Maria Kristiansen1, Sangeeta Dhami2, Gopal Netuveli3, Susanne Halken4, Antonella Muraro5, Graham Roberts6,7,8, Desiree Larenas-Linnemann9, Moises A Calderón10, Martin Penagos10, George Du Toit11,12, Ignacio J Ansotegui13, Jörg Kleine-Tebbe14, Susanne Lau15, Paolo Maria Matricardi16, Giovanni Pajno17, Nikolaos G Papadopoulos18,19, Oliver Pfaar20,21, Dermot Ryan22, Alexandra F Santos10, Frans Timmermanns23, Ulrich Wahn16, Aziz Sheikh22. 1. Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. 2. Evidence-Based Health Care Ltd, Edinburgh, UK. 3. Institute for Health and Human Development, University of East London, London, UK. 4. Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark. 5. Department of Mother and Child Health, The Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region, University of Padua, Padua, Italy. 6. The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK. 7. NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK. 8. Faculty of Medicine, University of Southampton, Southampton, UK. 9. Hospital Medica Sur, Mexico City, Mexico. 10. Section of Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK. 11. Division of Asthma, Allergy and Lung Biology, Department of Paediatric Allergy, MRC & Asthma Centre in Allergic Mechanisms of Asthma, King's College London, London, UK. 12. St Thomas NHS Foundation trust, London, United Kingdom. 13. Department of Allergy & Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain. 14. Allergy & Asthma Center Westend, Berlin, Germany. 15. Clinic for Pediatric Pneumonology and Immunology, Charité Medical University Berlin, Berlin, Germany. 16. Department for Ped Pneumology and Immunology, Charite, Berlin, Germany. 17. Department of Pediatrics, University of Messina, Messina, Italy. 18. Institute of Human Development, University of Manchester, Manchester, UK. 19. Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece. 20. Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Mannheim, Germany. 21. Center for Rhinology and Allergology, Wiesbaden, Germany. 22. University of Edinburgh, Edinburgh, UK. 23. Netherlands Anaphylaxis Networks, The Netherlands.
Abstract
BACKGROUND: There is a need to establish the effectiveness, cost-effectiveness, and safety of allergen immunotherapy (AIT) for the prevention of allergic disease. METHODS: Two reviewers independently screened nine international biomedical databases. Studies were quantitatively synthesized using random-effects meta-analyses. RESULTS: A total of 32 studies satisfied the inclusion criteria. Overall, meta-analysis found no conclusive evidence that AIT reduced the risk of developing a first allergic disease over the short term (RR = 0.30; 95% CI: 0.04-2.09) and no randomized controlled evidence was found in relation to its longer-term effects for this outcome. There was, however, a reduction in the short-term risk of those with allergic rhinitis developing asthma (RR = 0.40; 95% CI: 0.30-0.54), with this finding being robust to a pre-specified sensitivity analysis. We found inconclusive evidence that this benefit was maintained over the longer term: RR = 0.62; 95% CI: 0.31-1.23. There was evidence that the risk of new sensitization was reduced over the short term, but this was not confirmed in the sensitivity analysis: RR = 0.72; 95% CI: 0.24-2.18. There was no clear evidence of any longer-term reduction in the risk of sensitization: RR = 0.47; 95% CI: 0.08-2.77. AIT appeared to have an acceptable side effect profile. CONCLUSIONS: AIT did not result in a statistically significant reduction in the risk of developing a first allergic disease. There was, however, evidence of a reduced short-term risk of developing asthma in those with allergic rhinitis, but it is unclear whether this benefit was maintained over the longer term. We are unable to comment on the cost-effectiveness of AIT.
BACKGROUND: There is a need to establish the effectiveness, cost-effectiveness, and safety of allergen immunotherapy (AIT) for the prevention of allergic disease. METHODS: Two reviewers independently screened nine international biomedical databases. Studies were quantitatively synthesized using random-effects meta-analyses. RESULTS: A total of 32 studies satisfied the inclusion criteria. Overall, meta-analysis found no conclusive evidence that AIT reduced the risk of developing a first allergic disease over the short term (RR = 0.30; 95% CI: 0.04-2.09) and no randomized controlled evidence was found in relation to its longer-term effects for this outcome. There was, however, a reduction in the short-term risk of those with allergic rhinitis developing asthma (RR = 0.40; 95% CI: 0.30-0.54), with this finding being robust to a pre-specified sensitivity analysis. We found inconclusive evidence that this benefit was maintained over the longer term: RR = 0.62; 95% CI: 0.31-1.23. There was evidence that the risk of new sensitization was reduced over the short term, but this was not confirmed in the sensitivity analysis: RR = 0.72; 95% CI: 0.24-2.18. There was no clear evidence of any longer-term reduction in the risk of sensitization: RR = 0.47; 95% CI: 0.08-2.77. AIT appeared to have an acceptable side effect profile. CONCLUSIONS: AIT did not result in a statistically significant reduction in the risk of developing a first allergic disease. There was, however, evidence of a reduced short-term risk of developing asthma in those with allergic rhinitis, but it is unclear whether this benefit was maintained over the longer term. We are unable to comment on the cost-effectiveness of AIT.
Authors: Ayşe Arzu Yorgancıoğlu; Bilun Gemicioğlu; Cemal Cingi; Ömer Kalaycı; Ali Fuat Kalyoncu; Claus Bachert; Peter Hellings; Oliver Pfaar; Holger J Schünemann; Dana Wallace; Anna Bedbrook; Wienczyslawa Czarlewski; Jean Bousquet Journal: Turk Thorac J Date: 2020-03-01