Background
Methods
Study selection criteria
Search strategy
Data extraction
Methodological assessment
Statistical analysis
GRADE
Results
First author, publication year, country | Treatment duration, follow-up duration | Duration of AR (mean (SD)) | Number of participants of randomized/ assessed | Age (mean (SD) or range in years), gender (M/F) | Intervention (route of administration) | Control (route of administration, dosage) | Adverse events (number of events) |
---|---|---|---|---|---|---|---|
1 YPFS vs placebo | |||||||
Chan 2014 [14], Hong Kong China | 4 weeks, 3 months | I: >1 year; C: >1 year | I: 83/80; C:83/79 | I: 18–25, 32/48; C: 18–25, 35/44 | Modified YPFS (oral) | Placebo (oral, 70 ml each time, once per day) | Increased acne and abdominal distension (4) |
Feng 2004 [15], China | 8 weeks, NS | I:10.57 (7.31) years C:11.31 (8.17) years | I: 43/43; C: 43/43 | I: 37.74 (14.57), 22/21; C: 38.17 (14.21), 22/21 | Allergic Rhinitis oral liquid (oral) | Saline (oral, 20 ml each time, three times a day) | NS |
2 YPFS vs pharmacotherapy | |||||||
Fang 2014 [16], China | 1 month, NS | I: 3.26 (1.27) years; C: 3.17 (1.12) years | I: 118/118; C: 102/102 | I: 35.18 (13.72), 53/65; C: 36.03(12.85), 43/59 |
Yu ping feng capsule (oral) | Cetirizine Hydrochlorde (oral, 10 mg once per day), Budesonide aerosol (nasal spray, twice per day) | No AE |
Wang 2014 [17], China | 14 days, NS | I: NS; C: NS | I: 30/30; C: 30/30 | I: 33 (10.78), 14/16; C:35 (11.94), 15/15 | Modified YPFS (oral) | Cetirizine Hydrochloride (oral, 10 mg once per day) | NS |
Luo 2012 [18], China | 28 days, 1 year | I: 4.34 (4.29) years C: 4.52 (4.45) years | I: 60/60; C: 60/60 | I: 34.64 (11.35), 38/22; C: 35.20 (10.43), 34/26 | Modified YPFS (oral) | Cetirizine Hydrochloride (oral, 10 mg once per day) | NS |
Wu 2013 [19], China | 14 days, 1 year | I: 5 (1–11) years; C: 6 (1–8) years | I: 50/50; C: 50/50 | I: 36, 22/28; C: 39, 27/23 |
Yu ping zhi ti granule (oral) | Loratadine (oral, 10 mg before bedtime) | NS |
Wang 2009 [20], China | 14 days, 1 month | I: 4.34 (4.29) years; C: 4.52 (4.45) years | I: 30/30; C: 30/30 | I: 34.64 (11.35), 19/11; C: 35.2 (10.43), 17/13 | Modified YPFS (oral) | Cetirizine Hydrochloride (oral, 10 mg once per day) | NS |
Guo 2015 [21], China | 15 days, NS | I: NS; C:NS | I: 35/35; C: 35/35 | I: 26.5 (6.3), 20/15; C: 32 (4.3), 16 /19 |
Yu ping feng granule (oral) | Cetirizine Hydrochloride (oral, 10 mg once per day) | NS |
Yao 2015 [22], China | 4 weeks, NS | I: 8. 8(3.5) years; C: 8.6 (3.1) years | I: 43/43; C: 40/40 | I: 41.8 (5.5), 18/25; C: 40.3 (4.9), 17 /23 | Modified YPFS (oral) | Cetirizine Hydrochlorde (oral, 10 mg before bedtime) | No AE |
3 YPFS + pharmacotherapy vs pharmacotherapy | |||||||
