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Effectiveness of subcutaneous immunotherapy for allergic rhinoconjunctivitis and asthma: A Systematic Review
Author(s) -
Erekosima Nkiruka,
SuarezCuervo Catalina,
Ramanathan Murugappan,
Kim Julia M.,
Chelladurai Yohalakshmi,
Segal Jodi B.,
Lin Sandra Y.
Publication year - 2014
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.24295
Subject(s) - medicine , asthma , allergy , placebo , allergen immunotherapy , adverse effect , randomized controlled trial , anaphylaxis , quality of life (healthcare) , clinical trial , meta analysis , desensitization (medicine) , pharmacotherapy , allergen , immunology , alternative medicine , pathology , nursing , receptor
Objectives/Hypothesis To systematically review the effectiveness and safety of subcutaneous immunotherapy (SCIT) for treatment of allergic rhinoconjunctivitis and asthma, using formulations currently approved in the United States. Study Design We searched the following databases up to May 21, 2012: MEDLINE, Embase, LILACS, and the Cochrane Central Register of Controlled Trials. Methods We included randomized controlled trials published in English comparing SCIT to placebo, pharmacotherapy, or other SCIT regimens that reported clinical outcomes of interest. Studies of adults or mixed age populations were included. Studies were excluded if the diagnosis of allergy and/or asthma was not confirmed with objective testing. Paired reviewers selected articles for inclusion and extracted data. We assessed the risk of bias for each study and graded the strength of evidence for each outcome as high, moderate, or low. Results Sixty‐one studies met our inclusion criteria. Majority of the studies (66%) evaluated single‐allergen immunotherapy regimens. The literature provides high‐grade evidence that SCIT reduces asthma symptoms, asthma medication usage, rhinitis/rhinoconjunctivitis symptoms, conjunctivitis symptoms, and rhinitis/rhinoconjunctivitis disease‐specific quality of life in comparison to placebo or usual care. There is moderate evidence that SCIT decreases rhinitis/rhinoconjunctivitis medication usage. Respiratory reactions were the most common systemic reaction. There were few reports of anaphylaxis; no deaths were reported. Conclusions Generally moderate to strong evidence supports the effectiveness of SCIT for treatment of allergic rhinitis and asthma, particularly with single‐allergen immunotherapy regimens. Adverse reactions to SCIT are common, but no deaths were reported in the included studies. Level of Evidence 1a. Laryngoscope , 124:616–627, 2014