Allergic Rhinitis

Risk assessment of asthma and allergic rhinitis in atopic dermatitis patients treated with biologics and JAK inhibitors: a systematic review and network meta-analysis of randomized controlled trials.

Zeng L, Zhou T, Zhang L, Xian M, Zhu Z, Liu J · BMC medicine · 2026 · n=69

Numerous emerging systemic therapies, including monoclonal antibodies and Janus kinase (JAK) inhibitors, are effective for atopic dermatitis (AD). However, their effects on the incidence of airway comorbidities like asthma and allergic rhinitis in AD patients remain unclear. This network meta-analysis evaluates and compares the risks of these adverse events among patients with AD receiving different biologics and systemic JAK inhibitors. PubMed, Cochrane Library, Embase, and Web of Science were searched for randomized controlled trials (RCTs) evaluating asthma and allergic rhinitis in AD patients receiving JAK inhibitors or biologics, from inception to January 4, 2025. Data synthesis employed a Bayesian network meta-analysis with random-effects modeling, using relative risk (RR) and 95% credible intervals (CI) as effect measures. Meta-regression assessed the impact of study design and participant characteristics on intervention effectiveness. The surface under the cumulative ranking c

Efficacy and safety of montelukast-levocetirizine combination therapy in combined allergic rhinitis and asthma syndrome: a systematic review and meta-analysis.

Shao M, Sun J, Zheng Q · The Journal of asthma : official journal of the Association for the Care of Asthma · 2025 · n=950

This meta-analysis aims to evaluate the efficacy and safety of montelukast combined with levocetirizine in the treatment of allergic rhinitis with asthma, and to provide objective and effective evidence-based medical evidence for clinical use. PubMed, Web of Science, Cochrane Library, WANFANG DATA, CNKI, and Chinese BioMedical Literature Database were retrieved to identify records related to montelukast combined with levocetirizine in the treatment of allergic rhinitis with asthma. First, the eligibility criteria were employed to screen search results. Then, two investigators independently assessed titles, abstracts, and the full text of all retrieved references to identify potentially eligible studies. As of 2024-02-03, a total of six articles were included in this meta-analysis, covering 2,950 patients with allergic rhinitis with asthma. The meta-analysis results exhibited a pooled NSS of -1.28 (95%CI: -1.64 to -0.92), suggesting that the combination of montelukast and levocetiriz

Probiotics in infants for prevention of allergic disease.

Wang HZ, Hayles EH, Fiander M, Sinn JK, Osborn DA · The Cochrane database of systematic reviews · 2025 · n=954

This is an update of a Cochrane review first published in 2007. Allergic disease and food allergy are prevalent, and contribute to a significant burden of disease on the individual, their family and the healthcare system. Probiotics are live bacteria that colonise the gastrointestinal tract, and have been studied in many clinical trials for preventing allergic conditions. To evaluate the benefits and harms of a probiotic, or a probiotic with added prebiotic ('synbiotic'), compared with control (placebo or no treatment) for preventing allergic diseases (asthma, eczema, allergic rhinitis) and dietary allergies in infants by two years of age. We searched CENTRAL, MEDLINE, Embase and trial registries in December 2023. We reviewed the reference lists of studies selected for inclusion in this review, and systematic reviews on similar topics. We manually searched conference abstracts. We included randomised controlled trials that compared a probiotic to a control, or a probiotic added to a

Mendelian Randomization Studies in Atopic Dermatitis: A Systematic Review.

Elhage KG, Kranyak A, Jin JQ, Haran K, Spencer RK, Smith PL · The Journal of investigative dermatology · 2024

Prior studies have found associations between atopic dermatitis (AD) and comorbidities, including depression, obesity, asthma, and allergic rhinitis. Although observational studies often cannot establish robust causality between potential risk factors and AD, Mendelian randomization minimizes confounding when exploring causality by relying on random allelic assortment at birth. In this study, we systematically reviewed 30 Mendelian randomization studies in AD. Body mass index, gut microbial flora, the IL-18 signaling pathway, and gastroesophageal reflux disease were among the causal factors for AD, whereas AD was causal for several medical conditions, including heart failure, rheumatoid arthritis, and conjunctivitis. These insights may improve preventive counseling in AD.

Complementary and Allergenic Food Introduction in Infants: An Umbrella Review.

