Allergen immunotherapy for allergic rhinoconjunctivitis: A systematic review and meta‐analysis
Background The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis. To inform the development of clinical recommendations, we undertook a systematic review to assess the effectiveness,...
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| Vydáno v: | Allergy (Copenhagen) Ročník 72; číslo 11; s. 1597 - 1631 |
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| Hlavní autoři: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
| Vydáno: |
Denmark
Blackwell Publishing Ltd
01.11.2017
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| Témata: | |
| ISSN: | 0105-4538, 1398-9995, 1398-9995 |
| On-line přístup: | Získat plný text |
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| Abstract | Background
The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis. To inform the development of clinical recommendations, we undertook a systematic review to assess the effectiveness, cost‐effectiveness, and safety of AIT in the management of allergic rhinoconjunctivitis.
Methods
We searched nine international biomedical databases for published, in‐progress, and unpublished evidence. Studies were independently screened by two reviewers against predefined eligibility criteria and critically appraised using established instruments. Our primary outcomes of interest were symptom, medication, and combined symptom and medication scores. Secondary outcomes of interest included cost‐effectiveness and safety. Data were descriptively summarized and then quantitatively synthesized using random‐effects meta‐analyses.
Results
We identified 5960 studies of which 160 studies satisfied our eligibility criteria. There was a substantial body of evidence demonstrating significant reductions in standardized mean differences (SMD) of symptom (SMD −0.53, 95% CI −0.63, −0.42), medication (SMD −0.37, 95% CI −0.49, −0.26), and combined symptom and medication (SMD −0.49, 95% CI −0.69, −0.30) scores while on treatment that were robust to prespecified sensitivity analyses. There was in comparison a more modest body of evidence on effectiveness post‐discontinuation of AIT, suggesting a benefit in relation to symptom scores.
Conclusions
AIT is effective in improving symptom, medication, and combined symptom and medication scores in patients with allergic rhinoconjunctivitis while on treatment, and there is some evidence suggesting that these benefits are maintained in relation to symptom scores after discontinuation of therapy. |
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| AbstractList | Background
The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis. To inform the development of clinical recommendations, we undertook a systematic review to assess the effectiveness, cost‐effectiveness, and safety of AIT in the management of allergic rhinoconjunctivitis.
Methods
We searched nine international biomedical databases for published, in‐progress, and unpublished evidence. Studies were independently screened by two reviewers against predefined eligibility criteria and critically appraised using established instruments. Our primary outcomes of interest were symptom, medication, and combined symptom and medication scores. Secondary outcomes of interest included cost‐effectiveness and safety. Data were descriptively summarized and then quantitatively synthesized using random‐effects meta‐analyses.
Results
We identified 5960 studies of which 160 studies satisfied our eligibility criteria. There was a substantial body of evidence demonstrating significant reductions in standardized mean differences (SMD) of symptom (SMD −0.53, 95% CI −0.63, −0.42), medication (SMD −0.37, 95% CI −0.49, −0.26), and combined symptom and medication (SMD −0.49, 95% CI −0.69, −0.30) scores while on treatment that were robust to prespecified sensitivity analyses. There was in comparison a more modest body of evidence on effectiveness post‐discontinuation of AIT, suggesting a benefit in relation to symptom scores.