Shi 2014 [24], China | 28 days, No follow up | I: 4.18 (2.82) years; C: 4.67 (2.33) years | I: 44/44; C: 32/32 | I: 36.5 (17.5), 23/21 C: 37.5 (16.5), 17/15 |
Yu ping feng drop pill and Cetirizine (oral) | Cetirizine (oral, 10 mg once per day) | No AE |
Lu 2014 [25], China | 2 weeks, 8 weeks | I: (1 month-3 years); C: (1 month-2.5 years) | I: 40/40 C: 40/40 | I: 40.3 (10.5), 28/12; C: 38.0 (11.2), 27/13 |
Yu ping feng granule (oral) + Ebastine (oral), Fluticasone propionate (nasal spray) | Ebastine (oral, 10 mg once per day), Fluticasone propionate (nasal spray, two sprays each nostril, once per day) | No AE |
Zhou 2010 [26], China | 1 month; NS | I: NS; C:NS | I: 36/36; C: 36/36 | I: 45.5, 15/21; C: 43.6, 15/21 |
Yu ping feng granule (oral) + Budesonide aerosol (nasal spray) | Budesonide aerosol (nasal spray, two sprays each nostril, twice per day) | No AE |
Huang 2014 [27], China | 4 weeks; 3 months | I: 12.7 (3.1) months; C:11.2 (2.5) months | I: 74/74; C: 71/71 | I: 30.3 (3.4), 40/34; C: 31.2 (2.7), 38/33 | Modified YPFS (oral) + Cetirizine Hydrochloride (oral); Budesonide aerosol (nasal spray) | Cetirizine Hydrochloride (oral, one spray each nostril, twice per day), Budesonide aerosol (nasal spray, 10 mg once per day) | NS |
Liu 2012 [28], China | 30 days; NS | I: 4 years; C: 4 years | I: 30/28; C: 30/29 | I: 39.25 (5.58), 13/15; C: 39.97 (4.15), 15/14 | Modified YPFS + Loratadine (oral) | Loratadine (oral, 10 mg once per day) | No AE |
Chen 2014 [29], China | 28 days; 6 months | I: NS; C: NS | I: 60/60; C: 60/60 | I: NS, NS; C: NS, NS | Modified YPFS + Cetirizine (oral) | Cetirizine (oral, 10 mg once per day) | I: skin rash (2), vomit (1), nausea (2); C:skin rash (5), vomit (4), nausea (3) |
Lin 2014 [30], China | 30 days; NS | I: 4.25 (1) years; C:4.28 (1.05) years | I: 30/28; C: 30/29 | I:33.18 (11.42), 16/12; C:33.89 (9.35), 16/13 | Modified YPFS + Cetirizine (oral) | Cetirizine (oral, 10 mg once per day) | No AE |
Guan 2013 [31], China | 14 days; NS | I: NS; C: NS | I: 27/27; C: 26/26 | I: NS, NS; C: NS, NS | YPFS (oral) + Budesonide aerosol (nasal spray) | Budesonide aerosol (nasal spray, 64μg each nostril, twice per day) | I: sedation (1), local mucosa irritation (2); C: local mucosa irritation (2), skin rash (2) |
Chen 2015 [32],China | 21 days; NS | I: 5.92(4.07) years; C: 6.16(4.39) years | I: 63/63; C: 63/63 | I:35.36 (7.19), 35/28; C:34.18 (6.82), 33/30 | Modified YPFS (oral) + Azelastine (nasal spray); | Azelastine (nasal spray, one spray each nostril, twice per day) | NS |
Ma 2017 [33],China | 4 weeks; NS | I: 5.1(0.3) years; C: 5.3(0.6) years | I: 37/37; C: 37/37 | I: 38.6 (6.9), 21/16; C: 37.9 (6.5), 20/17 |
Yu ping feng granule (oral) + Azelastine (nasal spray); | Azelastine (nasal spray, one spray each nostril, twice per day) | NS |
Qiu 2017 [34],China | 2 weeks; NS | I: 7.83(1.35) years; C: 7.68(1.40) years | I: 50/50; C: 50/50 | I: 35.41 (7.35),28/22; C: 36.07 (7.18),29/21 |
