This summer has been the worst ever for many hay fever sufferers in the UK. Hit with consecutive days of very high pollen counts and “pollen bombs”, one in four adults have been greeted with a runny nose, itchy eyes or sneezing fits during the warm weather. According to Met Office research, next summer will be no better, with longer hay fever seasons occurring thanks to the climate crisis. On top of that, those living in polluted urban areas can experience even worse symptoms.
Treatments to combat these increasingly prevalent allergies vary from antihistamine tablets to wearing wraparound glasses. As a lifelong hay fever sufferer, I have experimented with almost every solution available, but haven’t found lasting respite. An air filter chugs away in my bedroom at night and I take the most powerful antihistamines doctors can prescribe, but a picnic would still be a snotty nightmare.
Recently, though, an ancient solution has been attracting renewed interest. Nasal irrigation is the practice of rinsing warm saltwater through the nostrils. It is a remedy that has been in use for thousands of years in Ayurvedic medicine and has been the focus of scientific studies since the pandemic.
More commonly practised in south Asia, nasal irrigation has been steadily popularised in Europe and the US since it featured in a 2006 segment on The Oprah Winfrey Show. The doctor (and Republican former Senate candidate) Mehmet Oz described the benefits of using what he called a “nose bidet” – a teapot-like device used to pour water into one nostril and out the other.
Its adherents say regular irrigation clears airways and sinuses, washing out allergens to make breathing easier and even reduce the symptoms of sinus congestion, inflammation and pain. However, Oz has since been criticised for promoting ineffective and discredited health treatments. So, how useful is a regular nose rinse, especially for those of us fighting pollen?
“I recommend it in my daily nose practice, medicinally and for hygiene reasons,” says the ear, nose and throat specialist Prof Peter Andrews. “It can be used like washing the face, simply as a natural way to keep the nostrils clean, as well as helping to reduce crusting, inflammation, pollen and the other aeroallergens that can get stuck in the nose. It can also make nasal medicines and sprays work better if you clean the nose out first.”
Andrews says it is effective and safe, since rinsing has been researched as part of several systematic scientific reviews, one of which found that saline solution can help reduce the symptoms of chronic rhinosinusitis, a long-lasting sinus inflammation. A 2021 consensus on how to manage common sinus issues found that regular rinsing with saltwater can be helpful.
“You can use it as often as you want, since there is no dose maximum, and it therefore gives patients the power to intervene when they like to feel an immediate effect,” Andrews says. “There is also nothing adverse that results from nasal irrigation, if done correctly, only the minimal side-effects of water going down the side of the nose or the salt perhaps burning the throat.”
There are two ways that he recommends rinsing the nose: either using a saltwater spray such as Sterimar, or by dissolving sachets of sterile salt into a special plastic bottle and squirting it up the nose. Most remedies cost less than £10. You can use sea salt, but table salt has too many additives.
It is crucial that the water used is sterilised, either through being boiled and cooled to body temperature or by using bottled mineral water. If tap water is used, there is a chance of contracting a serious infection, although this is less likely in the UK than elsewhere. In 2011, two cases of a fatal brain infection in the US were linked to nasal irrigation using tap water. The organism responsible, Naegleria fowleri, which is also found in lakes, rivers and hot springs, is called the “brain-eating amoeba”. In 2023, another Naegleria fowleri death in the US was potentially linked to a tap water sinus rinse.
On the whole, though, these infections are very rare, with only 34 cases reported in the US over the past decade. They also typically occur when people get water up their nose after diving into lakes or rivers, rather than via rinsing. The amoeba is destroyed by stomach acid, so drinking contaminated water does not lead to infection.
Andrews hasn’t experienced his patients being put off nasal irrigation because of the news. If anything, awareness has been increasing. “The nose has had a lot of media attention because of Covid-19 being an airborne virus and I think people are more concerned about when theirs isn’t functioning properly, especially after potentially losing their sense of smell,” he says. “I’ve also noticed patients coming to me and wanting to address their nasal issues after taking up yoga, since so much of that practice is based around breathing.”
Yoga is, in fact, closely associated with nasal irrigation. Wendy Teasdill, a yoga teacher, explains that there are four types of nasal rinses, or neti, that have been used in Ayurvedic traditions for millennia, from sutra neti, which requires passing a fine root or thread through your nostril, down the back of your throat and into your mouth, to jala neti, the most common practice of applying a saltwater rinse, doodh neti, which uses milk, and ghee neti, which uses clarified butter.
“I know people with sinus problems who practise [the jala neti] all the time,” she says. “It is used in yoga to help with pranayama [breathing patterns] and it really makes your brain feel clearer once you can breathe more freely.”
Teasdill recommends using a ceramic neti pot, similar to the device that Oz advertised on Oprah, since it reduces plastic wastage. “It can take a bit of time to get the angle right for tilting your head and letting the water through, and it’s important to do it when you’re relaxed, so try to find someone who can supervise who has experience,” she says.
The neti pot seems too unwieldy for a first go. I opt instead for a plastic squeeze bottle, which I hope I can recycle, and a set of sachets. Thanks to the horrendous “brain-eating amoeba”, it is seared into my mind that I must boil and cool my water before using it. I tip my head over a sink, insert the tube and squeeze. I make sure to breathe through my mouth so I don’t suck the water down and choke, but I feel nothing. No water is coming out of my empty nostril, as it should be.
I dry my nose, give it a gentle blow and try again in the other nostril. This time, it works. It feels like a fizz of electricity shooting up my face; the surprise makes me stop. I remember Teasdill’s advice to relax and try again. The other nostril now also works. The effect is instantaneous – I can breathe more clearly, while my nose feels less dry and itchy. All that’s left is a slight saltiness that lingers at the back of my throat.
“The way nasal irrigation works is by cleaning our cilia,” Andrews says. “These microscopic hairs beat mucus [using a wafting motion] full of trapped bacteria into our throat to be swallowed and neutralised by our gut. We swallow around a litre of this mucus every day. When the cilia are inflamed or obstructed, they can’t do their job, which is why our nose might run when we have a cold. Nasal rinsing clears those obstructions and gives the cilia perfect conditions to work in.”
During the pandemic, research was undertaken into how this cilia-cleaning process might help stall the effects of airborne Covid. In 2021, a small study found that irrigating your nose twice a day with a saline solution after testing positive for Covid could decrease the chances of hospitalisation and death in higher-risk patients. However, another, in 2022, showed that the users of nasal rinses didn’t experience an improvement in their symptoms.
One of the authors of the 2021 study, Dr Amy Baxter, still uses nasal irrigation whenever she is going to be in a crowded place. “When I travel on a plane, I will bring my kit with me and do a nasal rinse when I arrive,” she says.
After two weeks of daily nasal rinsing, I am starting to notice the difference. I realise how often my nose is blocked or cannot intake air properly, since after a rinse I feel as if I can breathe again. My head feels a bit clearer. The boiling and cooling of water is an administrative effort, but I am sneezing less frequently, so it does seem like my hay fever symptoms are starting to abate.
It might all be down to the fact that the worst of hay fever season has now passed, but if the practice is helping even a small amount, it feels like a worthy investment to carry on next year. Perhaps then I will finally be able to brave a summertime picnic.
