Rhinophototherapy, an alternative treatment of allergic rhinitis: Systematic review and meta-analysis

Costa, Tatyana Machado Ramos; Carneiro, Fernanda Melo; Oliveira, Karen Amanda Soares de; Souza, Maria Fernanda Barbosa; Avelino, Melissa Ameloti Gomes; Wastowski, Isabela Jubé

doi:10.1016/j.bjorl.2020.12.016

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Brazilian Journal of Otorhinolaryngology

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REVIEW ARTICLE • Braz. j. otorhinolaryngol. 87 (06) • 2021 • https://doi.org/10.1016/j.bjorl.2020.12.016 copy

Rhinophototherapy, an alternative treatment of allergic rhinitis: Systematic review and meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

Allergic rhinitis is a chronic inflammatory disease of the nasal mucosa, mediated by immunoglobulin E, affecting 1 in 6 individuals. The treatment aims at attaining symptomatic control with minimal side effects, a requirement for new alternative therapies, including phototherapy, as it has an immunosuppressive and immunomodulatory effect.

Objective:

To identify the effectiveness of phototherapy in the treatment of allergic rhinitis through a meta-analysis.

Methods:

We searched Web of Science, Scielo, PubMed, SCOPUS, PEDro, and LILACS databases, using the terms: ‘‘intranasal irradiation’’, ‘‘phototherapy’’ and ‘‘allergic rhinitis’’. The R software Metafor package was used for the meta-analysis and the effect size was calculated for each symptom individually.

Results:

All symptoms decreased considerably after phototherapy: rhinorrhea (ES• = -1.35; p < 0.0001; I² = 91.84%), sneezing (ES• = -1.24; p < 0.0001; I² = 91.43%), nasal pruritus (ES• = -1.10; p < 0.0001; I² = 91.43%); nasal obstruction (ES• = -1.11; p < 0.0001; I² = 91.88%). The effects were more significant in perennial allergic rhinitis than in the seasonal type.

Conclusion:

Considering the effect size and the statistical significance attained in our study, rhinophototherapy showed to be an effective treatment for reducing the nasal symptom scores triggered by AR.

KEYWORDS
Phototherapy; Intranasal irradiation; Allergic rhinitis; Rhinophototherapy; Hay fever