Soriano VX, Ciciulla D, Gell G, Wang Y, Peters RL, McWilliam V · Pediatrics · 2023

Multiple systematic reviews examine the introduction of foods in relation to individual health outcomes, but the balance of harms and benefits has not been overviewed systematically. We aimed to perform an overview of systematic reviews on age of introduction of complementary and allergenic foods to the infant diet and long and short-term health outcomes. We searched Medline, Embase, Cochrane, and PubMed (July 25, 2022). Included systematic reviews examining the introduction of complementary or allergenic foods before age 1. Outcomes included allergic, autoimmune, and inflammatory diseases, neurodevelopment, nutrition, and weight. Extraction and quality assessment were performed in duplicate (A Measurement Tool to Assess Systematic Reviews) and strength of evidence was assessed. We screened 4015 articles and included 32 systematic reviews. There was moderate evidence that peanut and egg should be introduced from 4 to 11 months to prevent food allergy (6 of 10 reviews). Complementa

Health supplements for allergic rhinitis: A mixed-methods systematic review.

Pellow J, Nolte A, Temane A, Solomon EM · Complementary therapies in medicine · 2020

Allergic rhinitis is a chronic inflammatory condition caused by an exaggerated response of the immune system to common allergens. Most pharmacological therapies tend to be palliative and in some cases are associated with adverse effects. There is a growing tendency for people to self-medicate with health supplements as they are generally considered safe, however clinical studies relating to their efficacy and safety are limited. This mixed-methods systematic review aims to synthesise the available evidence relating to the treatment of allergic rhinitis with a variety of health supplements. A total of 57 062 articles were derived from searching seven online databases and evidence from 48 RCTs and 10 observational studies were reviewed for methodological quality and risk of bias. No qualitative studies meeting the inclusion criteria could be found, therefore only a quantitative review was performed. Promising evidence for the following single supplements were found: apple polyphenols, to

Allergic Rhinitis and Its Impact on Asthma (ARIA)-EAACI Guidelines-2024-2025 Revision: Part I-Guidelines on Intranasal Treatments.

Sousa-Pinto B, Bousquet J, Vieira RJ, Schünemann HJ, Zuberbier T, Bognanni A · Allergy · 2026

Allergic rhinitis (AR) impacts quality of life, work and school productivity. Over the last years, an important body of evidence resulting from mHealth data has led to a better understanding of AR. Such advances have motivated an EAACI-endorsed update of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines (ARIA 2024-2025). This manuscript presents the ARIA 2024-2025 recommendations for intranasal treatments, one of the mainstays for AR management. The ARIA 2024-2025 guideline panel issued recommendations following the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) evidence-to-decision framework. Several sources of evidence were used to inform panel judgments and recommendations, including systematic reviews, evaluation of mHealth and pharmacovigilance data, as well as a survey of experts on costs. Eleven guideline questions concerning intranasal treatments for AR were prioritized, leading to recommendations. Overall, these questions concern t

Practical guideline for the management of allergic rhinitis in Japan 2024.

Okano M, Okubo K, Gotoh M, Asako M, Ohta N, Kamijo A · Auris, nasus, larynx · 2025

The Practical Guideline for the Management of Allergic Rhinitis in Japan was first published in 1993. After the COVID-19 pandemic, the current 10th edition was published in 2024. The most recent collection of evidence from the literature, such as the sustained post-treatment effect of sublingual immunotherapy on Japanese cedar pollinosis, was added to the revised guideline, which incorporates evidence-based medicine. In this revised guideline, a diagram illustrating the pathogenesis of allergic rhinitis and the mechanisms of action of various pharmacological treatments has been added. Also included is a diagram that shows the mechanism of action of allergen immunotherapy and a more detailed description of the oral allergy syndrome. The clinical question and answer section was also revised along with the introduction of new questions, such as: Does anti-IgE antibody treatment effectively reduce the symptoms of severe seasonal allergic rhinitis? Also updated was the evidence-based step-b

Clinical practice guideline for acupuncture and moxibustion: Allergic rhinitis.

Du SH, Chen S, Wang SZ, Wang GQ, Du S, Guo W · Journal of integrative medicine · 2024

Acupuncture is one of the most effective complementary therapies for allergic rhinitis (AR) and has been recommended by several clinical practice guidelines (CPGs) for AR. However, these CPGs mentioned acupuncture without making recommendations for clinical implementation and therapeutic protocols, therefore limiting the applicability of acupuncture therapies for AR. Hence, for the benefit of acupuncture practitioners around the world, the World Federation of Acupuncture-moxibustion Societies have initiated a project to develop the CPG for the use of acupuncture and moxibustion to treat AR. This CPG was developed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, referring to the principles of the World Health Organization Handbook for Guideline Development. During the development of the CPG, the guideline development group (GDG) played an important role. The clinical questions, recommendations and therapeutic protocols were all for

Effect of prenatal high-dose vitamin D on childhood atopic dermatitis is modified by maternal cotinine metabolome: A secondary analysis of a randomized clinical trial.

