xRead - Nonallergic Rhinitis (September 2025)

15314995, 2023, 12, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/lary.30706 by University Of Chicago, Wiley Online Library on [15/07/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

numbers presented are not rigorous and re fl ect only part of reality because of the unavailability of data and because the digitization of the graphs is not accurate. Second, the studies are very heterogeneous, and only two of the fi ve studies were conducted in a similar manner, extending over 8 weeks of assessment and using similar IB doses. The others recruited exclusively children and adolescents or were 1-day studies. Meta-regression and tests for small study effects were not possible because of the very small number of studies (<10). CONCLUSION IB nasal spray is effective at reducing watery rhinorrhea in patients with NAR. In comparison to pla cebo, IB is both safe and effective in reducing the severity and duration of rhinorrhea with only minor side effects. Both physicians and patients agreed that the treatment was bene fi cial and improved one ’ s quality of life. BIBLIOGRAPHY 1. Kaliner MA. Classi fi cation of nonallergic rhinitis syndromes with a focus on vasomotor rhinitis, proposed to be known henceforth as nonallergic Rhinopathy. World Allergy Organ J . 2009;2(6):98-101. 2. Pattanaik D, Lieberman P. Vasomotor rhinitis. Vol. 10, Current Allergy and Asthma Reports. Curr Allergy Asthma Rep. p. 84 – 91. 2010. 3. Hellings PW, Klimek L, Cingi C, et al. Non-allergic rhinitis: position paper of the European academy of allergy and clinical immunology. Allergy . 2017;72(11):1657-1665. 4. Varricchio A, Capasso M, De Lucia A, et al. Intranasal fl unisolide treatment in patients with non-allergic rhinitis. Int J Immunopathol Pharmacol . 2011;24(2):401-409. 5. Schroer B, Pien LC. Nonallergic rhinitis: common problem, chronic symp toms. Cleve Clin J Med . 2012;79(4):285-293. 6. Yan CH, Hwang PH. Surgical management of nonallergic rhinitis. Otolaryngol Clin North Am . 2018;51(5):945-955. 7. Naclerio R. Anticholinergic drugs in nonallergic rhinitis. World Allergy OrganJ. 2009;2(8):162-165. 8. Georgitis JW, Banov C, Boggs PB, et al. Ipratropium bromide nasal spray in non-allergic rhinitis: ef fi cacy, nasal cytological response and patient evaluation on quality of life. Clin Exp Allergy . 1994;24(11):1049-1055. 9. Van Rijswijk JB, Blom HM, Fokkens WJ. Idiopathic rhinitis, the ongoing quest. Allergy . 2005;60(12):1471-1481. 10. Rohatgi A. Webplotdigitizer: Version 4.6 [Internet]. 2022 https://automeris. io/WebPlotDigitizer. 11. Cochrane Handbook for Systematic Reviews of Interventions [Internet]. [cited 2023 Mar 1]. https://handbook-5-1.cochrane.org/. 12. Elandt-Johnson RC, Johnson NL. Survival Models and Data Analysis . New York: Wiley; 1980:457 (Wiley series in probability and mathematical statistics). 13. Stuart A, Ord JK. In: Kendall MG, ed. Distribution Theory . 6th ed. Chichester: Wiley & Sons; 2004:676 (Kendall ’ s advanced theory of statistics). 14. R Core Team. R: A language and environment for statistical computing [Internet]. R Foundation for Statistical Computing, Vienna, Austria. 2021 https://www.r-project.org/. 15. Balduzzi S, Rücker G, Schwarzer G. How to perform a meta-analysis with R: a practical tutorial. Evid Based Ment Health . 2019;22(4):153-160. 16. Meltzer EO, Orgel HA, Biondi R, et al. Ipratropium nasal spray in children with perennial rhinitis. Ann Allergy Asthma Immunol off Publ Am Coll Allergy Asthma Immunol . 1997;78(5):485-491. 17. Bronsky EA, Druce H, Findlay SR, et al. A clinical trial of ipratropium bro mide nasal spray in patients with perennial nonallergic rhinitis. JAllergy Clin Immunol . 1995;95(5):1117-1122. 18. Bonadonna P, Senna G, Zanon P, et al. Cold-induced rhinitis in skiers — clinical aspects and treatment with ipratropium bromide nasal spray: a randomized controlled trial. AmJ Rhinol . 2001;15(5):297-301. https://doi. org/10.1177/194589240101500502. 19. Becker B, Borum S, Nielsen K, Mygind N, Borum P. A time-dose study of the effect of topical ipratropium bromide on methacholine-induced rhinorrhoea in patients with perennial non-allergic rhinitis. Clin Otolaryngol Allied Sci . 1997;22(2):132-134. 20. Segboer CL, Terreehorst I, Gevorgyan A, Hellings PW, van Drunen CM, Fokkens WJ. Quality of life is signi fi cantly impaired in nonallergic rhini tis patients. Allergy . 2018;73(5):1094-1100. 21. Segboer C, Gevorgyan A, Avdeeva K, et al. Intranasal corticosteroids for non-allergic rhinitis. Cochrane Database Syst Rev . 2019;2019(11):1-27.