Yu ping feng granule (oral) + Ebastine (oral); | Ebastine (oral, 10 mg once per day) | NS |
Zheng 2017 [35],China | 4 weeks; NS | I: 7.7(1.3) years; C: 8.1(1.5) years | I: 36/36; C: 36/36 | I: 42.7 (12.3),18/18; C: 43.1 (11.6),20/16 |
Yu ping feng granule (oral) + Levocetirizine (oral); | Levocetirizine (oral, 5 mg once per day) | No AE |
4 YPFS + pharmacotherapy vs pharmacotherapy vs YPFS | |||||||
Yu 2012 [23], China | 14 days; NS | I: 2.7 (0.5) years; C1: 2.8 (0.4) years; C2: 2.5 (0.6) years | I: 60/60; C1: 60/60; C2: 60/60; | I:32.9 (6.4), 33/27; C1: 34.0 (5.9), 31/29; C2: 33.0 (6.1), 32/28 | YPFS plus Cang er zi san (oral) | C1: Azelastine Hydrochloride (nasal spray, one spray each nostril, twice per day); C2: YPFS plus Cang er zi san (oral) + Azelastine Hydrochloride (nasal spray, one spray each nostril, twice per day) | I: no AE; C1 and C2: dryness in the nasal cavity (6) |
Participants
Interventions
First author, publication year, country | Name | Form of the CHM | Ingredients (dosage) | Packaging dosage; Dosage and times of administration | Modification |
---|---|---|---|---|---|
Chan 2014 [14], Hong Kong China | Modified YPFS | Syrup |
Huangqi 15 g, baizhu 12 g, fangfeng 3 g, xinyi 3 g, cangerzi (NS), gancao (NS). | NS; 70 ml of syrup once a day | Add xinyi 3 g, cangerzi (NS), gancao (NS). |
Feng 2004 [15], China | Allergic Rhinitis oral liquid | Oral liquid |
Huangqi (NS), baizhu (NS), fangfeng (NS), guizhi (NS), baishao (NS), dazao (NS), shanyao (NS), fuling (NS), baibiandou (NS), xinyi (NS), cangerzi (NS), mudanpi (NS), gancao (NS). | 10 ml each bottle; 20 ml each time, three times per day | Add guizhi (NS), baishao (NS), dazao (NS), shanyao (NS), fuling (NS), baibiandou (NS), xinyi (NS), cangerzi (NS), mudanpi (NS), gancao (NS). |
Fang 2014 [16], China |
Yu ping feng capsule | Capsule |
Huangqi (NS), baizhu (NS), fangfeng (NS). | 0.5 g each capsule, 20 capsules in one box; Two capsules each time, three times per day | None |
Wang 2014 [17], China | Modified YPFS | Decoction |
Huangqi 10 g, baizhu 10 g, fangfeng 10 g, guizhi 6 g, cangerzi 10 g, xinyi 10 g, baizhi 6 g, wumei 10 g, gancao 6 g. | NS; One dosage for twice per day | Add guizhi 6 g, cangerzi 10 g, xinyi 10 g, baizhi 6 g, wumei 10 g, gancao 6 g. |
Luo 2012 [18], China | Modified YPFS | Decoction |
Huangqi 20 g, baizhu 15 g, fangfeng 9 g, dangshen 20 g, fuling 15 g, dilong 12 g, wuweizi 12 g, jingjie 9 g, xinyi 9 g, chantui 9 g, ganjiang 6 g, xixin 6 g, gancao 6 g. | NS; One dosage each time, twice per day | Add dangshen 20 g, fuling 15 g, dilong 12 g, wuweizi 12 g, jingjie 9 g, xinyi 9 g, chantui 9 g, ganjiang 6 g, xixin 6 g, gancao 6 g. |
Wu 2013 [19], China |
Yu ping zhi ti granule | Granule |
