{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T07:03:41Z","timestamp":1789542221286,"version":"build-2803163510"},"reference-count":36,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Allergy Immunology"],"published-print":{"date-parts":[[2026,8]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We performed a systematic review, searching three bibliographic databases and\n clinicaltrials.gov<\/jats:ext-link>\n for randomized controlled trials assessing the use of oral antihistamines (OAH) or leukotriene receptor antagonists (LTRA) in children (<12\u2009years 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\u2010of\u2010Life Questionnaire (RQLQ), development of adverse or serious adverse events, and withdrawals due to adverse events. We performed network meta\u2010analysis at both class and individual treatment levels. Certainty in the body of evidence was assessed using the GRADE approach for network meta\u2010analysis.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n We included eight primary studies with 906 participants. Overall, OAH were more effective against placebo in improving the TNSS (mean difference (MD)\u2009=\u2009\u22121.60; 95%CI\u2009=\u2009\u22122.25 to \u22120.95). On the other hand, OAH+LTRA did not demonstrate additional benefit over OAH in improving the TNSS (MD\u2009=\u2009\u20100.15; 95% CI\u2009=\u2009\u22121.18 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.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n 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.<\/jats:p>\n \n 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\u2009+\u2009oral leukotriene receptor antagonists (OLTRA) were not found to be better than OAH. We identified trivial differences between different OAH.\n \n \n image<\/jats:alt-text>\n <\/jats:graphic>\n <\/jats:boxed-text>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/pai.70431","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T08:48:06Z","timestamp":1786697286000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and safety of oral treatments for allergic rhinitis in children: A network meta\u2010analysis"],"prefix":"10.1111","volume":"37","author":[{"given":"Tuuli","family":"Thomander","sequence":"first","affiliation":[{"name":"MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine University of Porto Porto Portugal"},{"name":"The Heart and Lung Center Helsinki University Hospital and University of Helsinki Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Gil\u2010Mata","sequence":"additional","affiliation":[{"name":"MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine University of Porto Porto Portugal"},{"name":"CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine University of Porto Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pau","family":"Riera\u2010Serra","sequence":"additional","affiliation":[{"name":"CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine University of Porto Porto Portugal"},{"name":"Health Research Institute of the Balearic Islands Palma de Mallorca Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1834-3055","authenticated-orcid":false,"given":"Rafael Jos\u00e9","family":"Vieira","sequence":"additional","affiliation":[{"name":"MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine University of Porto Porto Portugal"},{"name":"CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine University of Porto Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9","family":"Ferreira","sequence":"additional","affiliation":[{"name":"CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine University of Porto Porto Portugal"},{"name":"Unit of Anatomy, Department of Biomedicine, Faculty of Medicine University of Porto Porto Portugal"},{"name":"Department of Ophthalmology Centro Hospitalar Universit\u00e1rio do Porto Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0128-903X","authenticated-orcid":false,"given":"Antonio","family":"Bognanni","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology and Research Center (CERC) Humanitas University and Humanitas Research Hospital Milan Italy"},{"name":"Department of Health Research Methods, Evidence and Impact McMaster University Hamilton Ontario Canada"},{"name":"Department of Medicine, Evidence in Allergy Group McMaster University Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V\u00edtor Henrique","family":"Duarte","sequence":"additional","affiliation":[{"name":"MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine University of Porto Porto Portugal"},{"name":"CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine University of Porto Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo","family":"Viegas","sequence":"additional","affiliation":[{"name":"MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine University of Porto Porto Portugal"},{"name":"CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine University of Porto Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5468-0932","authenticated-orcid":false,"given":"Ana Margarida","family":"Pereira","sequence":"additional","affiliation":[{"name":"MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine University of Porto Porto Portugal"},{"name":"PaCeIT \u2013 Patient Centered Innovation and Technologies, Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine University of Porto Porto Portugal"},{"name":"Allergy Unit Instituto and Hospital CUF Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6517-6021","authenticated-orcid":false,"given":"Renato","family":"Ferreira\u2010da\u2010Silva","sequence":"additional","affiliation":[{"name":"MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine University of Porto Porto Portugal"},{"name":"CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine University of Porto Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrique","family":"Ferreira\u2010Cardoso","sequence":"additional","affiliation":[{"name":"MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine University of Porto Porto Portugal"},{"name":"CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine University of Porto Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Marques\u2010Cruz","sequence":"additional","affiliation":[{"name":"MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine University of Porto Porto Portugal"},{"name":"CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine University of Porto Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o","family":"Castro\u2010Teles","sequence":"additional","affiliation":[{"name":"MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine University of Porto Porto