The efficacy and safety of combining different Chinese patent medicines with conventional Western drugs in the treatment of pediatric allergic rhinitis:Network meta-analysis

Yue Ma¹WenRui Huang²Hang Wu³Chunbo Zhang⁴Zhiyue Xiao¹Yuying Gao¹Junying Xie¹Jingyao Xu^1*

• ¹Changchun University of Chinese Medicine, Changchun, China
• ²Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
• ³The Third Affiliated Clinical Hospital of Changchun University of Chinese Medicine, Changchun, China
• ⁴Jilin Central Hospital, jilin, China

Background: Pediatric allergic rhinitis (AR) is commonly managed with conventional Western medical therapy (CWMT), which may cause adverse effects. Combining Chinese patent medicines (CPMs) with CWMT has shown potential benefits, but no PRISMA-compliant network meta-analysis has systematically compared their efficacy and safety. Methods: Eight databases were searched through May 2025. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool, and evidence certainty was graded using the CINeMA framework. Analyses were performed in StataMP 18, and treatment hierarchies were ranked using the surface under the cumulative ranking curve (SUCRA) method. Results: A total of 49 RCTs involving 5,062 participants and 13 CPMs were included. Compared with CWMT alone, the combination of CPMs and CWMT significantly improved the Total Nasal Symptom Score (TNSS). Tongqiao Biyan Granules (TBG) achieved the greatest improvements across nasal obstruction (SMD = -1.79, 95% CI: -2.84 to -0.74; SUCRA 72.3%), sneezing (-2.09, -3.27 to -0.91; 78.8%), and rhinorrhea (-1.88, -3.20 to -0.56; 78.2%), indicating consistent superiority over other regimens, and Sanfeng Tongqiao Dropping Pills (STDP) being most effective for nasal pruritus (−1.57; 81.9%). For overall efficacy, all CPM combinations outperformed CWMT, with Cang'er Zibi Yan Pills (CBP) achieving the highest improvement (RR = 1.25, 95% CI: 1.06–1.49; SUCRA 77.2%). Although seven CPMs showed a trend toward reduced serum IgE, none reached statistical significance; Xinqin Granules (XG) ranked highest (SUCRA 76.9%). Adverse events were generally mild and less frequent with combination therapy, with Yuping Feng Granules (YG) showing the lowest risk (OR = 0.33, 95% CI: 0.19–0.55 SUCRA 79.5%). Recurrence analysis indicated that most CPM combinations lowered relapse risk, with Huaiqi Huang Granules (HG) performing best (0.24, 0.06–0.92; 84.8%). Sensitivity and meta-regression analyses confirmed the robustness of these findings, and all significant TNSS improvements exceeded the minimal clinically important difference (MCID = 0.55), indicating clinically meaningful symptom relief. Conclusion: Combining CPMs with CWMT may offer superior efficacy and safety for pediatric AR. These findings support CPMs as an adjunct to standard therapy, though large, high-quality RCTs are warranted for confirmation.