mucosa, which stimulate the gland directly via musca rinic receptors. 19 There are several subcategories of NAR that can be identi fi ed based on the trigger of the symptoms; these include occupation, cigarette smoke, hormones, medicine, food, and age. 3 Patients usually report nasal blockage, anterior rhinorrhea/postnasal drip, and sneezing. To diag nose NAR, a thorough medical history, the absence of clinically signi fi cant sensitization to allergens, the exclu sion of clinical signs of rhinosinusitis, and other factors are taken into consideration. Other treatment options include capsaicin, intrana sal corticosteroids (INCS), and intranasal antihistamines. A recent Cochrane review suggested that patients with NAR responded favorably to INCS. It may slightly reduce patient-reported illness severity as indicated by the total nasal symptom score change from baseline after up to 4weeks. 21 Moreover, based on safety investigations and the fi ndings of the two trials conducted by Banov et al., the FDA approved azelastine HCl in November 2000 for the treatment of individuals (>12 years old) with vasomo tor rhinitis. 22,23 However, the majority of the outcomes on the use of intranasal corticosteroid therapy or intranasal antihistamines have low or very low certainty in the evidence. 21 Although pharmaceutical treatments are the fi rst line treatment for NAR, surgery may be used if drugs fail to relieve symptoms. It consists of inferior turbinate reduction, botulinum toxin injection, and vidian nerve neurectomy. 6 Because vidian neurectomy carries a risk of dry eye, newer procedures have concentrated on the dis tal branches of the nasal parasympathetic system, also known as the posterior nasal nerves (PNN). The posterior portion of the middle meatus provides access to the poste rior nasal nerve, allowing for minimally invasive treat ments. In-of fi ce procedures such as cryotherapy and radiofrequency ablation have been used successfully to treat chronic rhinitis. Temperature-controlled neurolysis of the PNN area is safe and effective in reducing the symptom burden of chronic rhinitis, surpassing a sham procedure. 24 Patients report enhanced quality of life up to 24 months after the procedure. 25,26 Moreover, cryother apy is shown to be superior to a sham procedure in terms of improving chronic rhinitis symptoms and patient qual ity of life. 27,28 There are no speci fi c recommendations or guidelines for the optimal treatment of NAR. It is a common disease with a signi fi cant impact on quality of life. A clear set of guidelines is clearly required, especially now that so many topical treatments and in-of fi ce procedures are available. To our knowledge, this is the fi rst systematic review of all placebo-controlled INIB trials for the treatment of NAR. All the studies included are double blind, RCTs with low reporting bias. LIMITATIONS This study had some limitations, including small sample sizes, unclear sampling strategies, and non-validated outcome assessments across trials. It should be kept in mind that the

Laryngoscope 133: December 2023

El Khoury et al.: Ipratropium Bromide in Non-Allergic Rhinitis

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