xRead - Nonallergic Rhinitis (September 2025)

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Ipratropium Bromide Nasal Spray in Non-Allergic Rhinitis: A Systematic Review and Meta-Analysis

Patrick El Khoury, MD ; Walid Abou Hamad, MD; Michel G. Khalaf, MD ; Christopher El Hadi, MD; Ralph Assily, MD; Simon Rassi, MD; Nadim Khoueir, MD

Objective: This study aims to compare the effectiveness of intranasal ipratropium bromide (INIB) to a placebo in reduc ing nasal symptoms, particularly rhinorrhea, and enhancing quality of life in non-allergic rhinitis (NAR) patients. Study Design: Systematic review and meta-analysis. Methods: A comprehensive review of the literature was conducted on Medline, Embase, and Cochrane libraries. Random ized controlled trials (RCTs) and non-randomized comparative parallel group trials comparing IB nasal spray to placebo were included. Results: Five RCTs assessed a total of 472 participants with a diagnosis of NAR. IB nasal spray 0.03% were used across all studies. IB has a better impact on decreasing rhinorrhea than the placebo, with a standardized mean difference (SMD) of 0.93 (95% CI 0.06 – 1.8). The mean change in rhinorrhea severity was 85% (95% CI 77 – 92%) and I ^ 2 26% ( p = 0.24). IB out performed the placebo in terms of shortening the symptom ’ s duration/day, as shown by an SMD of 0.35 (95% CI 0.15 – 0.55). The difference between treatments was noticeable within the fi rst week and remained consistent throughout the treatment. Patients who were administered IB experienced a substantially greater improvement in physical and mental outcomes. Nasal adverse events with IB were generally intermittent and brief. Conclusion: Compared with a placebo, IB nasal spray is both safe and effective in treating the rhinorrhea associated with NAR. IB signi fi cantly reduces the severity and duration of rhinorrhea. The treatment was determined to be bene fi cial by both patients and physicians and resulted in a better quality of life. KeyWords: ipratropium bromide, nasal spray, nonallergic rhinitis, treatment. Level of Evidence: 1 Laryngoscope , 133:3247 – 3255, 2023

INTRODUCTION Non-allergic rhinitis (NAR) is characterized by nasal mucosa dysfunction and noninfectious in fl ammation caus ing nasal blockage, rhinorrhea, sneezing, or nasal/ocular irritation. It comprises multiple distinct conditions with a pathogenesis that is not clearly elucidated. NAR is diag nosed when anatomic, infectious, and allergic etiologies are ruled out and symptoms have lasted more than 12 weeks. It may be distinguished from allergic rhinitis by negative allergy tests. 1,2 Subtypes of NAR include drug-induced rhinitis, rhi nitis in the elderly, hormonal rhinitis, including pregnancy-induced rhinitis, non-allergic occupational rhi nitis, gustatory rhinitis, and idiopathic rhinitis (IR). IR, formerly known as vasomotor rhinitis, is thought to account for 40% to 50% of those cases. Patients having From the Department of Otolaryngology – Head and Neck Surgery, Hotel Dieu de France Hospital ( P . E . K ., W . A . H ., M . G . K ., C . E . H ., R . A ., S . R ., N . K .), Saint Joseph University, Beirut, Lebanon. Editor ’ s Note: This Manuscript was accepted for publication on April 02, 2023 This manuscript is not supported by any grant. All authors have equal contribution and no con fl icts of interest to disclose. Send correspondence to Patrick El Khoury, Department of Otolaryngology — Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Alfred Naccache Boulevard, P.O.Box: 166830 Ashra fi eh, Beirut, Lebanon. Email: patrick.khoury@hotmail.com

NAR symptoms who fall under no other subtype are referred to as IR patients. 3 The management of NAR is complicated by an unclear understanding of the underlying pathophysiology, limited evidence on treatment options, and a lack of guidelines. Unlike allergic rhinitis, there are no standards or data on the optimal treatment for NAR. NAR treatment should be tailored as much as possi ble to the underlying cause. Patients suffering from NAR may bene fi t from antiin fl ammatory medications, such as nasal corticosteroids or nasal antihistamines. 4,5 All rhini tis patients should be counseled to avoid irritants and to cease smoking. Moreover, repeated nasal administration of capsaicin resulted in a signi fi cant long-term reduction in symptoms. Other types of treatment include the vidian neurectomy, a surgical procedure that is rarely used. 6 The parasympathetic nervous system is involved in the pathogenesis of several types of rhinitis. 7,8 Ipratropium bromide (IB) blocks muscarinic cholin ergic receptors, acting as an acetylcholine antagonist. Cyclic guanosine monophosphate (cGMP) synthesis is reduced by blocking cholinergic receptors. Intranasal IB triggers a local parasympathetic response that causes the mucosal glands to secrete less fl uids, which decreases rhinorrhea symptoms. 8 IB is commonly used to treat geri atric rhinitis because it relieves rhinorrhea, the primary symptom. 9 El Khoury et al.: Ipratropium Bromide in Non-Allergic Rhinitis 3247

DOI: 10.1002/lary.30706

Laryngoscope 133: December 2023