Allergen immunotherapy for allergic rhinoconjunctivitis: A systematic review and meta-analysis

Dhami S 1 , Nurmatov U 2 , Arasi S 3 , Khan T 4 , Asaria M 5 , Zaman H 6 Show all authors , Agarwal A 7 , Netuveli G 8 , Roberts G 9 , Pfaar O 10 , Muraro A 11 , Ansotegui IJ 12 , Calderon M 13 , Cingi C 14 , Durham S 13 , van Wijk RG 15 , Halken S 16 , Hamelmann E 17 , Hellings P 18 , Jacobsen L 19 , Knol E 20 , Larenas-Linnemann D 21 , Lin S 22 , Maggina P 23 , Mösges R 24 , Oude Elberink H 25 , Pajno G 26 , Panwankar R 27 , Pastorello E 28 , Penagos M 13 , Pitsios C 29 , Rotiroti G 30 , Timmermans F 31 , Tsilochristou O 32 , Varga EM 33 , Schmidt-Weber C 34 , Wilkinson J 34 , Williams A 35 , Worm M 36 , Zhang L 37 , Sheikh A 38

Affiliations 

  • 1 Evidence-Based Health Care Ltd, Edinburgh, UK
  • 2 Division of Population Medicine, School of Medicine, Cardiff University, Heath Park, Cardiff, UK
  • 3 Department of Pediatrics, Allergy Unit, University of Messina, Messina, Italy
  • 4 School of Pharmacy, Monash University, Subang Jaya, Malaysia
  • 5 Centre for Health Economics, University of York, York, UK
  • 6 Bradford School of Pharmacy, Bradford, UK
  • 7 School of Medicine, University of Toronto, Toronto, ON, Canada
  • 8 Institute for Health and Human Development, University of East London, London, UK
  • 9 The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK
  • 10 Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
  • 11 Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padova, Italy
  • 12 Hospital Quiron Bizkair, Bilbao, Spain
  • 13 National Heart and Lung Institute, Imperial College, London, UK
  • 14 Department of ENT, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey
  • 15 Department of Internal Medicine, Section of Allergology, Erasmus MC Rotterdam, Rotterdam, The Netherlands
  • 16 Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
  • 17 Children's Center Bethel, EvKB, Bieledelf, Germany
  • 18 Laboratory of Experimental Immunology, University Hospitals Leuven, Leuven, Belgium
  • 19 ALC, Allergy Learning and Consulting, Copenhagen, Denmark
  • 20 University Medical Center, Utrecht, The Netherlands
  • 21 Hospital Medica Sur, Mexico City, Mexico
  • 22 Department of Otolaryngology-Head & Neck Surgery, John Hopkins, Baltimore, MD, USA
  • 23 Allergy and Clinical Immunology Unit, 2nd Department of Pediatrics, University of Athens, P&A Kiriakou Children's Hospital, Athens, Greece
  • 24 Department of Allergology, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  • 25 University Medical Center of Groningen, University of Groningen, Groningen, The Netherlands
  • 26 Department of Pediatrics, University of Messina, Messina, Italy
  • 27 Department of Pediatrics, Nippon Medical School, Tokyo, Japan
  • 28 University of Milano, Milano, Italy
  • 29 Medical School, University of Cyprus
  • 30 The Royal National Throat, Nose and Ear Hospital, University College London, London, UK
  • 31 Netherlands Anafylaxis Network, Dordrecht, The Netherlands
  • 32 Charite University Hospital, Berlin, Germany
  • 33 Department of Paediatrics, Respiratory and Allergic Disease Division, Medical University Graz, Graz, Austria
  • 34 Pharmaceutical Group of the European Union, Brussels, Belgium
  • 35 Guy's and St Thomas' NHS Foundation Trust, London, UK
  • 36 Charite-Universitatsmedizin, Berlin, Germany
  • 37 Beijing Institute of Otolaryngology, Beijing, China
  • 38 Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
Allergy, 2017 Nov;72(11):1597-1631.
PMID: 28493631 DOI: 10.1111/all.13201

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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