Author/year	N	Type of phototherapy	Study objective	Study conclusion	Study design	Risk of bias
Sematonyte et al., 2018²⁵25 Semantonyte J, Bajouriene I, Satkauskiene B. Effect of intranasal phototherapy on quality-of-life of patients with allergic rhinitis. In: Abstracts from the European Academy of Allergy and Clinical Immunology Congress, 26-30 May 2018, Munich, Germany. Clin Transl Allergy. 2018;73 Suppl 105:3-859.	15	UV-A (25%), UV-B (5%) laser, visible light (70%), 310-600 nm	To investigate the effect of endonasal phototherapy on the quality of life of patients with perennial AR.	Endonasal phototherapy can relieve nasal symptoms and improve quality of life of patients with moderate/severe AR.	Prospective	High
Bella et al., 2017¹³13 Bella Z, Kiricsi Á, Viharosné ÉDR, Dallos A, Perényi Á, Kiss M, et al. Rhinophototherapy in persistent allergic rhinitis. Eur Arch Otorhinolaryngol. 2017;274:1543-50.	25	UV-A (25%), UV-B (5%) laser, visible light (70%), 310-600 nm	To evaluate whether endonasal phototherapy is safe and effective in the treatment of perennial AR.	Endonasal phototherapy is an effective and safe treatment in perennial AR.	Prospective, randomized, double-blind, placebo controlled	High
Alyasin et al., 2016¹⁰10 Alyasin S, Nabavizadeh SH, Houshmand H, Esmaeilzadeh H, Jelodar S, Amin R. Short time efficiency of rhinophototherapy in management of patients with allergic rhinitis resistant to medical therapy. Iran J Allergy Asthma Immunol. 2016;15:317-27.	62	UV-A (25%), UV-B (5%) laser, visible light (70%), 310-600 nm	Treat AR with phototherapy in patients who are unresponsive to treatment with antihistamines or in those whose work contraindicates the use of the drug, or who do not use medication.	Endonasal phototherapy was an effective treatment in patients with AR. However, a grounding study is still recommended.	Prospective, randomized and blind	High
Lee et al., 2013²⁶26 Lee HM, Park MS, Park IH, Lee SH, Lee SK, Kim KS, et al. A comparative pilot study of symptom improvement before and after phototherapy in Korean patients with perennial allergic rhinitis. Photochem Photobiol. 2013;89:751-7.	42	LED 650 nm	To evaluate the safety and efficacy of low energy phototherapy in patients with perennial AR.	Phototherapy is effective for the treatment of perennial AR and is a therapeutic option in the treatment management without the use of steroids, of immune-mediated diseases of the nasal mucosa	Open clinical study	High
Albu and Baschir, 2013²⁰20 Albu S, Baschir S. Intranasal phototherapy versus azelastine in the treatment of seasonal allergic rhinitis. Auris Nasus Larynx. 2013;40:447-51.	77	UV-A (25%), UV-B (5%) laser, visible light (70%), 310-600 nm	To compare the effectiveness of rhinophototherapy and azelastine hydrochloride for the treatment of seasonal AR.	Both rhinophototherapy and azelastine hydrochloride are capable of significantly improving TNSS.	Randomized, prospective	Medium
Yildirim; Apuhan e Kocoglu, 2013²⁷27 Yildirim YS, Apuhan T, Koçoˇglu E. Effects of intranasal phototherapy on nasal microbial flora in patients with allergic rhinitis. Iran J Allergy Asthma Immunol. 2013;12:281-6.	31	UV-A (25%), UV-B (5%) laser, visible light (70%), 310-600 nm	To evaluate the effect of endonasal phototherapy on the microbial flora in a patient with AR.	Endonasal phototherapy does not change the aerobic microbial flora of the nasal mucosa in patients with perennial AR.	Prospective, self-compared and blind.	High
Garaczi et al., 2011¹²12 Garaczi E, Boros-Gyevi M, Bella Z, Csoma Z, Kemény L, Koreck A. Intranasal phototherapy is more effective than fexofenadine hydrochloride in the treatment of seasonal allergic rhinitis: Results of a pilot study. Photochem Photobiol. 2011;87:474-7.		UV-A (25%), UV-B (5%) laser, visible light (70%), 310-600 nm	To compare the efficacy between endonasal phototherapy and fexofenadine hydrochloride, in the treatment of seasonal AR.	Endonasal phototherapy is more effective than fexofenadine hydrochloride in reducing clinical symptoms of seasonal AR.	Randomized prospective,	High
Bremher and Schön, 2011²⁸28 Brehmer D, Schön MP. Endonasal phototherapy significantly alleviates symptoms of allergic rhinitis, but has a limited impact on the nasal mucosal immune cells. Eur Arch Otorhinolaryngol. 2011;268:393-9.	10	UV-A (25%), UV-B (5%) laser, visible light (70%), 310-600 nm	To correlate clinical symptom scores with possible changes in Langerhans cells of the nasal mucosa induced by ultraviolet irradiation	The irradiation effect was positive, however, no effect was observed on Langerhans cells or other cells of the nasal mucosa immune system.	Open clinical study	High
Cingi et al., 2010¹⁴14 Cingi C, Cakli H, Yaz A, Songu M, Bal C. Phototherapy for allergic rhinitis: a prospective, randomized, single-blind, placebocontrolled study. Ther Adv Respir Dis. 2010;4:209-13.	79	UV-A (25%), UV-B (5%) laser, visible light (70%), 310-600 nm	To investigate the effectiveness of phototherapy treatment in patients with AR using TNSS.	Phototherapy can be an effective modality in the treatment of AR, especially when the drugs used are contraindicated and/or show insufficient efficacy	Prospective, randomized, blind, placebo-controlled	Medium
Csoma et al., 2006⁴4 Csoma Z, Koreck A, Ignacz F, Bor Z, Szabo G, Bodai L, et al. PUVA treatment of the nasal cavity improves the clinical symptoms of allergic rhinitis and inhibits the immediate-type hypersensitivity reaction in the skin. J Photochem Photobiol B. 2006;83:21-6.	13	PUVA laser 305-440 nm	To investigate the efficacy of endonasal PUVA light in the treatment of AR and its effect on skin testing.	Phototherapy plus UV-A is also an effective modality in the treatment of AR.	Open clinical study	Medium
Koreck et al., 2005²2 Koreck AI, Csoma Z, Bodai L, Ignacz F, Kenderessy AS, Kadocsa E, et al. Rhinophototherapy: a new therapeutic tool for the management of allergic rhinitis. J Allergy Clin Immunol. 2005;115:541-7.	49	UV-A (25%), UV-B (5%) laser, visible light (70%), 310-600 nm	To assess whether phototherapy, using a combination of UV-B, UV-A and visible light, is effective in the treatment of AR.	Phototherapy is an effective modality for the treatment of AR and immune-mediated diseases of the mucous membranes.	Randomized, double blind	Low
Csoma et al., 2004¹1 Csoma Z, Ignacz F, Bor Z, Szabo G, Bodai L, Dobozy A, et al. Intranasal irradiation with the xenon chloride ultraviolet B laser improves allergic rhinitis. J Photochem Photobiol B. 2004;75:137-44.	15	XeCL laser UV-B 308 nm	To investigate the clinical efficacy of UV-B irradiation in AR.	It suggests that the XeCL UV-B laser may be a new therapeutic tool in AR.	Open clinical study	High

