Year: 2017
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: BACKGROUND: To inform the development of the European Academy of Allergy and Clinical Immunology's (EAACI) Guidelines on Allergen Immunotherapy (AIT) for allergic asthma, we assessed the evidence on the effectiveness, cost-effectiveness and safety of AIT. METHODS: We performed a systematic review, which involved searching nine databases. Studies were screened against predefined eligibility criteria and critically appraised using established instruments. Data were synthesized using random-effects meta-analyses. RESULTS: 98 studies satisfied the inclusion criteria. Short-term symptom scores were reduced with a standardized mean difference (SMD) of -1.11 (95% CI -1.66, -0.56). This was robust to a prespecified sensitivity analyses, but there was evidence suggestive of publication bias. Short-term medication scores were reduced SMD -1.21 (95% CI -1.87, -0.54), again with evidence of potential publication bias. There was no reduction in short-term combined medication and symptom scores SMD 0.17 (95% CI -0.23, 0.58), but one study showed a beneficial long-term effect. For secondary outcomes, subcutaneous immunotherapy (SCIT) improved quality of life and decreased allergen-specific airway hyperreactivity (AHR), but this was not the case for sublingual immunotherapy (SLIT). There were no consistent effects on asthma control, exacerbations, lung function, and nonspecific AHR. AIT resulted in a modest increased risk of adverse events (AEs). Although relatively uncommon, systemic AEs were more frequent with SCIT; however no fatalities were reported. The limited evidence on cost-effectiveness was mainly available for sublingual immunotherapy (SLIT) and this suggested that SLIT is likely to be cost-effective. CONCLUSIONS: AIT can achieve substantial reductions in short-term symptom and medication scores in allergic asthma. It was however associated with a modest increased risk of systemic and local AEs. More data are needed in relation to secondary outcomes, longer-term effectiveness and cost-effectiveness.
Source: Allergy
DOI: 10.1111/all.13208
Authors: S. Dhami, A. Kakourou, F. Asamoah, I. Agache, S. Lau, M. Jutel, A. Muraro, G. Roberts, C. A. Akdis, M. Bonini, O. Cavkaytar, B. Flood, P. Gajdanowicz, K. Izuhara, Ö. Kalayci, R. Mosges, O. Palomares, O. Pfaar, S. Smolinska, M. Sokolowska, M. Asaria, G. Netuveli, H. Zaman, A. Akhlaq, A. Sheikh
Institutions: University of Ioannina, Queen Mary University of London, Transilvania University of Brașov, Stiftung Charité, Charité – Universitätsmedizin Berlin, Wroclaw Medical University, All-Med, Azienda Ospedale - Università Padova, University Hospital Southampton NHS Foundation Trust, NIHR Southampton Biomedical Research Centre, St Mary's Hospital, David Hide Asthma and Allergy Research Centre, University of Southampton, CK-CARE, Imperial College London, European Federation of Allergy and Airways Diseases Patients Associations, Saga Medical School Hospital, Hacettepe University, University of Cologne, Universidad Complutense de Madrid, Heidelberg University, Zentrum für Rhinologie und Allergologie, Medizinische Fakultät Mannheim, University of York, University of East London, University of Bradford, Institute of Business Management, Asthma UK Centre for Applied Research, University of Edinburgh
Language: English
Subfield: Immunology and Allergy
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2620079877