Potential clinical benefits of probiotics in pediatric allergic rhinitis: a systematic review and network meta-analysis

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.