Conclusions
AIT is effective in improving symptom, medication, and combined symptom and medication scores in patients with allergic rhinoconjunctivitis while on treatment, and there is some evidence suggesting that these benefits are maintained in relation to symptom scores after discontinuation of therapy. The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis. To inform the development of clinical recommendations, we undertook a systematic review to assess the effectiveness, cost-effectiveness, and safety of AIT in the management of allergic rhinoconjunctivitis. We searched nine international biomedical databases for published, in-progress, and unpublished evidence. Studies were independently screened by two reviewers against predefined eligibility criteria and critically appraised using established instruments. Our primary outcomes of interest were symptom, medication, and combined symptom and medication scores. Secondary outcomes of interest included cost-effectiveness and safety. Data were descriptively summarized and then quantitatively synthesized using random-effects meta-analyses. We identified 5960 studies of which 160 studies satisfied our eligibility criteria. There was a substantial body of evidence demonstrating significant reductions in standardized mean differences (SMD) of symptom (SMD -0.53, 95% CI -0.63, -0.42), medication (SMD -0.37, 95% CI -0.49, -0.26), and combined symptom and medication (SMD -0.49, 95% CI -0.69, -0.30) scores while on treatment that were robust to prespecified sensitivity analyses. There was in comparison a more modest body of evidence on effectiveness post-discontinuation of AIT, suggesting a benefit in relation to symptom scores. AIT is effective in improving symptom, medication, and combined symptom and medication scores in patients with allergic rhinoconjunctivitis while on treatment, and there is some evidence suggesting that these benefits are maintained in relation to symptom scores after discontinuation of therapy. BackgroundThe European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis. To inform the development of clinical recommendations, we undertook a systematic review to assess the effectiveness, cost‐effectiveness, and safety of AIT in the management of allergic rhinoconjunctivitis.MethodsWe searched nine international biomedical databases for published, in‐progress, and unpublished evidence. Studies were independently screened by two reviewers against predefined eligibility criteria and critically appraised using established instruments. Our primary outcomes of interest were symptom, medication, and combined symptom and medication scores. Secondary outcomes of interest included cost‐effectiveness and safety. Data were descriptively summarized and then quantitatively synthesized using random‐effects meta‐analyses.ResultsWe identified 5960 studies of which 160 studies satisfied our eligibility criteria. There was a substantial body of evidence demonstrating significant reductions in standardized mean differences (SMD) of symptom (SMD −0.53, 95% CI −0.63, −0.42), medication (SMD −0.37, 95% CI −0.49, −0.26), and combined symptom and medication (SMD −0.49, 95% CI −0.69, −0.30) scores while on treatment that were robust to prespecified sensitivity analyses. There was in comparison a more modest body of evidence on effectiveness post‐discontinuation of AIT, suggesting a benefit in relation to symptom scores.ConclusionsAIT is effective in improving symptom, medication, and combined symptom and medication scores in patients with allergic rhinoconjunctivitis while on treatment, and there is some evidence suggesting that these benefits are maintained in relation to symptom scores after discontinuation of therapy. The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis. To inform the development of clinical recommendations, we undertook a systematic review to assess the effectiveness, cost-effectiveness, and safety of AIT in the management of allergic rhinoconjunctivitis.BACKGROUNDThe European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis. To inform the development of clinical recommendations, we undertook a systematic review to assess the effectiveness, cost-effectiveness, and safety of AIT in the management of allergic rhinoconjunctivitis.We searched nine international biomedical databases for published, in-progress, and unpublished evidence. Studies were independently screened by two reviewers against predefined eligibility criteria and critically appraised using established instruments. Our primary