Brustad N, Wang T, Chen L, Kaiser H, Gomes B, Klein A · Journal of the American Academy of Dermatology · 2026

Tobacco exposure has been shown to modulate the effect of vitamin D on the risk of atopic diseases. However, randomized clinical trials investigating the potential effect modification between tobacco exposure and vitamin D supplementation on atopic disease risk are lacking. We sought to investigate the potential effect modification from maternal tobacco exposure on the effect of prenatal high-dose vitamin D supplementation on the risk of child atopic dermatitis, asthma, and allergic rhinitis. A post hoc analysis in the double-blinded COPSAC2010 randomized clinical trial (NCT00856947) including 581 mother-child pairs randomized to 2800 IU/d (high-dose) versus 400 IU/d (standard-dose) from pregnancy week 24. Maternal blood metabolomic profiling was performed at inclusion, reflecting maternal tobacco exposure using a supervised sparse partial least squares model. We found a significant effect modification from the maternal cotinine metabolome score (Pinteraction < .01) where high-do

Probiotics combined with prebiotics alleviated seasonal allergic rhinitis by altering the composition and metabolic function of intestinal microbiota: a prospective, randomized, double-blind, placebo-controlled clinical trial.

Hou Y, Wang D, Zhou S, Huo C, Chen H, Li F · Frontiers in immunology · 2024 · n=53

Numerous studies have established that probiotics or prebiotics can relieve the symptoms of allergic rhinitis (AR), but their mechanism of action remain underexplored. This study aimed to observe the clinical efficacy of probiotics combined with prebiotics in seasonal AR patients and explore their underlying mechanisms. We conducted a prospective, randomized, double-blind, placebo-controlled clinical trial. The test group was given probiotics combined with prebiotics, whereas the placebo group was administered simulated preparation for 90 days. Outcome measures included total nasal symptom score (TNSS), visual analog scale, rhinitis quality of life questionnaire, fractional exhaled nitric oxide, and the rate and intensity of Loratadine use. Serum TNF-α, INF-γ, IL-4, IL-17, and IgE levels were measured by enzyme-linked immunosorbent assay. Intestinal microbiota was detected by 16S rRNA gene sequencing and quantitative PCR. Short-chain fatty acids were analyzed by gas chroma

Clinical Efficacy of Probiotics for Allergic Rhinitis: Results of an Exploratory Randomized Controlled Trial.

Lungaro L, Malfa P, Manza F, Costanzini A, Valentini G, Squarzanti DF · Nutrients · 2024 · n=19

Background: Allergic Rhinitis (AR) is an atopic disease affecting the upper airways of predisposed subjects exposed to aeroallergens. This study evaluates the effects of a mix of specific probiotics (L. acidophilus PBS066, L. rhamnosus LRH020, B. breve BB077, and B. longum subsp. longum BLG240) on symptoms and fecal microbiota modulation in subjects with AR. Methods: Probiotic effects were evaluated at the beginning (T0), at four and eight weeks of treatment (T1 and T2, respectively), and after four weeks of follow-up from the end of treatment (T3) (n = 19) compared to the placebo group (n = 22). AR symptoms and quality of life were evaluated by the mini rhinitis quality of life questionnaire (MiniRQLQ) at each time point. Allergic immune response and fecal microbiota compositions were assessed at T0, T2, and T3. The study was registered on Clinical-Trial.gov (NCT05344352). Results: The probiotic group showed significant improvement in the MiniRQLQ score at T1, T2, and T3 vs. T0 (p &lt

Efficacy and Safety of Combined Pharmacotherapies in Moderate-to-Severe Allergic Rhinitis: A Network Meta-Analysis.

