Probiotics for the Treatment of Pediatric Allergic Rhinitis: A Systematic Review and Network Meta-Analysis

ObjectiveThis study aimed to evaluate the efficacy, safety, and optimal strains of probiotics for pediatric allergic rhinitis (AR) using meta-analysis and network meta-analysis. MethodsA 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), serum IgE levels, clinical efficacy, or adverse events. 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. ResultsTwenty-six RCTs were included, involving 3,014 patients (1,565 in the probiotic group and 1,404 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 = -3.94, 95% CI [-4.55, -3.33], P < 0.05), enhanced clinical efficacy (RR = 1.16, 95% CI [1.07, 1.25], P < 0.05), and decreased adverse events (RR = 0.22, 95% CI [0.06, 0.82], P < 0.05), but exerted no overall effect on serum IgE (SMD = -0.39, 95% CI [-0.99, 0.09], P = 0.11). Subgroup and NMA analyses indicated that mixed strains performed superiorly across multiple outcomes. ConclusionsProbiotics, particularly mixed strains, are a safe and effective adjunctive therapy for pediatric AR, improving symptoms and quality of life. Large-scale RCTs are required to validate optimal regimens.