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Published on: August 7, 2017
Potential clinical benefits of probiotics in pediatric allergic rhinitis: a systematic review and network
Haiyan Li1,2, Zeyu Chen1, Lingyue Guo1,3
1Tianjin Kingmed Diagnostics Laboratory Co. Ltd, Tianjin, China.
Insights
Probiotic supplements may help children with allergic rhinitis (AR) by reducing nasal symptoms and improving quality of life. Mixed strains appear most effective, but more research is needed.
Area of Science:
- Pediatric Allergy and Immunology
- Microbiome Research
- Clinical Trial Analysis
Background:
- Pediatric allergic rhinitis (AR) significantly impacts children's quality of life.
- Current treatment options for AR have limitations.
- Probiotics are explored for their immunomodulatory effects.
Purpose of the Study:
- To evaluate the clinical benefits of probiotics for pediatric AR.
- To identify superior probiotic strains or formulations for AR management.
- To synthesize evidence using meta-analysis and network meta-analysis.
Main Methods:
- Systematic literature search of RCTs in major databases up to July 2025.
- Inclusion of pediatric AR patients receiving probiotics versus placebo/standard care.
- Meta-analysis and network meta-analysis (NMA) of outcomes like TNSS, PRQLQ, and clinical efficacy.
Main Results:
- Probiotics significantly reduced Total Nasal Symptom Score (TNSS) and improved Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) scores.
- Clinical efficacy was enhanced with probiotic use, but effects on Total Symptom Score (TSS) and IgE were not significant.
- Network meta-analysis indicated that mixed-strain probiotics were superior across multiple outcomes.
Conclusions:
- Probiotic supplementation, particularly multi-strain formulations, shows adjunctive benefits for pediatric AR.
- Probiotics may ameliorate nasal symptoms and improve quality of life in children with AR.
- Further high-quality, rigorously designed trials are necessary to confirm these findings.
Objective:
This study aimed to evaluate potential clinical benefits and superior strains of probiotics for pediatric allergic rhinitis (AR) using meta-analysis and network meta-analysis.
Methods:
A systematic search was conducted in databases including PubMed, Web of Science, Cochrane Library, and China National Knowledge Infrastructure up to July 31, 2025, to identify randomized controlled trials (RCTs). Inclusion criteria were pediatric patients with AR, probiotic interventions, control groups receiving placebo or standard treatment, and reported outcomes such as Total Nasal Symptom Score (TNSS), Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ), Total Symptom Score (TSS), serum total IgE levels, or clinical efficacy. Study quality was assessed using the JADAD scale, with meta-analysis and network meta-analysis (NMA) performed via RevMan and R software, calculating standardized mean differences (SMD), relative risks (RR), and surface under the cumulative ranking curve (SUCRA) values.
Results:
Eighteen RCTs were included, involving 1,789 patients (963 in the probiotic group and 826 in the control group). Meta-analysis showed that probiotics significantly reduced TNSS (SMD = -0.85, 95%CI [-1.25, -0.44], P < 0.05), improved PRQLQ scores (SMD = -2.53, 95% CI [-4.66, -0.40], P < 0.05) and enhanced clinical efficacy (RR = 1.16, 95%CI [1.07, 1.25], P < 0.05). However, no significant effects were observed on TSS (SMD = -1.79, 95%CI: [-4.06, 0.48], P = 0.12), or serum total IgE levels (SMD = -0.34, 95%CI [-0.84, 0.16], P = 0.18). Subgroup and NMA analyses indicated that mixed strains performed superiorly across multiple outcomes.
Conclusions:
Probiotic supplementation, especially multi-strain formulations, may provide adjunctive benefits in pediatric AR, with potential for ameliorating nasal symptoms and enhancing quality of life, though further validation through rigorously designed trials is warranted.
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