Abstract

Review Article

The Efficacy of Quercetin in Attenuating Oxidative Stress and Clinical Symptoms in Allergic Rhinitis: A Systematic Review

Niken Dyah Aryani K*, Harijono Kariosentono, Bambang Purwanto, Made Setiamika, Eti Poncorini, Paramasari Dirgahayu, Risya Cilmiaty and Teti Madiadipoera

Published: 26 August, 2025 | Volume 9 - Issue 1 | Pages: 011-019

Background: Allergic rhinitis (AR) affects approximately 10% - 30% of the global population and represents a significant healthcare burden. The condition involves complex inflammatory pathways where oxidative stress plays a crucial role, with malondialdehyde serving as a key biomarker of cellular damage. Quercetin, a naturally occurring flavonoid, demonstrates promising antioxidant and anti-inflammatory properties that may benefit allergic rhinitis management.
Methods: We conducted a systematic review following PRISMA 2020 guidelines. Four electronic databases (PubMed, Google Scholar, SagePub, and Semantic Scholar) were searched for studies published between 2000 and 2024. The PICO framework guided study selection, focusing on quercetin intervention in allergic rhinitis models. Both preclinical and clinical studies measuring malondialdehyde levels or clinical symptom improvement were included.
Results: Eighteen studies met our inclusion criteria, comprising 14 animal studies and four human clinical trials. Preclinical evidence consistently demonstrated quercetin’s ability to reduce malondialdehyde levels across various tissues, including serum, lung, and liver samples. Human studies showed superior symptom improvement when quercetin-containing supplements were added to standard therapy compared to conventional treatment alone.
The primary mechanism involves nuclear factor erythroid 2-related factor 2 pathway activation, enhancing endogenous antioxidant enzyme production.
Conclusion: Current evidence supports quercetin’s effectiveness in reducing oxidative stress and improving clinical outcomes in allergic rhinitis through dual antioxidant and anti-inflammatory mechanisms. While most evidence derives from animal studies, quercetin Shows promise as safe adjuvant therapy. Large-scale human clinical trials using high- high-bioavailability formulations are needed to establish standardized clinical protocols.
Key messages:
•    Quercetin consistently reduces oxidative stress markers in allergic rhinitis models.
•    Clinical symptoms improve significantly when quercetin supplements are added to standard therapy.
•    The therapeutic mechanism involves both direct antioxidant activity and endogenous defense system enhancement.
•    High-quality human clinical trials are needed to establish definitive treatment guidelines.

Read Full Article HTML DOI: 10.29328/journal.hor.1001032 Cite this Article Read Full Article PDF

Keywords:

Quercetin; Allergic rhinitis; Oxidative stress; Malondialdehyde; Systematic review