Huangqi 15 g, baizhu 10 g, fangfeng 10 g, jiangcan 10 g, chantui 9 g, jianghuang 6 g, dahuang 3 g, xinyi 9 g. | One herb granule in one small sized sachet; One sachet each time, twice per day | Add jiangcan 10 g, chantui 9 g, jianghuang 6 g, dahuang 3 g, xinyi 9 g. |
Wang 2009 [20], China | Modified YPFS | Decoction |
Huangqi 20 g, baizhu 15 g,
fangfeng 6 g, baijili 10 g, jingjie 10 g, xixin 3 g. | NS; One dosage per day | Add baijili 10 g, jingjie 10 g, xixin 3 g. |
Guo 2015 [21], China |
Yu ping feng granule | Granule |
Huangqi (NS), baizhu (NS), fangfeng (NS). | 5 g each sachet; One sachet each time, three times per day | None |
Yao 2015 [22],China | Modified YPFS | Decoction |
Huangqi 60 g, baizhu 20 g, fangfeng 15 g, cangerzi 10 g, xinyi 10 g, jingjie 15 g, baizhi 15 g,manjingzi 10 g, fuling 20 g, sharen 10 g. | NS; 100 ml each time, twice per day | Add cangerzi 10 g, xinyi 10 g, jingjie 15 g, baizhi 15 g, manjingzi 10 g, fuling 20 g, sharen 10 g. |
Yu 2012 [23], China | YPFS plus Cang er zi san
| Decoction |
huangqi 30 g, baizhu 10 g,
fangfeng 10 g, xixin 9 g, cangerzi 15 g, huangqin 12 g, baizhi 20 g, jingjie 10 g, shichangpu15g, guizhi5g. | NS; One dosage each time, three times per day | Add xixin 9 g, cangerzi 15 g, huangqin 12 g, baizhi 20 g, jingjie 10 g, shichangpu 15 g, guizhi 5 g.
|
Shi 2014 [24], China |
Yu ping feng drop pill | Drop pill |
Huangqi (NS), baizhu (NS), fangfeng (NS). | 2.4 g each sachet; One sachet each time, three times per day | None |
Lu 2014 [25], China |
Yu ping feng granule | Granule |
Huangqi (NS), baizhu (NS), fangfeng (NS). | 5 g each sachet; One sachet each time, three times per day | None |
Zhou 2010 [26], China |
Yu ping feng granule | Granule |
Huangqi (NS), baizhu (NS), fangfeng (NS). | 5 g each sachet; One sachet each time, three times per day | None |
Huang 2014 [27], China | Modified YPFS | Decoction |
Huangqi 30 g, baizhu 10 g, fangfeng 10 g, shanyao 15 g, zexie 12 g, zhiqiao 12 g, cheqianzi 12 g, shengma 12 g, cangerzi 10 g, xinyi 10 g, chaihu 10 g, hezi 10 g, dilong 8 g. | NS; One dosage for twice per day | Add shanyao 15 g, zexie 12 g, zhiqiao 12 g, cheqianzi 12 g, shengma 12 g, cangerzi 10 g, xinyi 10 g, chaihu 10 g, hezi 10 g, dilong 8 g. |
Liu 2012 [28], China | Modified YPFS | Decoction |
Huangqi 30 g, baizhu 12 g,
fangfeng 12 g, cangerzi 9 g, xinyi 9 g, baizhi 9 g, zisu 9 g, gancao 6 g. | NS; One dosage each time, twice per day | Add cangerzi 9 g, xinyi 9 g, baizhi 9 g, zisu 9 g, gancao 6 g. |
Chen 2014 [29], China | Modified YPFS | Decoction |
Huangqi 30 g, baizhu 20 g, fangfeng 12 g, dangshen 20 g, danggui 15 g, xinyi 12 g, gancao 12 g. | NS; 200 ml of one dosage, once per day | Add dangshen 20 g, danggui 15 g, xinyi 12 g, gancao12g. |
Lin 2014 [30], China | Modified YPFS | Decoction |
Huangqi 30 g, baizhu 30 g,
fangfeng 15 g, baizhi 10 g, xixin 3 g.
