis, sleep, and daytime somnolence in perennial allergic rhinitis. Ann Allergy Asthma Immunol 2000;85(1):53-57

Berger W, Meltzer EO, Amar N, Fox AT, Just J, Muraro A, et al. Efficacy of MP-AzeFlu in children with seasonal allergic rhinitis: Importance of paediatric symptom assessment. Pediatr Allergy Immunol 2016;27(2):126-33

Baldassarre ME, Di Mauro A, Labellarte G, Pignatelli M, Fanelli M, Schiavi E, et al. Resveratrol plus carboxymethyl-β-glucan in infants with common cold: A randomized double-blind trial. Heliyon 2020;6(4):e03814

Ciprandi G, La Mantia I, Brunese FP, Varricchio A, Varricchio AM. Hypertonic saline with xylitol and hyaluronate may shorten the viral shedding duration in asymptomatic COVID-19 positive subjects: a pilot study. J Biol Regul Homeost Agents 2021;35(3):1151-1154

Mastromarino P, Capobianco D, Cannata F, Nardis C, Mattia E, De Leo A, et al. Resveratrol inhibits rhinovirus replication and expression of inflammatory mediators in nasal epithelia. Antiviral Res 2015:123:15-21

Rossi GA, Sacco O, Capizzi A, Mastromarino P. Can Resveratrol-Inhaled Formulations Be Considered Potential Adjunct Treatments for COVID-19?. Front Immunol 2021:12:670955

Drago L, Daglia M, Brindisi G, Brunese FP, Dinardo G, Gori A, et al. Certainty and uncertainty in the biological activities of resveratrol. Food Front (in press)

Varricchio A, Tricarico D, De Lucia A, Utili R, Tripodi MF, Miraglia Del Giudice M, et al. Inhaled tobramycin in children with acute bacterial rhinopharyngitis. Int J Immunopathol Pharmacol 2006;19(1):131-140

Varricchio A, Capasso M, Di Gioacchino M, Ciprandi G. Inhaled thiamphenicol and acetylcysteine in children with acute bacterial rhinopharyngitis. Int J Immunopathol Pharmacol 2008;21(3):625-629

Solares CA, Batra PS, Hall GS, Citardi MJ. Treatment of chronic rhinosinusitis exacerbations due to methicillin-resistant Staphylococcus aureus with mupirocin irrigations. Am J Otolaryngol 2006;27(3):161-165

El-Hennawi DM, Ahmed MR, Farid AM, Al Murtadah AM.Comparative study of the efficacy of topical steroid and antibiotic combination therapy versus oral antibiotic alone when treating acute rhinosinusitis. J Laryngol Otol 2015;129(5):462-467

Passàli D, Damiani V, Passàli FM, Passàli GC, Bellussi L. Atomized nasal douche vs nasal lavage in acute viral rhinitis. Arch Otolaryngol Head Neck Surg 2005;131(9):788-790

El Khoury P, Hamad WA, Khalaf, MG El Hadi C, Assily R, Rassi S, et al. Ipratropium Bromide Nasal Spray in Non-Allergic Rhinitis: A Systematic Review and Meta-Analysis. Laryngoscope 2023;133(12):3247-3255

Deckx L, De Sutter AI, Guo L, Mir NA, van Driel ML. Nasal decongestants in monotherapy for the common cold. Cochrane Database Syst Rev 2016;10(10):CD009612

Yoo JK, Seikaly H, Calhoum KH. Extended use of topical nasal decongestants. Laryngosope 1997;107(1):40-3

Snidvongs K, Kalish L, Sacks R, Sivasubramaniam R, Cope D, Harvey RJ. Sinus surgery and delivery method influence the effectiveness of topical corticosteroids for chronic rhinosinusitis: systematic review and meta-analysis. Am J Rhinology Allergy 2013;27(3):221-233

Liao X, Guan Y, Asakawa T, Lin Z, Tang Q, Ma Z, et al. Benefit of Nasal Douche in COVID-19 Patients with Recurrence of Positive SARS-CoV-2 Viral RNA. Infect Drug Resist 2023:16:6269-6276

