{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T21:26:00Z","timestamp":1790717160212,"version":"4.1.0"},"reference-count":82,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The role of oral bacterial lysates (OBLs) as adjuvant immunomodulatory therapy in pediatric asthma requires clarification. This systematic review and meta-analysis evaluates their efficacy and safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched eight databases for randomized controlled trials (RCTs) in children comparing standard asthma therapy plus OBLs versus standard therapy\/placebo. Primary outcomes were clinical (wheezing\/infection frequency, symptom improvement time, treatment efficacy) and lung function parameters. Secondary outcomes included immune biomarkers and adverse events. Random-effects meta-analyses were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-eight RCTs (n = 2,893) were included. Adjunctive OBLs therapy significantly reduced wheezing\/exacerbation frequency (Mean Difference (MD) = \u22123.00,95% confidence intervals (CI): 4.07 to \u22121.93), shortened symptom improvement time (MD = \u22123.13 days, 95%CI: 4.10 to \u22122.15), reduced Respiratory Tract Infection (RTI) frequency (MD = \u22122.43,95%CI: 3.62 to \u22121.23) and increased overall treatment efficacy rate (relative rates (RR) = 1.17, 95%CI: 1.13\u20131.21). Improvements occurred in lung function (Forced Expiratory Volume in 1\u00a0s [FEV1], Forced Vital Capacity [FVC], Peak Expiratory Flow [PEF]) and immune parameters (increased the level of T-lymphocyte subsets (CD3+,CD4+,CD4+\/CD8+) and salivary secretory immunoglobulin A (sIgA), decreased peripheral eosinophil (EOS) count and the level of interleukin-4(IL-4), eosinophil cationic protein (ECP), fractional exhaled nitric oxide (FeNO). Adverse events did not increase significantly (RR = 1.26, 95%CI: 0.93\u20131.70). Subgroup analyses showed consistent benefits across follow-up duration, age, and sample size, with background inhaled corticosteroids (ICS) therapy being a potential effect modifier (P = 0.06).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Adjunctive OBLs therapy is associated with improved clinical outcomes, lung function, and immune modulation in pediatric asthma, with a favorable safety profile. However, methodological limitations, substantial heterogeneity, and potential biases warrant caution. While promising, more rigorous and long-term trials are needed to define its precise therapeutic role and target population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>Identifier CRD420261281796.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2026.1801312","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T22:10:23Z","timestamp":1781129423000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of oral bacterial lysates on asthma control and immune parameters in children: evidence from an updated systematic review and meta-analysis of randomized trials"],"prefix":"10.3389","volume":"17","author":[{"given":"Yifeng","family":"Chen","sequence":"first","affiliation":[{"name":"Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University","place":["Taizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingling","family":"Shi","sequence":"additional","affiliation":[{"name":"Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University","place":["Taizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaqin","family":"Wang","sequence":"additional","affiliation":[{"name":"Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University","place":["Taizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihua","family":"Chen","sequence":"additional","affiliation":[{"name":"Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University","place":["Taizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lizhen","family":"Wang","sequence":"additional","affiliation":[{"name":"Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University","place":["Taizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanfen","family":"Ying","sequence":"additional","affiliation":[{"name":"Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University","place":["Taizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"B1","article-title":"Gene-environment interactions in the development of asthma and atopy","volume":"6","author":"Adnan","year":"2012","journal-title":"Expert Rev. 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