outcomes of interest were symptom, medication, and combined symptom and medication scores. Secondary outcomes of interest included cost-effectiveness and safety. Data were descriptively summarized and then quantitatively synthesized using random-effects meta-analyses.METHODSWe searched nine international biomedical databases for published, in-progress, and unpublished evidence. Studies were independently screened by two reviewers against predefined eligibility criteria and critically appraised using established instruments. Our primary outcomes of interest were symptom, medication, and combined symptom and medication scores. Secondary outcomes of interest included cost-effectiveness and safety. Data were descriptively summarized and then quantitatively synthesized using random-effects meta-analyses.We identified 5960 studies of which 160 studies satisfied our eligibility criteria. There was a substantial body of evidence demonstrating significant reductions in standardized mean differences (SMD) of symptom (SMD -0.53, 95% CI -0.63, -0.42), medication (SMD -0.37, 95% CI -0.49, -0.26), and combined symptom and medication (SMD -0.49, 95% CI -0.69, -0.30) scores while on treatment that were robust to prespecified sensitivity analyses. There was in comparison a more modest body of evidence on effectiveness post-discontinuation of AIT, suggesting a benefit in relation to symptom scores.RESULTSWe identified 5960 studies of which 160 studies satisfied our eligibility criteria. There was a substantial body of evidence demonstrating significant reductions in standardized mean differences (SMD) of symptom (SMD -0.53, 95% CI -0.63, -0.42), medication (SMD -0.37, 95% CI -0.49, -0.26), and combined symptom and medication (SMD -0.49, 95% CI -0.69, -0.30) scores while on treatment that were robust to prespecified sensitivity analyses. There was in comparison a more modest body of evidence on effectiveness post-discontinuation of AIT, suggesting a benefit in relation to symptom scores.AIT is effective in improving symptom, medication, and combined symptom and medication scores in patients with allergic rhinoconjunctivitis while on treatment, and there is some evidence suggesting that these benefits are maintained in relation to symptom scores after discontinuation of therapy.CONCLUSIONSAIT is effective in improving symptom, medication, and combined symptom and medication scores in patients with allergic rhinoconjunctivitis while on treatment, and there is some evidence suggesting that these benefits are maintained in relation to symptom scores after discontinuation of therapy. |
| Author | Hellings, P. Asaria, M. Dhami, S. Roberts, G. Knol, E. Arasi, S. Lin, S. Wilkinson, J. Netuveli, G. Schmidt‐Weber, C. Khan, T. Maggina, P. Pastorello, E. Pfaar, O. Cingi, C. Penagos, M. Varga, E.‐M. Zhang, L. Oude Elberink, H. Pajno, G. Ansotegui, I. J. Zaman, H. Worm, M. Timmermans, F. Jacobsen, L. Wijk, R. Gerth Muraro, A. Rotiroti, G. Tsilochristou, O. Agarwal, A. Panwankar, R. Calderon, M. Sheikh, A. Durham, S. Larenas‐Linnemann, D. Nurmatov, U. Pitsios, C. Williams, A. Hamelmann, E. Halken, S. Mösges, R. |
| Author_xml | – sequence: 1 givenname: S. orcidid: 0000-0002-2823-3258 surname: Dhami fullname: Dhami, S. email: sangeetadhami@hotmail.com organization: Evidence‐Based Health Care Ltd – sequence: 2 givenname: U. surname: Nurmatov fullname: Nurmatov, U. organization: Cardiff University, Heath Park – sequence: 3 givenname: S. surname: Arasi fullname: Arasi, S. organization: Charité Medical University – sequence: 4 givenname: T. surname: Khan fullname: Khan, T. organization: Monash University – sequence: 5 givenname: M. orcidid: 0000-0002-3538-4417 surname: Asaria fullname: Asaria, M. organization: University of York – sequence: 6 givenname: H. surname: Zaman fullname: Zaman, H. organization: Bradford School of Pharmacy – sequence: 7 givenname: A. surname: Agarwal fullname: Agarwal, A. organization: University of Toronto – sequence: 8 givenname: G. surname: Netuveli fullname: Netuveli, G. organization: University of East London – sequence: 9 givenname: G. surname: Roberts fullname: Roberts, G. organization: University of Southampton – sequence: 10 givenname: O. orcidid: 0000-0003-4374-9639 surname: Pfaar fullname: Pfaar, O. organization: Center for Rhinology and Allergology – sequence: 11 givenname: A. surname: Muraro fullname: Muraro, A. organization: Padua General University Hospital – sequence: 12 givenname: I. J. surname: Ansotegui fullname: Ansotegui, I. J. organization: Hospital Quiron Bizkair – sequence: 13 givenname: M. surname: Calderon fullname: Calderon, M. organization: Imperial College – sequence: 14 givenname: C. orcidid: 0000-0003-3934-5092 surname: Cingi fullname: Cingi, C. organization: Eskisehir Osmangazi University Medical Faculty – sequence: 15 givenname: S. surname: Durham fullname: Durham, S. organization: Imperial College – sequence: 16 givenname: R. Gerth surname: Wijk fullname: Wijk, R. Gerth organization: Erasmus MC Rotterdam – sequence: 17 givenname: S. surname: Halken fullname: Halken, S. organization: Odense University Hospital – sequence: 18 givenname: E. surname: Hamelmann fullname: Hamelmann, E. organization: Allergy Center Buhr‐University – sequence: 19 givenname: P. surname: Hellings fullname: Hellings, P. organization: University Hospitals Leuven – sequence: 20 givenname: L. surname: Jacobsen fullname: Jacobsen, L. organization: ALC, Allergy Learning and Consulting – sequence: 21 givenname: E. surname: Knol fullname: Knol, E. organization: University Medical Center – sequence: 22 givenname: D. surname: Larenas‐Linnemann fullname: Larenas‐Linnemann, D. organization: Hospital Medica Sur – sequence: 23 givenname: S. surname: Lin fullname: Lin, S. organization: John Hopkins – sequence: 24 givenname: P. surname: Maggina fullname: Maggina, P. organization: University of Athens, P&A Kiriakou Children's Hospital – sequence: 25 givenname: R. surname: Mösges fullname: Mösges, R. organization: University of Groningen – sequence: 26 givenname: H. surname: Oude Elberink fullname: Oude Elberink, H. organization: University of Groningen – sequence: 27 givenname: G. surname: Pajno fullname: Pajno, G. organization: University of Messina – sequence: 28 givenname: R. surname: Panwankar fullname: Panwankar, R. organization: Nippon Medical School – sequence: 29 givenname: E. surname: Pastorello fullname: Pastorello, E. organization: University of Milano – sequence: 30 givenname: M. surname: Penagos fullname: Penagos, M. organization: Imperial College – sequence: 31 givenname: C. surname: Pitsios fullname: Pitsios, C. organization: University of Cyprus – sequence: 32 givenname: G. surname: Rotiroti fullname: Rotiroti, G. organization: University College London – sequence: 33 givenname: F. surname: Timmermans fullname: Timmermans, F. organization: Netherlands Anafylaxis Network – sequence: 34 givenname: O. surname: Tsilochristou fullname: Tsilochristou, O. organization: Charite University Hospital – sequence: 35 givenname: E.‐M. surname: Varga fullname: Varga, E.‐M. organization: Medical University Graz – sequence: 36 givenname: C. surname: Schmidt‐Weber fullname: Schmidt‐Weber, C. organization: Pharmaceutical Group of the European Union – sequence: 37 givenname: J. surname: Wilkinson fullname: Wilkinson, J. organization: Pharmaceutical Group of the European Union – sequence: 38 givenname: A. surname: Williams fullname: Williams, A. organization: Guy's and St Thomas’ NHS Foundation Trust – sequence: 39 givenname: M. surname: Worm fullname: Worm, M. organization: Charite‐Universitatsmedizin – sequence: 40 givenname: L. surname: Zhang fullname: Zhang, L. organization: Beijing Institute of Otolaryngology – sequence: 41 givenname: A. surname: Sheikh fullname: Sheikh, A. organization: The University of Edinburgh |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/28493631$$D View this record in MEDLINE/PubMed |
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| Publisher | Blackwell Publishing Ltd |
| Publisher_xml | – name: Blackwell Publishing Ltd |
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The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing Guidelines on Allergen Immunotherapy (AIT) for... The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing Guidelines on Allergen Immunotherapy (AIT) for Allergic... BackgroundThe European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing Guidelines on Allergen Immunotherapy (AIT) for... |
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| SubjectTerms | allergen allergen immunotherapy Allergens Allergens - immunology allergic rhinoconjunctivitis Allergies Conjunctivitis, Allergic - therapy Cost analysis Databases, Factual Desensitization, Immunologic - methods Evidence-based medicine Humans Immunotherapy Meta-analysis Rhinitis, Allergic, Seasonal - therapy Rhinoconjunctivitis subcutaneous sublingual Systematic review |
| Title | Allergen immunotherapy for allergic rhinoconjunctivitis: A systematic review and meta‐analysis |
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