Peer-reviewed article
Efficacy and safety of oral treatments for allergic rhinitis in children: A network meta-analysis.
Thomander T, Gil-Mata S, Riera-Serra P, Vieira RJ, Ferreira A et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This network meta-analysis examines the effectiveness and safety of oral medications (antihistamines and leukotriene receptor antagonists) for treating allergic rhinitis in children under 12 years old. The review included eight randomized controlled trials with 906 participants and found that oral antihistamines were more effective than placebo at reducing nasal symptoms, but combining them with leukotriene receptor antagonists provided no additional benefit. No significant safety concerns were identified, though the overall quality of evidence was low.
Key points
- Oral antihistamines reduced Total Nasal Symptom Score by 1.60 points compared to placebo
- Combining antihistamines with leukotriene receptor antagonists showed no additional benefit over antihistamines alone
- No important differences were found between individual antihistamine treatments
- No significant differences in adverse event frequency were observed between treatments
- Evidence quality was low or very low for most comparisons, with only eight primary studies available
Limitations
This analysis focuses narrowly on allergic rhinitis treatment efficacy and safety rather than broader child well-being outcomes. The review cannot address long-term impacts on children's development, quality of life, educational outcomes, or systemic health effects beyond the specific symptom measures used in the included trials.
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.