Efficacy and safety of oral treatments for allergic rhinitis in children: A network meta-analysis
In brief
Oral antihistamines lower children's nasal symptom scores by roughly 1.6 points versus placebo
A network meta-analysis of eight trials with 906 kids found that oral antihistamines significantly improved total nasal symptom scores compared with no treatment, while adding a leukotriene receptor antagonist gave no extra benefit. Adverse events were similar across groups, but most evidence was low certainty, highlighting the need for stronger pediatric trials.
- Journal
- Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (Q1)
- Published
- 1 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Tuuli Thomander, Sara Gil-Mata, Pau Riera-Serra, Rafael José Vieira, André Ferreira, Antonio Bognanni, et al.
- PMID
- 42596864
- DOI
- 10.1111/pai.70431
Why clinicians should know about it
- Picked for Internal Medicine (top studies of the week, 16 August 2026): Network meta‑analysis of oral treatments for allergic rhinitis in children
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.