Systematic review and meta-analysis of Xiangju capsules for allergic rhinitis symptoms and immunology

BackgroundAllergic rhinitis (AR) is a common chronic inflammatory disease, which seriously affects patients’ quality of life. Xiangju (XJ) capsules are often used as an adjunctive drug for AR treatment in clinical practice, but its efficacy and safety have not been systematically evaluated.MethodsThis study systematically searched eight Chinese and English databases for data from inception to 30 November 2025. Randomized controlled trials (RCTs) evaluating XJ capsules alone or in combination with conventional treatment for AR were included. Subgroup analyses and sensitivity analyses were used to test outcome stability. Funnel plots, Egger’s regression test and Begg’s rank correlation test were used to assess publication bias. When publication bias was detected, its potential influence was further assessed using the trim-and-fill method. The methodological quality of the included studies was evaluated using the Cochrane Risk of Bias tool, and the quality of evidence was graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.ResultsA total of 14 RCTs involving 1,968 patients were included. Meta-analysis showed that XJ capsules were associated with a higher reported overall effective rate (RR = 1.12, 95% CI: 1.08 to 1.16), lower runny nose scores (SMD = −1.81, 95% CI: −3.36 to −0.27) and lower sneezing scores (SMD = −1.14, 95% CI: −1.86 to −0.41), lower IL-4 levels (SMD = −1.55, 95% CI: −1.93 to −1.16) and lower IgE levels (SMD = −1.55, 95% CI: −2.92 to −0.18), and higher IL-12 levels (SMD = 1.76, 95% CI: 0.79 to 2.73). No significant difference was observed in adverse event incidence between groups (RR = 0.72, 95% CI: 0.43 to 1.20).ConclusionXJ capsules may offer additional benefits for AR symptoms and immunological markers, and were generally well tolerated in the included trials. However, given the limited certainty of the evidence, further high-quality studies are needed to confirm these findings.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261279480, identifier CRD420261279480.