	Rhinorrhea	Sneezing	Pruritus	Obstruction
Type of AR I² group	88.24%	88.99%	89.32%	88.30%
R2	59.37%	61.74%	56.88%	61.99%
Q model	73.8457	54.9171	34.2273	40.33
Perennial	-1.4947	-1.3587	-1.2595	-1.2614
Seasonal	-1.2474	-1.1598	-1.0105	-0.9955
Randomized study I² group	90.70%	90.42%	87.20%	91.81%
R2	48.99%	48.89%	45.62%	43.79%
Q model	76.1853	54.0509	44.9975	38.8202
Randomized	-1.1773	-1.3399	-1.3584	-1.1907
Non-randomized	-1.5052	-1.1374	-0.8207	-1.0187
Paired study I² group	75.90%	83.57%	49.59%	87.32%
R2	63.93%	56.65%	94.00%	50.60%
Q model	158.186	80.4247	199.863	72.8902
Paired	-1.0886	-1.0598	-0.8825	-0.9278
Unpaired	-1.8567	-1.6678	-1.8266	-1.3521
Double blind study I² group	90.69%	90.83%	90.54%	91.25%
R2	55.48%	55.28%	50.09%	54.01%
Q model	71.7681	52.0908	33.0588	37.8885
Double blind	-1.2352	-1.2846	-1.1861	-1.0836
Non-double blind	-1.4929	-1.2002	-1.0195	-1.1356

Parameter	Estimate	SE	z-value	_minCI	_maxCI	p-Value
Intercept	−0.4 ± 141	0.6795	−0.6094	−1.7459	0.9178	0.4554
Time	0.0313	0.0147	2.1255	0.0024	0.0601	0.0335
Weeks	−0.4498	0.2576	1.7459	−0.9547	0.055 ± 1	0.0808
Initial dose	−0.1189	0.6909	−0.1720	−1.4731	1.2353	0.8634
Final dose	−0.0177	0.5395	−0.0328	−1.0751	1.0397	0.9738

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] * Corresponding author. E-mail: tatyanamrcosta@gmail.com (T.M. Costa).