Esposito S, Rosazza C, Sciarrabba CS, Principi N. Inhaled Antibiotic Therapy for the Treatment of Upper Respiratory Tract Infections. J Aerosol Med Pulm Drug Deliv. 2017;30(1):14-19

Head K, Chong LY, Piromchai P, Hopkins C, Philpott C, Schilder AG, et al. Systemic and topical antibiotics for chronic rhinosinusitis. Cochrane Database Syst Rev. 2016;4(4):CD011994

Chadha NK, ZhangL , Mendoza-Sassi RA, César JA. Using nasal steroids to treat nasal obstruction caused by adenoid hypertrophy: does it work? Otolaryngol Head Neck Surg 2009;140(2):139-147

Ciprandi G, Varricchio A, Capasso M, Varricchio AM, De Lucia A, Ascione E, et al. Intranasal flunisolide treatment in children with adenoidal hypertrophy. Int J Immunopathol Pharmacol 2007;20(4):833-836

Duse M, Santamaria F, Verga MC, BergaminiM , Simeone G, Leonardi L, et al. Inter-society consensus for the use of inhaled corticosteroids in infants, children and adolescents with airway diseases. Ital J Pediatr 2021;47(1):97

Zeroli C, Gorica A, Monti G, Castelnuovo P, Bignami M, Macchi A. A systematic review of randomized controlled trials on topical nasal steroids. Acta ORL Ital 2024;44:71-75

Montella S, Cantone E, Maglione M, Iengo M, Santamaria F. Sodium hyaluronate improves quality of life and nasal endoscopy features in preschool children with upper respiratory tract infections. J Biol Regul Homest Agents 2016;30(1):303-308

Mozzanica F, Preti A, Gera R, Bulgheroni C, Cardella A, Albera A, et al. Double-blind, randomised controlled trial on the efficacy of saline nasal irrigation with sodium hyaluronate after endoscopic sinus surgery. J Laryngol Otol 2019;133(4):300-308

Macchi A, Castelnuovo P, Terranova P, Digilio E. Effects of sodium hyaluronate in children with recurrent upper respiratory tract infections: results of a randomised controlled study. Int J Immunopathol Pharmacol 2013;26(1):127-315

Liu H, Chen Y, Wang H, Luo X, Xie D, ji Q, et al. Efficacy of hyaluronic acid in the treatment of nasal inflammatory diseases: a systematic review and meta-analysis. Front Pharmacol 2024;15:1350063

Rollema C, van Roon EN, van Boven JFM, Hagedoorn P, Klemmeier T, Kocks JH, et al. Pharmacology, particle deposition and drug administration techniques of intranasal corticosteroids for treating allergic rhinitis. Clin Exp Allergy 2022,52:1247-1263

Rudmik L, Xu Y, Liu M, Bird C, Kukec E, QuanH. Utilization Patterns of Topical Intranasal Steroid Therapy for Chronic Rhinosinusitis: A Canadian Population-Based Analysis. JAMA Otolaryngol Head Neck Surg 2016;142(11):1056-1062

Yoo F, Ference EH, Kuan EC, Lee JT, Wang MB, Suh JD. Evaluation of patient nasal saline irrigation practices following endoscopic sinus surgery. Int Forum Allergy Rhinol 2018;8(1):32-40

Hellings PW. Paving the future of rhinosinusitis care. Rhinology 2017;55(3):193-194

McCarronTL, Moffat K, Wilkinson G, Zelinsky S, Boyd JM, White D, et al. Understanding patient engagement in health system decision-making: a co-designed scoping review. Syst Rev 2019;8(1):97

Ciprandi G. Self-Management in Allergic Rhinitis: Strategies, Outcomes and Integration into Clinical Care. J Asthma Allergy. 2023;16:1087-1095

Ciprandi G. Recent advances in the practical management of allergic rhinitis. Recenti Prog Med. 2024;115(4):1-10.

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04-09-2024

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Varricchio A, Presutti L, La Mantia I, Ciprandi G. Inter-societal Delphi Consensus on the topical nasal treatments in Italy. Multidiscip Respir Med [Internet]. 2024 Sep. 4 [cited 2024 Dec. 7];19(1). Available from: https://mrmjournal.org/index.php/mrm/article/view/991