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Allergen immunotherapy for allergic rhinoconjunctivitis: A systematic review and meta‐analysis
Author(s) -
Dhami S.,
Nurmatov U.,
Arasi S.,
Khan T.,
Asaria M.,
Zaman H.,
Agarwal Arnav,
Netuveli G.,
Roberts G.,
Pfaar O.,
Muraro A.,
Ansotegui I. J.,
Calderon M.,
Cingi C.,
Durham S.,
Wijk R. Gerth,
Halken S.,
Hamelmann E.,
Hellings P.,
Jacobsen L.,
Knol E.,
LarenasLinnemann D.,
Lin S.,
Maggina P.,
Mösges R.,
Oude Elberink H.,
Pajno G.,
Panwankar R.,
Pastorello E.,
Penagos M.,
Pitsios C.,
Rotiroti G.,
Timmermans F.,
Tsilochristou O.,
Varga E.M.,
SchmidtWeber C.,
Wilkinson J.,
Williams A.,
Worm M.,
Zhang L.,
Sheikh A.
Publication year - 2017
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.13201
Subject(s) - medicine , discontinuation , allergy , meta analysis , allergen immunotherapy , cochrane library , medline , systematic review , physical therapy , pediatrics , allergen , intensive care medicine , immunology , political science , law
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 Methods We searched nine international biomedical databases for published, in‐progress, and unpublished evidence.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.