Table 5.
The individual quality components of GRADE of included SRs.
| Included study | Type of Study | Outcomes | Downgrading factors | Outcome | ||||
|---|---|---|---|---|---|---|---|---|
| Risk of bias | Inconsistency | Indirectness | Imprecision | Publication bias | Quality of evidence | |||
| Li [24] (2009) | RCT | (6)∗ | serious | no | no | serious | strongly suspected | ⊕⊕⊕⊕ |
| (3) | serious | no | no | no | strongly suspected | ⊕⊕⊕ | ||
| Yan [19] (2015) | RCT | (1)∗ | serious | no | no | serious | strongly suspected | ⊕⊕⊕⊕ |
| (8) | serious | no | no | serious | strongly suspected | ⊕⊕⊕⊕ | ||
| Yao [22] (2016) | RCT | (1)∗ | serious | no | no | serious | strongly suspected | ⊕⊕⊕⊕ |
| Liang [41] (2016) | RCT | (1)∗ | serious | very serious | no | serious | strongly suspected | ⊕⊕⊕⊕ |
| (2) | serious | no | no | no | strongly suspected | ⊕⊕⊕ | ||
| (3) | serious | no | no | serious | strongly suspected | ⊕⊕⊕⊕ | ||
| (7) | serious | very serious | no | serious | strongly suspected | ⊕⊕⊕⊕ | ||
| Chen [33] (2016) | RCT | (4)∗ | serious | no | no | serious | strongly suspected | ⊕⊕⊕⊕ |
| An [38] (2016) | RCT | (1)∗ | very serious | serious | no | serious | strongly suspected | ⊕⊕⊕⊕ |
| (3) | very serious | serious | no | serious | strongly suspected | ⊕⊕⊕⊕ | ||
| Luo [39] (2016) | RCT | (1)∗ | very serious | serious | no | serious | strongly suspected | ⊕⊕⊕⊕ |
| (3) | very serious | serious | no | serious | strongly suspected | ⊕⊕⊕⊕ | ||
| (4) | very serious | serious | no | serious | strongly suspected | ⊕⊕⊕⊕ | ||
| Liu [35] (2017) | RCT/CCT | (4)∗ | serious | serious | no | serious | strongly suspected | ⊕⊕⊕⊕ |
| Pu [28] (2017) | RCT | (3) | serious | no | no | serious | strongly suspected | ⊕⊕⊕⊕ |
| (4) | serious | no | no | serious | strongly suspected | ⊕⊕⊕⊕ | ||
| Zhang [31] (2018) | RCT | (1)∗ | serious | no | no | serious | strongly suspected | ⊕⊕⊕⊕ |
| (5) | serious | no | no | no | strongly suspected | ⊕⊕⊕ | ||
| (6) | serious | no | no | serious | strongly suspected | ⊕⊕⊕⊕ | ||
| Liang [32] (2018) | RCT/quasi-RCT/CCT | (4)∗ | serious | no | no | serious | strongly suspected | ⊕⊕⊕⊕ |
| (6) | serious | no | no | serious | strongly suspected | ⊕⊕⊕⊕ | ||
| Zhu [21] (2018) | RCT | (4) | serious | no | no | serious | strongly suspected | ⊕⊕⊕⊕ |
| (10)∗ | serious | serious | no | serious | strongly suspected | ⊕⊕⊕⊕ | ||
| Li [37] (2018) | RCT | (1)∗ | serious | serious | no | serious | strongly suspected | ⊕⊕⊕⊕ |
| (3) | serious | no | no | serious | strongly suspected | ⊕⊕⊕⊕ | ||
| (6) | serious | serious | no | serious | strongly suspected | ⊕⊕⊕⊕ | ||
| Wei [26] (2019) | RCT | (3) | serious | no | no | serious | strongly suspected | ⊕⊕⊕⊕ |
| (4)∗ | serious | no | no | serious | strongly suspected | ⊕⊕⊕⊕ | ||
| (6) | serious | no | no | serious | undetected | ⊕⊕⊕ | ||
| Zhao [40] (2019) | RCT | (1)∗ | serious | no | no | serious | strongly suspected | ⊕⊕⊕⊕ |
| (3) | serious | no | no | serious | strongly suspected | ⊕⊕⊕⊕ | ||
| (6) | serious | no | no | serious | strongly suspected | ⊕⊕⊕⊕ | ||
