![]() ![]() Unfortunately, except for a narrative description conducted in adults, adolescents, and children with AR ( 10), there lacks systematic reviews or meta-analyses comprehensively synthesizing remarkable evidence of CTZ application in children with allergic diseases. Physicians, pharmacists, and patients’ parents express widespread concerns about the efficacy compared with other AHs as well as the long-term safety of CTZ in allergic symptom control. Therefore, the application of CTZ in children, based on direct childhood evidence, remain controversial. The use of CTZ in children was extrapolated from adult patients rather than from direct evidence in children ( 9). However, central nervous system (CNS) adverse events (AEs) are increasingly observed in clinical practice and frequently reported ( 7, 8). Previous results from several clinical trials have reported the efficacy and quality of life (QOL) of CTZ in children with seasonal allergic rhinitis (SAR), chronic spontaneous urticaria, and allergic asthma ( 6). H 1-antihistamines (H 1-AHs) play a critical role in controlling allergic symptoms, and cetirizine (CTZ) is one of the most commonly administered second-generation H 1-AHs in children ( 5). Controlling allergic symptoms in children is of great significance, especially after the global coronavirus disease 2019 (COVID-19) pandemic in 2020. The most prevalent childhood allergic diseases worldwide include allergic rhinitis (AR), allergic rhino-conjunctivitis, urticaria, asthma, and atopic dermatitis (AD), leading to a negative and extensive impact on the health and lives of a large population of children ( 1– 4). Systematic review registration:, identifier. ![]() CTZ is well tolerated in the pediatric population, except for an increased risk of somnolence. Ĭonclusion: Moderate-to-low certainty evidence revealed that CTZ could improve clinical improvement and QOL in children with AR and have comparable efficacy with other AHs. Moderate-to-low certainty evidence demonstrated that CTZ was well tolerated and did not increase the risk of severe and overall AEs, cardiotoxicity, damage to the central nervous and digestive systems, or other systems in children, except for the risk of somnolence. ![]() It had similar efficacy compared with other antihistamines (AHs) or montelukast, without showing better control of AD severity in children. Moderate certainty evidence showed that CTZ was found to benefit allergic symptom control and QOL in children with AR. Results: A total of 22 studies (5,867 patients) were ultimately included, most of which had a low or unclear risk of bias. Data were pooled using the Cochrane Review Manager 5.4, and a fixed-effects model was used if heterogeneity was evaluated as low ( I 2 < 50%) otherwise, a random-effects model was adopted. Secondary outcomes included laboratory test changes, safety (adverse events, AEs), and quality of life (QOL). Primary outcomes included scales that evaluated the recovery of allergic conditions in AR, such as the total symptom score (TSS). Two investigators independently identified articles, extracted data, conducted meta-analyses, assessed the Cochrane risk of bias of individual studies, and evaluated the evidence certainty using the Grading of Recommendations Assessment, Development, and Evaluation approach any discrepancies were resolved by consulting with a third investigator. Randomized controlled trials (RCTs) or quasi-RCTs of children with allergic diseases receiving CTZ compared with those receiving placebo or other drugs were included without language limitations. Methods: PubMed, Embase, the Cochrane Library, World Health Organization International Clinical Trials Registry Platform,, and the European Union Clinical Trials Register were systematically searched from inception to April 21, 2022. This study investigates the efficacy, acceptability, and safety of cetirizine (CTZ) for treating allergic diseases in children and provides evidence-based assertions for decision-making. Objective: The global prevalence of allergic diseases has led to a negative and extensive impact on the health and lives of a large population of children.
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