Portugal"},{"name":"CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine University of Porto Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7112-3580","authenticated-orcid":false,"given":"Miguel","family":"Campos\u2010Lopes","sequence":"additional","affiliation":[{"name":"MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine University of Porto Porto Portugal"},{"name":"CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine University of Porto Porto Portugal"},{"name":"Department of Otolaryngology Unidade Local de Sa\u00fade de Entre o Douro e Vouga Santa Maria da Feira Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Teixeira","family":"Ferreira","sequence":"additional","affiliation":[{"name":"MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine University of Porto Porto Portugal"},{"name":"CINTESIS@RISE, Centre for Health Technology 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Research, Health Research Network, Faculty of Medicine University of Porto Porto Portugal"},{"name":"Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine University of Porto Porto Portugal"},{"name":"Clinical Immunology Service, Internal Medicine Department, Faculty of Medicine Fluminense Federal University Niter\u00f3i Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9666-5425","authenticated-orcid":false,"given":"Ewa","family":"Borowiack","sequence":"additional","affiliation":[{"name":"Evidence Prime Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8585-4109","authenticated-orcid":false,"given":"Ewelina","family":"Sadowska","sequence":"additional","affiliation":[{"name":"Evidence Prime Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raquel Albuquerque","family":"Costa","sequence":"additional","affiliation":[{"name":"MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine University of Porto Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7298-7858","authenticated-orcid":false,"given":"Paula","family":"Perestrelo","sequence":"additional","affiliation":[{"name":"MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine University of Porto Porto Portugal"},{"name":"CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine University of Porto Porto Portugal"},{"name":"Oncology Department Local Health Unit of Tr\u00e1s\u2010os\u2010Montes e Alto Douro Vila Real 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L.","family":"Chu","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence and Impact McMaster University Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Izabela Pera","family":"Calvi","sequence":"additional","affiliation":[{"name":"MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine University of Porto Porto Portugal"},{"name":"CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine University of Porto Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria In\u00eas","family":"Torres","sequence":"additional","affiliation":[{"name":"MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine University of Porto Porto Portugal"},{"name":"CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research 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Yepes","family":"Nu\u00f1ez","sequence":"additional","affiliation":[{"name":"School of Medicine Universidad de los Andes Bogot\u00e1 DC Colombia"},{"name":"Fundaci\u00f3n Santa Fe de Bogot\u00e1 Bogot\u00e1 DC Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1466-8875","authenticated-orcid":false,"given":"Torsten","family":"Zuberbier","sequence":"additional","affiliation":[{"name":"Institute of Allergology, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin Corporate Member of Freie Universit\u00e4t Berlin and Humboldt\u2010Universit\u00e4t zu Berlin Berlin Germany"},{"name":"Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo M.","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Clinical Pharmacology and Therapeutics, Instituto de Medicina Molecular, Faculty of Medicine University of Lisbon Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2549-0523","authenticated-orcid":false,"given":"Alessandro","family":"Fiocchi","sequence":"additional","affiliation":[{"name":"Allergy Department Bambino Ges\u00f9 Children's Hospital, IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5713-5331","authenticated-orcid":false,"given":"D\u00e9sir\u00e9e E.","family":"Larenas\u2010Linnemann","sequence":"additional","affiliation":[{"name":"Center of Excellence in Asthma and Allergy M\u00e9dica Sur Clinical Foundation and Hospital M\u00e9xico City Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nh\u00e2n","family":"Pham\u2010Thi","sequence":"additional","affiliation":[{"name":"Ecole Polytechnique de Palaiseau Palaiseau France"},{"name":"IRBA (Institut de Recherche Bio\u2010M\u00e9dicale des Arm\u00e9es), Br\u00e9tigny sur Orge France"},{"name":"Universit\u00e9 Paris Cit\u00e9 Paris France"},{"name":"Center for Allergy and Clinical Immunology Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos G.","family":"Papadopoulos","sequence":"additional","affiliation":[{"name":"Allergy Department, 2nd Pediatric Clinic University of Athens Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2252-1248","authenticated-orcid":false,"given":"Graham","family":"Roberts","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Southampton Southampton UK"},{"name":"The David Hide Asthma and Allergy Centre, St Mary's Hospital Isle of Wight UK"},{"name":"NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust Southampton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arunas","family":"Valiulis","sequence":"additional","affiliation":[{"name":"Interdisciplinary Research Group of Human Ecology, Institute of Clinical Medicine and Institute of Health Sciences Medical Faculty of Vilnius University Vilnius Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o A.","family":"Fonseca","sequence":"additional","affiliation":[{"name":"MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine University of Porto Porto Portugal"},{"name":"CINTESIS@RISE, Centre for Health Technology and Services Research, Health Research Network, Faculty of Medicine University of Porto Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3211-8479","authenticated-orcid":false,"given":"Holger J.","family":"Sch\u00fcnemann","sequence":"additional","affiliation":[{"name":"Clinical 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Health Technology and Services Research, Health Research Network, Faculty of Medicine University of Porto Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the ARIA 2024\u20132025 guideline 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