TOPLINE

Oral antihistamines appeared to be safe and effective in reducing nasal symptoms and improving quality of life compared with placebo in children with allergic rhinitis, but the addition of leukotriene receptor antagonists to antihistamine therapy did not provide additional benefits.

METHODOLOGY

• Researchers conducted a systematic review and network meta-analysis of randomized controlled trials assessing the use of oral antihistamines and leukotriene receptor antagonists in children with seasonal or perennial allergic rhinitis. 
• A total of eight studies involving preschool- or school-age children (mean ages, 4.4-12.1 years; 39.3% girls) were included; a ninth study was incorporated following a subsequent search update. Overall, 752 participants had perennial allergic rhinitis and 301 had seasonal allergic rhinitis; follow-up ranged from 2 to 16 weeks.
• Outcomes included the severity of nasal symptoms assessed using the Total Nasal Symptom Score (TNSS), disease-specific health-related quality of life assessed using the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores, and adverse events.

TAKEAWAY

• Among children with seasonal allergic rhinitis, oral antihistamines improved the TNSS compared with placebo (mean difference, -1.60; 95% CI, -2.25 to -0.95), with a 100% probability of a clinically relevant improvement.
• Among children with perennial allergic rhinitis, antihistamines improved RQLQ scores compared with placebo (mean difference, -0.83; 95% CI, -1.33 to -0.32), with an 82.4% probability of a clinically meaningful improvement.
• The combination of antihistamines and leukotriene receptor antagonists showed no additional benefit over antihistamines alone in children with perennial allergic rhinitis (mean difference, -0.15; 95% CI, -1.18 to 0.88); the certainty of evidence was very low.
• The use of antihistamines was associated with a nonsignificantly higher risk of developing at least one adverse event than placebo in children with perennial allergic rhinitis; the certainty of evidence was moderate.

IN PRACTICE

Oral antihistamines “appear to be effective and safe in children, while comedication with [leukotriene receptor antagonists] does not seem to be associated with additional benefits,” the researchers reported.

SOURCE

Bernardo Sousa-Pinto, with the University of Porto, Porto, Portugal, was the corresponding author of the study, which was published online on August 14 in Pediatric Allergy and Immunology.

LIMITATIONS

The number of primary studies, particularly for seasonal allergic rhinitis, was limited, restricting comparisons of individual treatments and treatment classes. No study was considered to have a low risk for bias, and most comparisons had low or very low certainty of evidence. The review excluded studies that scored nasal symptoms differently, which may limit comparability with older literature.

DISCLOSURES

The study was funded by different funding bodies, including Mylan-Viatris, the Finnish ORL-HNS Foundation, the Research Foundation of the Pulmonary Diseases, and other sources. One author reported receiving personal grants from several of the funding bodies. Two authors reported receiving speaker honoraria, advisory or consultancy fees, research funding, or personal or other fees from multiple pharmaceutical and technology companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.