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

Sangeeta Dhami, Ulugbek Nurmatov, Stefania Arasi, Tahir Khan, Miqdad Asaria, Hadar Zaman, Arnav Agarwal, Gopal Netuveli, Graham Roberts, Oliver Pfaar, Antonella Muraro, Ignacio J Ansotegui, Moises A Calderón, Cemal Cingi, Stephen R Durham, Ronald Gerth van Wijk, Susanne Halken, Eckard Hamelmann, Peter Hellings, Lars JacobsenEdward Knol, Desiree Larenas Linnemann, Sandra Lin, Paraskevi Maggina, Ralph Mösges, Hanneke Oude Elberink, Giovanni Pajno, Ruby Panwankar, Elide A Pastorello, Martin Penagos, Constantinos Pitsios, Giuseppina Rotiroti, Frans Timmermans, Olympia Tsilochristou, Eva-Maria Varga, Carsten Schmidt-Weber, Jamie Wilkinson, Andrew Williams, Margitta Worm, Luo Zhang, Aziz Sheikh

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Abstrakt

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 Methods: We searched nine international biomedical databases for published, in-progress, and unpublished evidence.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.

OriginalsprogEngelsk
TidsskriftAllergy: European Journal of Allergy and Clinical Immunology
Vol/bind72
Udgave nummer11
Sider (fra-til)1597–1631
ISSN0105-4538
DOI
StatusUdgivet - nov. 2017

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