Efficacy and safety of oral treatments for allergic rhinitis in children: A network meta‐analysis
Year: 2026
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: BACKGROUND: Allergic rhinitis is the most common chronic disease in children. Information on efficacy and safety of oral allergic rhinitis treatments in children is scarce. We aimed to comprehensively evaluate the efficacy and safety of oral medications for allergic rhinitis in children. METHODS: We performed a systematic review, searching three bibliographic databases and clinicaltrials.gov for randomized controlled trials assessing the use of oral antihistamines (OAH) or leukotriene receptor antagonists (LTRA) in children (<12 years old) with seasonal or perennial allergic rhinitis. Evaluated outcomes included the Total Nasal Symptom Score (TNSS), the Total Ocular Symptom Score (TOSS), the Rhinoconjunctivitis Quality-of-Life Questionnaire (RQLQ), development of adverse or serious adverse events, and withdrawals due to adverse events. We performed network meta-analysis at both class and individual treatment levels. Certainty in the body of evidence was assessed using the GRADE approach for network meta-analysis. RESULTS: We included eight primary studies with 906 participants. Overall, OAH were more effective against placebo in improving the TNSS (mean difference (MD) = -1.60; 95%CI = -2.25 to -0.95). On the other hand, OAH+LTRA did not demonstrate additional benefit over OAH in improving the TNSS (MD = -0.15; 95% CI = -1.18 to 0.88), and there were no important differences between individual OAH. Evidence on the TOSS was not found. No significant differences in the frequency of adverse events were observed. Certainty of evidence was low or very low for most comparisons. CONCLUSIONS: Oral treatments for allergic rhinitis appear to be effective and safe in children. However, evidence is scarce and the quality of evidence is mostly low. We performed a systematic review of randomised controlled trials assessing oral medications for allergic rhinitis in children and reporting results on nasal symptoms, ocular symptoms, quality of life and adverse events. Oral antihistamines (OAH) were found to be better than placebo, and OAH + oral leukotriene receptor antagonists (OLTRA) were not found to be better than OAH. We identified trivial differences between different OAH.
Source: Pediatric Allergy and Immunology
DOI: 10.1111/pai.70431
Authors: Tuuli Thomander, Sara Gil‐Mata, Pau Riera‐Serra, Rafael José Vieira, André Ferreira, Antonio Bognanni, Vítor Henrique Duarte, Hugo Viegas, Ana Margarida Pereira, Renato Ferreira‐da‐Silva, Henrique Ferreira‐Cardoso, Manuel Marques‐Cruz, João Castro‐Teles, Miguel Campos‐Lopes, Ana Teixeira Ferreira, Nuno Lourenço‐Silva, José Laerte Boechat, Ewa Borowiack, Ewelina Sadowska, Raquel Albuquerque Costa, Paula Perestrelo, Juliana Pereira‐Macedo, Despo Ierodiakonou, Alexandro W. L. Chu, Izabela Pera Calvi, Maria Inês Torres, Rita Silva Ribeiro, Ivan Chérrez‐Ojeda, Juan Jose Yepes Nuñez, Torsten Zuberbier, Ricardo M. Fernandes, Alessandro Fiocchi, Désirée E. Larenas‐Linnemann, Nhân Pham‐Thi, Nikolaos G. Papadopoulos, Graham Roberts, Arunas Valiulis, João A. Fonseca, Holger J. Schünemann, Mattia Giovannini, Bernardo Sousa‐Pinto, the ARIA 2024–2025 guideline panel
Institutions: University of Helsinki, Universidade do Porto, Helsinki University Hospital, Centre for Health Technology and Services Research, Health Research Institute of the Balearic Islands, Centro Hospitalar do Porto, Humanitas University, McMaster University, CUF Porto Hospital, Unidade Local de Saúde de Entre Douro e Vouga, Universidade Federal Fluminense, Unidade Local de Saúde de Trás-os-Montes e Alto Douro, University of Nicosia, Universidad Espíritu Santo, Universidad de Los Andes, Fundación Santa Fe de Bogotá, Humboldt-Universität zu Berlin, Fraunhofer Institute for Translational Medicine and Pharmacology, Charité – Universitätsmedizin Berlin, University of Lisbon, Instituto de Medicina Molecular João Lobo Antunes, Bambino Gesù Children's Hospital, Hospital Médica Sur, École Polytechnique, Université Paris Cité, National and Kapodistrian University of Athens, University Hospital Southampton NHS Foundation Trust, NIHR Southampton Biomedical Research Centre, University of Southampton, Vilnius University, Meyer Children's Hospital, University of Florence
Language: English
Subfield: Immunology and Allergy
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7203481695