Allergen immunotherapy for the prevention of allergy: a systematic review and meta-analysis

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

Maria Kristiansen, Sangeeta Dhami, Gopal Netuveli, Susanne Halken, Muraro Antonella, Graham Roberts, Desiree Larenas-Linnemann, Moises A. Calderón, Martin Penagos, George Du Toit, Ignacio J. Ansotegui, Jörg Kleine-Tebbe, Susanne Lau, Paolo Maria Matricardi, Giovanni Pajno, Nikolaos G. Papadopoulos, Oliver Pfaar, Dermot Ryan, Alexandra F. Santos, Frans Timmermanns & 2 andre Ulrich Wahn, Aziz Sheikh

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:
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 to 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 0.29 to 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 to 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 to 2.18. There was no clear evidence of any longer-term reduction in the risk of sensitization: RR=0.47; 95%CI 0.08 to 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
OriginalsprogEngelsk
TidsskriftPediatric Allergy and Immunology
Vol/bind28
Udgave nummer1
Sider (fra-til)18–29
Antal sider12
ISSN0905-6157
DOI
StatusUdgivet - feb. 2017

ID: 166059175