title: Do probiotics have a role in the treatment of allergic rhinitis? A comprehensive systematic review and meta-analysis.
abstract: OBJECTIVE
  To investigate clinical evidence for the efficacy of probiotics in the treatment of allergic rhinitis (AR).
  
  
  METHODS
  A systematic search was conducted to review the results of all randomized, double-blind, placebo-controlled trials by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. Primary outcome measurements were total nasal and ocular symptom scores (SS) and quality of life (QoL) questionnaires. Secondary outcome measurements were individual nasal SS and immunologic parameters.
  
  
  RESULTS
  Twenty-two randomized, double-blind, placebo-controlled studies were included. Seventeen trials showed significant benefit of probiotics clinically, whereas eight trials showed significant improvement in immunologic parameters compared with placebo. All five studies with Lactobacillus paracasei (LP) strains demonstrated clinically significant improvements compared with placebo. Probiotics showed significant reduction in nasal and ocular SS (standardized mean difference [SMD], -1.23, p < 0.001; and SMD, -1.84, p < 0.001; respectively), total, nasal, and ocular QoL scores compared with placebo (SMD, -1.84, p < 0.001; SMD, -2.30, p = 0.006; and SMD, -3.11, p = 0.005; respectively). Although heterogeneity was high, in subgroup analysis, SMD for total nasal and ocular symptoms with patients with seasonal AR and for nasal QoL scores for studies with LP-33 strain were significant and homogenous. Scores of nasal blockage, rhinorrhea, and nasal itching were significantly lower in the probiotic group compared with placebo. The meta-analysis studies SS the Japanese guidelines revealed a significant, homogenous SMD score of -0.34 for individual nasal SS, above the minimal important clinical difference value of 0.3. The T-helper 1 to T-helper 2 ratio was significantly lower in the probiotic group compared with placebo (SMD, -0.78; p = 0.045).
  
  
  CONCLUSIONS
  Despite high variability among the studies, synthesis of available data provided significant evidence of beneficial clinical and immunologic effects of probiotics in the treatment of AR, especially with seasonal AR and LP-33 strains. With the rising pool of studies, the most promising strains in specific allergies can be revealed and adjuvant therapy with probiotics can be recommended for the treatment of AR.
authors.affiliation: Department of Otorhinolaryngology, Çigli Regional Education Hospital, İzmir, Turkey.
authors.forename: Işıl Adadan
authors.initials: IA
authors.lastname: Güvenç
authors.forename: Nuray Bayar
authors.initials: NB
authors.lastname: Muluk
authors.forename: Fezan Şahin
authors.initials: FŞ
authors.lastname: Mutlu
authors.forename: Erkan
authors.initials: E
authors.lastname: Eşki
authors.forename: Niyazi
authors.initials: N
authors.lastname: Altıntoprak
authors.forename: Tugba
authors.initials: T
authors.lastname: Oktemer
authors.forename: Cemal
authors.initials: C
authors.lastname: Cingi
mesh_terms: D000818:Animals; D002986:Clinical Trials as Topic; D005123:Eye / Q000276:immunology*; D006801:Humans; D000069980:Lacticaseibacillus paracasei / Q000276:immunology*; D010256:Paranasal Sinuses / Q000276:immunology*; D019936:Probiotics / Q000627:therapeutic use*; D011788:Quality of Life; D065631:Rhinitis, Allergic / Q000276:immunology / Q000382:microbiology / Q000628:therapy*; D011795:Surveys and Questionnaires