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Allergen immunotherapy and/or biologicals for IgE‐mediated food allergy: A systematic review and meta‐analysis
Author(s) -
Silva Debra,
Rodríguez del Río Pablo,
Jong Nicolette W.,
Khaleva Ekaterina,
Singh Chris,
NowakWegrzyn Anna,
Muraro Antonella,
Begin Philippe,
Pajno Giovanni,
Fiocchi Alessandro,
Sanchez Angel,
Jones Carla,
Nilsson Caroline,
BindslevJensen Carsten,
Wong Gary,
Sampson Hugh,
Beyer Kirsten,
Marchisotto MaryJane,
Fernandez Rivas Montserrat,
Meyer Rosan,
Lau Susanne,
Nurmatov Ulugbek,
Roberts Graham
Publication year - 2022
Publication title -
allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.363
H-Index - 173
eISSN - 1398-9995
pISSN - 0105-4538
DOI - 10.1111/all.15211
Subject(s) - medicine , peanut allergy , oral immunotherapy , food allergy , immunotherapy , allergy , milk allergy , adverse effect , immunoglobulin e , oral food challenge , immunology , randomized controlled trial , meta analysis , anaphylaxis , allergen , immune system , antibody
Background There is substantial interest in immunotherapy and biologicals in IgE‐mediated food allergy. Methods We searched six databases for randomized controlled trials about immunotherapy alone or with biologicals (to April 2021) or biological monotherapy (to September 2021) in food allergy confirmed by oral food challenge. We pooled the data using random‐effects meta‐analysis. Results We included 36 trials about immunotherapy with 2126 mainly child participants. Oral immunotherapy increased tolerance whilst on therapy for peanut (RR 9.9, 95% CI 4.5.–21.4, high certainty); cow's milk (RR 5.7, 1.9–16.7, moderate certainty) and hen's egg allergy (RR 8.9, 4.4–18, moderate certainty). The number needed to treat to increase tolerance to a single dose of 300 mg or 1000 mg peanut protein was 2. Oral immunotherapy did not increase adverse reactions (RR 1.1, 1.0–1.2, low certainty) or severe reactions in peanut allergy (RR 1,6, 0.7–3.5, low certainty), but may increase (mild) adverse reactions in cow's milk (RR 3.9, 2.1–7.5, low certainty) and hen's egg allergy (RR 7.0, 2.4–19.8, moderate certainty). Epicutaneous immunotherapy increased tolerance whilst on therapy for peanut (RR 2.6, 1.8–3.8, moderate certainty). Results were unclear for other allergies and administration routes. There were too few trials of biologicals alone (3) or with immunotherapy (1) to draw conclusions. Conclusions Oral immunotherapy improves tolerance whilst on therapy and is probably safe in peanut, cow's milk and hen's egg allergy. More research is needed about quality of life, cost and biologicals.