Nasal nitric oxide – an inflammatory marker in paediatric allergic rhinitis?
Reviewed by Shiying Hey

Nasal nitric oxide (nNO) is mainly produced in the paranasal sinus mucosa and was shown in some studies to have increased expression in allergic rhinitis (AR). Although it represents a potential non-invasive tool for AR measurement, there remains no consensus as to how best to measure it. This small-scale (n=24 in each arm), double-blinded, placebo-controlled RCT aimed to evaluate the efficacy of nasal budesonide (Rhinocort) in paediatric allergic rhinitis patients. The objective and subjective outcome measures were the nNO level, and nasal symptoms (Total 5 Symptoms Score – T5SS) and sleep quality (Pittsburgh Sleep Quality Index – PSQI), respectively. For three weeks, budesonide nasal spray 100μg was administered twice daily in children with persistent allergic rhinitis for at least a year and had positive skin-prick tests for house dust mite (Dermatophagoides pteronyssinus). The placebo used was 0.9% sodium chloride nasal spray. The nNO was measured with an electrochemical sensor in one nostril while the contralateral nostril was occluded with an inert olive at the vestibule. At the end of treatment period, the authors showed a statistically significant reduction in nNO in children with AR treated with budesonide spray, as compared to the placebo group. In addition, budesonide was also found to give symptomatic relief in children with AR, particularly for nasal congestion. With the observed clinical and biochemical benefits, and the lack of adverse events, the authors thus concluded that a three-week course of budesonide spray 100μg BD is an effective and well-tolerated regime for paediatric allergic rhinitis.

Nasal budesonide efficacy for nasal nitric oxide and nasal obstruction in rhinitis.
Ferrante G, Fasola S, Cilluffo G, et al.
PAEDIATRIC ALLERGY AND IMMUNOLOGY
2017;28(4):393-7.