***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Recent but limited evidence suggests that nasal lavage with hypertonic saline may be useful as an adjunctive treatment modality in the management of pediatric allergic rhinitis . The aim of this study was to clarify whether nasal irrigation with hypertonic solution should be routinely recommended to children with seasonal grass pollen rhinoconjunctivitis . Methods : Fourty-four children with seasonal grass pollen rhinoconjunctivitis were recruited . Twenty-two patients were r and om ized to receive three-times daily nasal rinsing with hypertonic saline during the pollen season , which lasted 7 weeks . Twenty-two patients were allocated to receive no nasal irrigation and were used as controls .  Twenty patients per group completed the study . A mean daily rhinoconjunctivitis score based on the presence of nasal discharge and obstruction as well as ocular symptoms as reddening and itching were calculated for each week of the pollen season . Patients were allowed to use oral antihistamines when required and the mean number of drugs taken per week was also calculated . Results : The mean weekly rhinoconjunctivitis score in the active group was reduced during the whole pollen period . This difference was statistically significant in week 6 and 7 of therapy . A markedly reduced intake of oral antihistamines was also observed in patients allocated to nasal rinsing , being statistically significant in 5 of the 7 weeks . No adverse effect was reported in the active group . Conclusions : This study supports the use of nasal rinsing with hypertonic saline in the pediatric patient with seasonal allergic rhinoconjunctivitis . This treatment proved to be tolerable , inexpensive and effective BACKGROUND Nasal irrigation has been used as an adjunctive therapy of allergic rhinitis ( AR ) . Available evidence suggested that buffered hypertonic saline ( BHS ) is superior to buffer normal saline ( BNS ) for relief nasal symptoms . OBJECTIVE To evaluate the effectiveness of BHS nasal irrigation in the management of children with symptomatic AR . DESIGN This was a r and omized , prospect i ve , double-blind placebo-controlled study . METHODS The present study was a r and omized prospect i ve double-blind placebo-controlled study . Eighty-one children with symptomatic AR who had a total nasal symptom score (TNSS)≥4 were included in this study . Each participant was r and omly treated with either normal saline ( NSS ) or BHS by a blinded investigator . Nasal saccharine clearance time ( SCT ) and TNSS were measured before and 10 min after nasal irrigation . Quality of life ( QoL ) was assessed using the question naire for Thai allergic rhinoconjunctivitis patients ( Rcq-36 ) . The 7-point Likert scale for satisfaction was also performed . All participants were assigned to perform nasal irrigation twice daily for the period of 4 weeks . During this period , they recorded TNSS , side effects and antihistamine use on daily diary card . A physical examination and subjective evaluation were performed at 2nd and 4th week visits , and daily diary cards were collected . RESULTS Patients with BHS were significantly improved in SCT ( 39.2 % versus 15.5 % , P=0.009 ) and TNSS ( 82.7 % versus 69.3 % , P=0.006 ) compared to the NSS group . However , at 2nd and 4th week both groups had improvement in TNSS and QoL compared to baseline visit . There was a significant improvement in mean QoL score in BHS group at 2nd week visit compared to NSS group ( P=0.04 ) but not at the 4th week . Nasal congestion but not TNSS was significantly improved in the BHS group ( P=0.04 ) . Moreover , a decreased use of oral antihistamine was observed in BHS group ( P=0.04 ) . There were few complaints reported , and side effects were seen equally in both groups . CONCLUSION Nasal irrigation with BHS causes an improvement in SCT , TNSS and QoL compare to NS in children with symptomatic AR Recent evidence suggests that nasal irrigation with hypertonic saline may be useful as an adjunctive treatment modality in the management of many sinonasal diseases . However , no previous studies have investigated the efficacy of this regimen in the prevention of seasonal allergic rhinitis-related symptoms in the pediatric patient . Twenty children with seasonal allergic rhinitis to Parietaria were enrolled in the study . Ten children were r and omized to receive three-times daily nasal irrigation with hypertonic saline for the entire pollen season , which had lasted 6 weeks . Ten patients were allocated to receive no nasal irrigation and were used as controls . A mean daily rhinitis score based on the presence of nasal itching , rhinorrea , nasal obstruction and sneezing was calculated for each week of the pollen season . Moreover , patients were allowed to use oral antihistamines when required and the mean number of drug assumption per week was also calculated . In patients allocated to nasal irrigation , the mean daily rhinitis score was reduced during 5 weeks of the study period . This reduction was statistically significantly different in the 3th , 4th and 5th week of therapy . Moreover , a decreased consumption of oral antihistamines was observed in these patients . This effect became evident after the second week of treatment and result ed in statistically significant differences during the 3th , 4th and 6th week . This study