References

  1. Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR, et al. Clinical practice guideline: allergic rhinitis. Otolaryngol Head Neck Surg. 2015;152(Suppl 1):S1–43. Available from: https://doi.org/10.1177/0194599814561600
  2. Bousquet J, Schünemann HJ, Togias A, Bachert C, Erhola M, Hellings PW, et al. Next-generation Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines for allergic rhinitis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and real-world evidence. J Allergy Clin Immunol. 2020;145(1):70–80. Available from: https://doi.org/10.1016/j.jaci.2019.06.049
  3. Meltzer EO, Rosario NA, Van Bever H, Lucio L. Fexofenadine: review of safety, efficacy, and unmet needs in children with allergic rhinitis. Allergy Asthma Clin Immunol. 2021;17:113. Available from: https://doi.org/10.1186/s13223-021-00614-6
  4. Ibi M, Sawada K, Nakanishi M, Kirilovas D, Kitamura Y, Matsumura Y, et al. Role of oxidative stress in pathogenesis of allergic rhinitis. Oxid Antioxid Med Sci. 2017;6(1):13–17.
  5. Meiyanti M, Yohana, Margo E, Chudri J, Pusparini, Faradilla MA. Factors associated with plasma malondialdehyde levels in people over 40 years. J Drug Deliv Ther [Internet]. 2023 Jul 15 [cited 2025 Aug 24];13(7):52–6. Available from: https://jddtonline.info/index.php/jddt/article/view/6142
  6. Jafarinia M, Sadat Hosseini M, Kasiri N, Fazel N, Fathi F, Ganjalikhani Hakemi M, et al. Quercetin with the potential effect on allergic diseases. Allergy Asthma Clin Immunol. 2020;16:36. Available from: https://doi.org/10.1186/s13223-020-00434-0
  7. Anand David AV, Arulmoli R, Parasuraman S. Overviews of biological importance of quercetin: a bioactive flavonoid. Pharmacogn Rev. 2016;10(20):84–89. Available from: https://doi.org/10.4103/0973-7847.194044
  8. Mlcek J, Jurikova T, Skrovankova S, Sochor J. Quercetin and its anti-allergic immune response. Molecules. 2016;21(5):623. Available from: https://doi.org/10.3390/molecules21050623
  9. Kejík Z, Kaplánek R, Masařík M, Babula P, Matkowski A, Filipenský P, et al. Iron complexes of flavonoids—antioxidant capacity and beyond. Int J Mol Sci. 2021;22(2):646. Available from: https://doi.org/10.3390/ijms22020646
  10. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. Available from: https://doi.org/10.1136/bmj.n71
  11. Bidian C, Dumitrascu D, Leucuta D, Zdrenghea M, Todea D. The effect of quercetin on oxidative stress in an experimental model of allergic rhinitis in rats. Farmacia. 2020;68(1):99–105.
  12. Helianti I, Sari DK, Wahyuni D, Kartikasari E, Winarni D, Arfian N, et al. The effect of onion peel (Allium cepa L.) infusion on malondialdehyde levels and lung histology of male Wistar rats exposed to cigarette smoke. J Kedokteran dan Kesehatan Indones. 2024;15:357–368.
  13. Shebl M, El-Gheit REA, Madi M. Effect of quercetin on exercise tolerance in experimental hyperthyroidism in male albino rats. Med J Cairo Univ. 2018;86:613–622.
  14. Khoiruddin MA, Helianti D, Hasan M, Dewi R, Rachmania S. The effect of shallot peel ethanol extract in reducing kidney MDA levels in diazinon-induced Wistar rats. J Agromed Med Sci. 2022;8(2):148–153. Available from: http://dx.doi.org/10.19184/ams.v8i2.27424
  15. Yiga HJ, Samuel M. Analysis of antioxidant effects of quercetin, rutin and Phagnalon rupestre on rats intoxicated by aluminium. J Drug Deliv Ther. 2024;14(2):130–136. Available from: https://jddtonline.info/index.php/jddt/article/view/6729
  16. Marogna M, Ciprandi G. A nutraceutical-based approach for the treatment of allergic rhinitis: a pilot study in real-life. J Biol Regul Homeost Agents. 2023;37(1):297–302.
  17. Gori A, Brindisi G, Anania C, Spalice A, Zicari AM. Synergic efficacy of a multicomponent nutraceutical add-on therapy in seasonal allergic rhinitis in children: a prospective, randomized, parallel-group study. J Clin Med. 2025;14(5):1517. Available from: https://www.mdpi.com/2077-0383/14/5/1517
  18. Ravikumar P, Kavitha V. Therapeutic effect of quercetin on airway hyperresponsiveness in an experimental model of allergic rhinitis. Biomed Pharmacother. 2020;129:110438.
  19. Sutanegara SWD, Fredlina Y. Effectiveness of Dewandaru leaf extract (Eugenia uniflora L.) in an animal model of allergic rhinitis. Oto Rhino Laryngol Indones. 2022;52(1):1–10. Available from: https://mdpub.net/index.php?mno=84204
  20. Nyarko K. Investigating the antioxidant properties of quercetin. In: Quercetin – Effects on Human Health. IntechOpen; 2024. Available from: https://www.intechopen.com/chapters/1180684
  21. Saeedi S, Dayani F, Rafieian-Kopaei M, Shirzad H, Khalilian A, Narimani M, et al. The effect of quercetin on the Nrf2 signaling pathway in neurological disorders: a systematic review of preclinical studies. Food Funct. 2021;12(6):2908–2923.
  22. Al-Samydai A, Al-Mamoori F, Al-Jobori K, Al-Azzawi W. Quercetin nanoparticles-loaded intranasal in situ gel for the management of allergic rhinitis. AAPS PharmSciTech. 2022;23:238.
  23. Askari G, Ghavami A, Giti H, Malek-Ahmadi M. The effect of quercetin supplementation on inflammatory factors and clinical symptoms in women with rheumatoid arthritis: a double-blind, randomized controlled trial. Phytother Res. 2022;36(7):2931–2938.
  24. Chauhan B, Gupta M, Chauhan K. Role of antioxidants on the clinical outcome of patients with perennial allergic rhinitis. Allergy Rhinol (Providence). 2016;7(2):e74–e81. Available from: https://doi.org/10.2500/ar.2016.7.0163
  25. Paunović MG, Ognjanović B, Matić M, Stajn A, Saicic Z. Protective effects of quercetin and vitamin C against nicotine-induced toxicity in the blood of Wistar rats. Arh Hig Rada Toksikol. 2016;67(4):304–310. https://doi.org/10.1515/aiht-2016-67-2795
  26. El-Khateeb S, Mahmoud A, Ibrahem NE. Protective role of quercetin on hippocampus inflammatory and oxidative damage induced by monosodium glutamate in rats. Mansoura J Forensic Med Clin Toxicol. 2020;28(1):15–31. Available from: https://mjfmct.journals.ekb.eg/article_99003_ab3c40d23ed630ca842b2918b3a3a5b9.pdf
  27. Oremosu A, Akang E, Dosumu O, Usman IT, Akanmu A. Cerebellar perturbations of combination antiretroviral therapy (CART): Can bioflavonoids help? Niger J Neurosci. 2018;9(2):53–59. Available from: https://neurosociety.org.ng/journal/publication/NJN_10.47081_njn2018.9.2_004.pdf
  28. Riva A, Ronchi M, Petrangolini G, Bosisio S, Allegrini P. Improved oral absorption of quercetin from Quercetin Phytosome®, a new delivery system based on food grade lecithin. Eur J Drug Metab Pharmacokinet. 2019;44(2):169–177. https://doi.org/10.1007/s13318-018-0517-3

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