| (7) | serious | no | no | serious | strongly suspected | ⊕⊕⊕⊕ | ||
| (10) | serious | serious | no | serious | strongly suspected | ⊕⊕⊕⊕ | ||
| Li [36] (2019) | RCT | (3) | serious | no | no | serious | strongly suspected | ⊕⊕⊕⊕ |
| (6)∗ | serious | no | no | serious | strongly suspected | ⊕⊕⊕⊕ | ||
| Wu [29] (2019) | RCT | (1)∗ | serious | serious | no | serious | undetected | ⊕⊕⊕⊕ |
| (3) | serious | no | no | serious | undetected | ⊕⊕⊕ | ||
| Zhao [30] (2019) | RCT/CCT | (1)∗ | serious | no | no | serious | strongly suspected | ⊕⊕⊕⊕ |
| (3) | serious | no | no | serious | strongly suspected | ⊕⊕⊕⊕ | ||
| (4) | serious | no | no | serious | strongly suspected | ⊕⊕⊕⊕ | ||
| Yao [20] (2019) | RCT | (1) | serious | serious | no | serious | strongly suspected | ⊕⊕⊕⊕ |
| (11)∗ | serious | no | no | serious | strongly suspected | ⊕⊕⊕⊕ | ||
| Zhao [27] (2020) | RCT | (1)∗ | serious | no | no | serious | strongly suspected | ⊕⊕⊕⊕ |
| (3) | serious | no | no | no | strongly suspected | ⊕⊕⊕ | ||
| (10) | serious | serious | no | serious | strongly suspected | ⊕⊕⊕⊕ | ||
| Zhang [34] (2020) | RCT/quasi-RCT | (1)∗ | serious | no | no | no | undetected | ⊕⊕ |
| (3) | serious | no | no | no | undetected | ⊕⊕ | ||
| (6) | serious | no | no | no | undetected | ⊕⊕ | ||
| Xiao [23] (2020) | RCT | (1)∗ | very serious | serious | no | serious | undetected | ⊕⊕⊕⊕ |
| (3) | very serious | no | no | serious | undetected | ⊕⊕⊕⊕ | ||
| Ke [25] (2021) | RCT | (1)∗ | serious | no | no | serious | undetected | ⊕⊕⊕⊕ |
| (4) | serious | no | no | serious | undetected | ⊕⊕⊕⊕ | ||
Note: ∗ represents the primary outcome measure, which determines the overall quality of the article; ⊕ represents the ranking of quality as high, ⊕⊕ represents the ranking of quality as moderate, ⊕⊕⊕ represents the ranking of quality as low, and ⊕⊕⊕⊕ represents the ranking of quality as very low. (1) Risk of Bias: the included study has large biases in terms of randomization, allocation concealment, blinding, and loss of follow-up. (2) Inconsistency: the overlapping of confidence intervals of different studies is poor, and the I2 value of the combined results is large. (3) Indirectness: differences in populations, interventions, and outcomes. (4) Imprecision: the sample size of the included studies was too small and the confidence interval was wide. (5) Publication bias: funnel diagram shows asymmetry, gray literature was not retrieved and the search database is incomplete.Outcomes: (1) total efficiency: according to the severity of clinical symptoms using 4 scores; the total score is the sum of the individual scores. Symptom Score Reducing Index (SSRI) = (total score before treatment-total score after treatment)/total score before treatment×100%; (2) adverse reaction rate; (3) recurrence rate; (4) clinical efficacy rate: the clinical complete recovery is considered to be effective, others are invalid; (5) improvement rate; (6) curing rate; (7) IgE levels; (8) the Dermatology Quality Life Index (DLQI); (9) quality of life score (QoL); (10) total improvement of clinical signs and symptoms; (11) disease activity control.