supports the use of nasal irrigation with hypertonic saline in the pediatric patient with seasonal allergic rhinitis during the pollen season . This treatment was tolerable , inexpensive and effective OBJECTIVE To evaluate the potential of nasal isotonic saline application to prevent reappearance of cold and flu in children during the winter . DESIGN Prospect i ve , multicenter , parallel-group , open , and r and omized comparison . SETTING Eight pediatric outpatient clinics . PATIENTS A total of 401 children ( aged 6 - 10 years ) with uncomplicated cold or flu . INTERVENTIONS We r and omly assigned patients to 2 treatment groups , one with just st and ard medication , the other with nasal wash with a modified seawater solution ( Physiomer ) plus st and ard medication , and observed them for 12 weeks . MAIN OUTCOME MEASURES The primary efficacy end points were nasal symptoms resolution during acute illness ( visits 1 and 2 ) . We also looked for reappearance of cold or flu , consumption of medication , complications , days off school , and reported days of illness during the following weeks when preventive potential was evaluated ( visits 3 and 4 ) . RESULTS At visit 2 , patients in the saline group achieved primary end points ( measured on a 4-point numeric scale on which 1 indicated no symptoms and 4 , severe symptoms ) in the parameters nasal secretion and obstruction ( mean scores vs nonsaline group , 1.79 vs 2.10 and 1.25 vs 1.58 , respectively ) ( P < .05 for both ) . During the prevention phase ( at visit 3 , 8 weeks after study entry ) patients in the saline group showed significantly lower scores in sore throat , cough , nasal obstruction , and secretion ( P < .05 for all ) . By visit 3 , significantly fewer children in the saline group were using antipyretics ( 9 % vs 33 % ) , nasal decongestants ( 5 % vs 47 % ) , mucolytics ( 10 % vs 37 % ) , and systemic antiinfectives ( 6 % vs 21 % ) ( P < .05 for all ) . During the same period children in the saline group also reported significantly fewer illness days ( 31 % vs 75 % ) , school absences ( 17 % vs 35 % ) , and complications ( 8 % vs 32 % ) ( P < .05 for all ) . Similar results were found at the final visit . CONCLUSION Children in the saline group showed faster resolution of some nasal symptoms during acute illness and less frequent reappearance of rhinitis subsequently Allergic rhinitis ( AR ) is a very common childhood disease that is associated with a significant reduction in the patients ' quality of life . Its treatment combines educating the patients and their parents , immunotherapy and drug administration . However , even the best approach does not relieve the symptoms of a number of patients . Alternative therapies are particularly needed for children because the fear of adverse events frequently reduces parental compliance to the prescribed drugs , and immunotherapy is less easy to administer than in adults . In this prospect i ve investigator-blinded study we evaluated whether children , with a documented history of seasonal grass pollen-related AR , benefit from nasal irrigation by assessing the effects on nasal signs and symptoms , on middle ear effusion and on adenoidal hypertrophy . We r and omized children aged 5 to 9 years ( median age 82 months ) to normal saline or hypertonic saline (  a 2.7 % sodium chloride solution ) , administered twice-daily using a disposable 20 ml syringe , or no treatment .  Nasal symptoms ( rhinorrhea , itching , sneezing , nasal obstruction ) , swelling of turbinates , adenoid hypertrophy or middle ear effusion were assessed at baseline and after 4 weeks of treatment . Two hundred and twenty children ( normal saline : 80 ; hypertonic saline : 80 ; no treatment : 60 ) completed the study . After four weeks , all the considered items were significantly reduced in the group receiving hypertonic saline ( P < 0.0001 ) , whereas in the group receiving normal saline only rhinorrhea ( P = 0.0002 ) and sneezing ( P = 0.002 ) were significantly reduced . There was no significant change in any of the items in the control group . The duration of oral antihistamines was significantly lower in the children receiving hypertonic saline than in those treated with normal saline or in controls . No adverse events were reported and parental satisfaction and compliance with the procedure were globally very good , regardless of the solution used . Using our procedure , hypertonic saline is effective , inexpensive , safe , well tolerated and easily accepted by children with seasonal grass pollen-related AR and their parents . Our data suggest that nasal irrigation with hypertonic saline might be included in the wide spectrum of therapies recommended for grass-pollen AR 
    Output:
    
Nasal saline douching appears to be effective , being accepted and tolerated in the majority of children ( 78 - 100 % ) .
NSD has a significant positive impact on the quality of life in children with allergic rhinitis .
When used as an adjunctive treatment having mainly a cleansing property , NSD potentiates the effects and may reduce the dose required of AR medications .
Among the principal factors that influence the acceptability and tolerability of NSD are the child 's age , delivery system and method , and tonicity .
Nasal saline douching provides an accessible , low cost , low morbidity , easy to use treatment in children with allergic rhinitis