Zhang Y, Zhang Z, Wang C, Zhang L · International forum of allergy & rhinology · 2025 · n=188

Combination pharmacotherapies are often selected for moderate-to-severe allergic rhinitis (AR), particularly when monotherapies do not control symptoms effectively. However, few studies have compared the efficacy and safety of different combination regimens. Therefore, we performed this study to investigate the clinical benefits of different combination strategies for moderate-to-severe AR. Electronic databases were searched (inception-May 31, 2024) for randomized controlled trials involving combination therapies for treating moderate-to-severe AR. The medication classes included intranasal corticosteroids (INCS), intranasal antihistamines (INAH), oral antihistamines (OAH), and oral leukotriene receptor antagonists (LTRA). A network meta-analysis with a random-effects model was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Forty-eight eligible studies with 17,188 participants were included. In this meta-analysis, INAH and INCS,

Dietary Bioactive Compounds and Their Role in Allergy Prevention: A Comprehensive Review.

Zafrilla P, Ballester P, Victoria-Montesinos D, Cerdá B, Marhuenda J, Arcusa R · Nutrients · 2025

Background/Objectives: Allergic diseases are highly prevalent worldwide and represent a significant public health burden. Current therapies mainly alleviate symptoms without addressing underlying immune dysfunction, which has increased interest in nutritional bioactive compounds as preventive or modulatory agents. This review summarizes evidence on omega-3 polyunsaturated fatty acids, vitamin D, curcumin, ginger bioactives, quercetin, and epigallocatechin gallate (EGCG) in allergy prevention and management. Methods: A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science up to July 2025, including preclinical and clinical studies reporting immunological, mechanistic, and clinical outcomes. Results: Omega-3 fatty acids modulate Th2 responses, promote regulatory T cells, and generate specialized pro-resolving mediators, with modest clinical benefits observed in pregnancy and early life. Vitamin D contributes to immune tolerance and epithelial integrity, alth

Efficacy and safety of intranasal medications for allergic rhinitis: Network meta-analysis.

Sousa-Pinto B, Vieira RJ, Bognanni A, Gil-Mata S, Ferreira-da-Silva R, Ferreira A · Allergy · 2025

Intranasal antihistamines (INAH), corticosteroids (INCS), and their fixed combinations (INAH+INCS) are one of the cornerstones of the treatment of allergic rhinitis (AR). We performed a systematic review and network-meta-analysis comparing the efficacy and safety of INAH, INCS, and INAH+INCS in patients with AR. We searched four electronic bibliographic databases and three clinical trial databases for randomised controlled trials assessing the use of INAH, INCS, and INAH+INCS in adults with seasonal or perennial AR. We performed a network meta-analysis on the Total Nasal Symptom Score, Total Ocular Symptom Score, Rhinoconjunctivitis Quality-of-Life Questionnaire, development of adverse events, and withdrawals due to adverse events. Certainty of evidence was assessed using GRADE-NMA. We included 167 primary studies, most of which assessed patients with seasonal AR. Among individual medications, azelastine-fluticasone, and fluticasone furoate were the most frequently highest-ranked int

Effectiveness of topical intranasal curcumin in the experimentally induced allergic rhinitis model in rats (revised).

Demir E, Koten M, Keskin FEU, Eryıldız C, Güven SG · Allergologia et immunopathologia · 2026

Curcumin, a flavonoid derived from turmeric, has demonstrated antioxidant, anti-inflammatory, and antiallergic effects. This study evaluated the therapeutic efficacy of intranasal curcumin in an allergic rhinitis (AR) rat model. Forty rats were randomized into four groups: a sham control, an AR model with no treatment (negative control), an AR model treated with intranasal mometasone furoate (positive control), and an AR model treated with intranasal curcumin. Allergic symptoms (sneezing, itching, nasal discharge) were evaluated by both unblinded and blinded observers. Serum Ovalbumin (OVA)-specific IgE levels were measured using ELISA. Nasal mucosal histopathology (edema, cilia loss, goblet cell hyperplasia, inflammation, eosinophilia) was assessed by light microscopy. Intranasal curcumin significantly improved histopathological findings and reduced allergic symptoms, with efficacy comparable to steroid treatment. It alleviates AR symptoms and inflammation, suggesting a promising, low

Effectiveness of topical intranasal curcumin in the experimentally induced allergic rhinitis model in rats.

