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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Veröffentlicht in:Allergy (Copenhagen) Jg. 72; H. 11; S. 1597 - 1631
Hauptverfasser: Dhami, S., Nurmatov, U., Arasi, S., Khan, T., Asaria, M., Zaman, H., Agarwal, A., Netuveli, G., Roberts, G., Pfaar, O., Muraro, A., Ansotegui, I. J., Calderon, M., Cingi, C., Durham, S., Wijk, R. Gerth, Halken, S., Hamelmann, E., Hellings, P., Jacobsen, L., Knol, E., Larenas‐Linnemann, D., Lin, S., Maggina, P., Mösges, R., Oude Elberink, H., Pajno, G., Panwankar, R., Pastorello, E., Penagos, M., Pitsios, C., Rotiroti, G., Timmermans, F., Tsilochristou, O., Varga, E.‐M., Schmidt‐Weber, C., Wilkinson, J., Williams, A., Worm, M., Zhang, L., Sheikh, A.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: Denmark Blackwell Publishing Ltd 01.11.2017
Schlagworte:
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
subcutaneous
allergen
allergen immunotherapy
allergic rhinoconjunctivitis
sublingual
ISSN:0105-4538, 1398-9995, 1398-9995
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Zusammenfassung: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 Methods We searched nine international biomedical databases for published, in‐progress, and unpublished evidence.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.
Bibliographie:Funding information
EAACI and BM4SIT project (grant number 601763) in the European Union's Seventh Framework Programme FP7.
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ObjectType-Evidence Based Healthcare-1
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ISSN:0105-4538
1398-9995
1398-9995
DOI:10.1111/all.13201