| NS; One dosage each time, twice per day | Add baizhi10g, xixin 3 g.
|
Guan 2013 [31], China | YPFS | Granule |
Huangqi (NS), baizhu (NS), fangfeng (NS). | 5 g each sachet; One sachet each time, three times per day | None |
Chen 2015 [32], China | Modified YPFS | Decoction |
Huangqi 30 g, baizhu 15 g, fangfeng 15 g, cangerzi 9 g,baizhi 9 g, gancao 6 g, xixin 3 g, zisu 9 g. | NS; 200 ml each time, twice per day | Add cangerzi 9 g, baizhi 9 g, gancao 6 g, xixin 3 g, zisu 9 g. |
Ma 2017 [33], China |
Yu ping feng granule | Granule |
Huangqi (NS), baizhu (NS), fangfeng (NS). | 15 g each sachet; 5 g each time, three times per day | None |
Qiu 2017 [34], China |
Yu ping feng granule | Granule |
Huangqi (NS), baizhu (NS), fangfeng (NS). | 5 g each sachet; 5 g each time, three times per day | None |
Zheng 2017 [35], China |
Yu ping feng granule | Granule |
Huangqi (NS), baizhu (NS), fangfeng (NS). | NS; One sachet each time, three times per day | None |
Outcomes
Treatment duration and follow-up
Dropouts
Risk of bias assessment
Effectiveness
Intervention vs control | Overall analysis or subgroup analysis | Subgroup details | Outcome measure | Number of studies | References | Number of participants | Results | I2
|
---|---|---|---|---|---|---|---|---|
YPFS vs Pharmacotherapy | Overall | N/A | Effective rate | 8 | 833 | RR1.07, 95%CI [0.94, 1.22] | 70% | |
YPFS vs Pharmacotherapy | Subgroup analysis (Pharmacotherapy) | Second-generation antihistamines | Effective rate | 7 | 613 | RR1.04, 95%CI [0.90, 1.19] | 64% | |
YPFS vs Pharmacotherapy | Subgroup analysis (treatment duration) | Two weeks | Effective rate | 5 | 410 | RR1.04, 95%CI [0.92, 1.18] | 6% | |
YPFS vs Pharmacotherapy | Subgroup analysis (treatment duration) | Three weeks or more | Effective rate | 3 | 423 | RR1.08, 95%CI [0.82, 1.42] | 90% | |
YPFS plus pharmacotherapy versus pharmacotherapy | Overall | Second-generation antihistamines | Itchy nose | 4 | 418 | MD-0.46, 95%CI [−0.50, −0.42]* | 0 | |
YPFS plus pharmacotherapy versus pharmacotherapy | Overall | Second-generation antihistamines | Sneezing | 4 | 418 | MD-0.41, 95%CI [−0.47, −0.35]* | 54% | |
YPFS plus pharmacotherapy versus pharmacotherapy | Overall | Second-generation antihistamines | Blocked nose | 4 | 418 | MD-0.46, 95%CI [−0.54, −0.39]* | 60% | |
YPFS plus pharmacotherapy versus pharmacotherapy | Overall | Second-generation antihistamines | Runny nose | 3 | 318 | MD-0.42, 95%CI [−0.58, −0.26]* | 70% | |
YPFS plus pharmacotherapy versus pharmacotherapy | Overall | N/A | Effective rate | 12 | 1077 | RR1.27, 95%CI [1.19, 1.34]* | 22% | |
YPFS plus pharmacotherapy versus pharmacotherapy | Subgroup analysis (Pharmacotherapy) | Second-generation antihistamines | Effective rate | 8 | 727 | RR1.28, 95%CI [1.19, 1.37]* | 43% | |
YPFS plus pharmacotherapy versus pharmacotherapy | Subgroup analysis (Pharmacotherapy) | Second-generation antihistamine + intranasal glucocorticosteroids | Effective rate | 2 | 225 | RR1.29, 95%CI [1.14,1.46]* | 0 | |
