Intranasal budesonide in children affected by persistent allergic rhinitis and its effect on nasal patency and Nasal Obstruction Symptom Evaluation (NOSE) score

Background: Intranasal steroids are recognized as an effective treatment for allergic rhinitis (AR) although their effect on nasal patency has never been evaluated with an objective instrument such as anterior rhinomanometry in children. Moreover this effect has been widely assessed with total Nasal Symptom Scores (NSS) including all symptoms of allergic rhinitis and not with scores specifically focused on nasal obstruction such as the Nasal Obstruction Symptom Evaluation score (NOSE). Materials and methods: Sixty children (42 males and 18 female) aged 6-10 years, affected by persistent AR, were randomized and divided in two groups of 30 children to be included in an unblinded trial: one group treated with intranasal budesonide and isotonic nasal saline for 2 weeks and the other group treated only with isotonic nasal saline for 2 weeks. Each child underwent rhinomanometry and completed the NSS and the NOSE scores before and after treatment. Results: At the baseline nasal patency and NSS total score, NOSE total scores were correlated (r = -0.29, p<0.001; r = -60, p<0.001). After 2 weeks of treatment improvements in nasal patency, NSS and NOSE were seen (Delta NSS 4.13 +/- 1.38 vs 1.33 +/- 1.93, p<0.001; Delta NOSE 34 +/- 17.97 vs 9 +/- 18.21, p<0.001; Delta nasal patency -26.13 +/- 25.25 vs -11.83 +/- 11.31, p<0.001). Correlations were found between rhinitis duration and Delta nasal patency and Delta NOSE (r = -0.84, p<0.001; r = 0.43, p<0.01). Conclusion: Intranasal budesonide is effective in increasing nasal patency in children. Moreover the NOSE score was strongly correlated with nasal flow and, hence, this score should be regarded as a valid and reliable instrument in children.