Demir E, Koten M, Keskin FEU, Eryıldız C, Güven SG · Allergologia et immunopathologia · 2026

Curcumin, a flavonoid derived from turmeric, has demonstrated antioxidant, anti-inflammatory, and anti-allergic effects. This study evaluated the therapeutic efficacy of intranasal curcumin in an allergic rhinitis (AR) rat model. Forty rats were randomized into five groups: a Sham control, an AR model with no treatment (negative control), an AR model treated with intranasal mometasone furoate (positive control), and an AR model treated with intranasal curcumin. Allergic symptoms (sneezing, itching, nasal discharge) were evaluated by both unblinded and blinded observers. Serum ovalbumin (OVA)-specific IgE levels were measured using ELISA. Nasal mucosal histopathology (edema, cilia loss, goblet cell hyperplasia, inflammation, eosinophilia) was assessed by light microscopy. Intranasal curcumin significantly improved histopathological findings and reduced allergic symptoms, with efficacy comparable to steroid treatment. Intranasal curcumin alleviated allergic rhinitis symptoms and inflamma

Polypharmacological effects of honokiol on allergic rhinitis: Modulation of TMEM16A, TRPV1, and calcium signaling.

Phan HTL, Nam YR, Kim HJ, Van NTH, Vo NT, Woo J · Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie · 2025

Allergic rhinitis (AR) affects approximately 400 million people globally and causes rhinorrhea, nasal congestion, and sneezing. Nonetheless, current treatments often provide incomplete relief and have side effects. Recent studies have indicated that various ion channels contribute to AR symptoms, suggesting that multichannel targeting may offer a more effective treatment. We first demonstrated that the inhibition of either ANO1 or ORAI1 channels individually alleviated symptoms in an ovalbumin-induced AR mouse model, with enhanced effects when both channels were targeted simultaneously. We then investigated whether honokiol, from magnolia bark, exhibited anti-AR effects by inhibiting multiple ion channels (ANO1, TRPV1, ORAI1). These effects were assessed using patch-clamp electrophysiology, calcium imaging, immune cell function assays (in T and mast cells), and in vivo studies. Honokiol inhibited all three ion channels with comparable potency (IC₅₀ values: ANO1, 7.50&#x

Allergic rhinitis

NHS

The NHS website offers detailed information on allergic rhinitis, covering its symptoms, when to see a GP, and various self-help and medical treatments. It aims to inform the public about managing this common condition.

Allergies

NHS

This page provides information on allergies, including symptoms, causes, diagnosis, and treatment for allergic rhinitis.

Leukotriene D4 Nasal Provocation Test: Rationale, Methodology, Diagnostic Value and Its Impact on Airway Inflammation in Allergic Rhinitis With or Without Asthma

n=60 · NCT01963741 · COMPLETED · COMPLETED

Leukotrienes play critical roles in the inflammatory process in allergic rhinitis and bronchial asthma, therefore, anti-leukotriene therapy is part of treatment for asthma. However, not all allergic rhinitis accompanied with or without asthma treated with anti-leukotriene were effective. So it is critical to develop a method to identify the response subgroup. In this study, it is assumed that nasal physiological responsiveness to leukotriene nasal provocation test (NPT) is able to gain evidence on the effect of leukotriene on the development of allergic rhinitis and asthma, and is helpful to the use of anti-leukotriene agent. The purpose of the study is to establish the methodology and diagnostic value of leukotriene D4 (LTD4) nasal provocation.

A Double Blind, Placebo Controlled Randomized Trial Evaluating the Effects of Fluticasone Nasal Spray in Subjects With Seasonal Allergic Rhinitis and a History of Sleep Disturbance on Cognitive Performance and Daytime Sleepiness

n=40 · NCT00997620 · COMPLETED · COMPLETED

The hypothesis is that treating hay fever patients who had daytime sleepiness and slowed thinking because of the hay fever will improve when treated with an effective anti-hay fever medication, an intranasal steroid, that is will have less daytime sleepiness and demonstrate better thinking.

Safety Study of Olopatadine Nasal Spray

n=890 · NCT00578331 · COMPLETED · COMPLETED

The purpose of this study is to determine whether olopatadine nasal spray is safe and effective when used for up to one year by patients with perennial allergic rhinitis.

Cochrane Library: Allergic Rhinitis

Cochrane

The Cochrane Library provides a collection of high-quality, independent evidence to inform healthcare decision-making, including systematic reviews related to allergic rhinitis. It synthesizes research findings on the effectiveness of various interventions.

TRIP Database: Allergic Rhinitis

TRIP Database

The TRIP Database is a clinical search engine designed to allow users to quickly and easily find high-quality research evidence to support their practice. It aggregates evidence on allergic rhinitis from various sources, including guidelines, systematic reviews, and primary research.

Cochrane Reviews on Allergic Rhinitis

Cochrane

Provides systematic reviews and meta-analyses on various interventions for allergic rhinitis, offering high-quality evidence to inform clinical decisions.