YPFS plus pharmacotherapy versus pharmacotherapy | Subgroup analysis (Pharmacotherapy) | Intranasal glucocorticosteroids | Effective rate | 2 | 125 | RR1.15, 95%CI [0.97, 1.36] | 0 | |
YPFS plus pharmacotherapy versus pharmacotherapy | Subgroup analysis (treatment duration) | Two weeks | Effective rate | 4 | 353 | RR1.13, 95%CI [0.84, 1.54] | 88% | |
YPFS plus pharmacotherapy versus pharmacotherapy | Subgroup analysis (treatment duration) | Three weeks or more | Effective rate | 8 | 725 | RR1.15, 95%CI [1.01,1.32]* | 74% |
YPFS versus placebo
YPFS versus pharmacotherapy
YPFS plus pharmacotherapy versus pharmacotherapy
Safety
Publication bias
GRADE for the main comparisons of YPFS
Quality assessment | Number of patients | Effect | Quality | Importance | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Number of studies | Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other conside-rations | YPFS or its combi-nation | Pharmaco-therapy | Relative (95% CI) | Absolute (95% CI) | ||
Effective rate: YPFS vs Antihistamine for Adult Allergic Rhinitis | ||||||||||||
7 [17–23] | Randomiz-ed trials | seriousa
| seriousb
| not serious | not serious | none | 229/308(74.4%) | 234/305 (76.7%) | RR 1.04 (0.90 to 1.19) | 29 more per 1000 (from75 fewer to 141 more) | ⨁⨁◯◯ LOW | NOT IMPORTANT |
Score of Itchy nose: YPFS + Antihistamine vs Antihistamine for Adult Allergic Rhinitis | ||||||||||||
4 [29, 32,34,35] | Randomiz-ed trials | seriousa
| not serious | not serious | seriousc
| none | 209 | 209 | MD −0.46(−0.50 to −0.42) | 0.46 fewer (0.5 fewer to 0.42 fewer) | ⨁⨁◯◯ LOW | IMPORTANT |
Score of sneezing: YPFS + Antihistamine vs Antihistamine for Adult Allergic Rhinitis | ||||||||||||
4 [29,32,34, 35] | Randomiz-ed trials | seriousa
| seriousb
| not serious | not serious | none | 209 | 209 | MD −0.41 (−0.47 to −0.35) | 0.41 fewer (0.47 fewer to 0.35 fewer) | ⨁⨁◯◯ LOW | IMPORTANT |
Score of blocked nose: YPFS +Antihistamine vs Antihistamine for Adult Allergic Rhinitis | ||||||||||||
4 [29, 32,34,35] | Randomiz-ed trials | seriousa
| seriousb
| not serious | not serious | none | 209 | 209 | MD −0.46(−0.54 to −0.39) | 0.46 fewer (0.54 fewer to 0.39 fewer) | ⨁⨁◯◯ LOW | IMPORTANT |
Score of runny nose: YPFS +Antihistamine vs Antihistamine for Adult Allergic Rhinitis | ||||||||||||
3 [29, 32, 35] | Randomiz-ed trials | seriousa
| seriousb
| not serious | not serious | none | 209 | 209 | MD −0.42(−0.58 to −0.26) | 0.42 fewer (0.58 fewer to 0.26 fewer) | ⨁⨁◯◯ LOW | IMPORTANT |
Effective rate: YPFS +Antihistamine vs Antihistamine for Adult Allergic Rhinitis | ||||||||||||
8 [23,24, 28–30,32, 34,35] | Randomiz-ed trials | seriousa
| not serious | not serious | not serious | none | 338/369 (91.6%) | 257/358 (71.8%) | RR 1.28 (1.19 to 1.37) | 201 more per 1000 (from 136 more to 265 more) | ⨁⨁◯◯ LOW | NOT IMPORTANT |