Prevalence and risk factors of allergic rhinitis in Chinese children: a systematic review and meta-analysis

Abstract Background Allergic rhinitis (AR) imposes an escalating health burden on Chinese children, with prevalence surges linked to rapid urbanisation and distinctive environmental exposures. Objective To estimate the pooled prevalence of AR and synthesise observational evidence on factors associated with AR among Chinese children aged 0–18 years. Methods We conducted a comprehensive literature search across Embase, PubMed, Web of Science, Cochrane, Chinese Biomedical Literature Database, China National Knowledge Infrastructure (CNKI), VIP Database for Chinese Technical Periodicals, and Wanfang databases. We selected literature published from January 2014-June 2024, and the types of literature included cohort studies, cross-sectional studies, and case–control studies. Study quality was evaluated using the Newcastle–Ottawa Scale (NOS) and JBI criteria, Meta-analysis was performed using random-effects or fixed-effect models, and heterogeneity, publication bias, and sensitivity were assessed. Results The search identified 7,403 records, of which 226 underwent full-text assessment; 42 studies involving 1,405,844 participants were included. The pooled prevalence was 16.1% (95% confidence interval (CI): 13.8%-18.3%), with considerable between-study heterogeneity (I 2 = 99.7%). Prevalence estimates varied across regions, although several regional estimates were based on a single study. Male sex, caesarean delivery, family and parental history of allergy, asthma, antibiotic exposure during the first year of life, environmental tobacco smoke exposure, and having no siblings were associated with higher odds of AR. Home redecoration during infancy showed only a borderline association and should be interpreted cautiously. Breastfeeding was associated with lower odds. These associations should not be interpreted as causal because the included studies were observational. Conclusions AR was common among Chinese children in the included studies, but the pooled prevalence varied substantially across settings. Several demographic, familial, clinical, and environmental factors were associated with AR; however, substantial heterogeneity and the observational study designs require cautious interpretation. Trial registration PROSPERO registration number: CRD42024581359.