Allergen immunotherapy for IgE‐mediated food allergy: a systematic review and meta‐analysis
Background The European Academy of Allergy and Clinical Immunology (EAACI) is developing Guidelines for Allergen Immunotherapy (AIT) for IgE‐mediated Food Allergy. To inform the development of clinical recommendations, we sought to critically assess evidence on the effectiveness, safety and cost‐eff...
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| Published in | Allergy (Copenhagen) Vol. 72; no. 8; pp. 1133 - 1147 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Denmark
Blackwell Publishing Ltd
01.08.2017
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| Subjects | |
| Online Access | Get full text |
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| Abstract | Background
The European Academy of Allergy and Clinical Immunology (EAACI) is developing Guidelines for Allergen Immunotherapy (AIT) for IgE‐mediated Food Allergy. To inform the development of clinical recommendations, we sought to critically assess evidence on the effectiveness, safety and cost‐effectiveness of AIT in the management of food allergy.
Methods
We undertook a systematic review and meta‐analysis that involved searching nine international electronic databases for randomized controlled trials (RCTs) and nonrandomized studies (NRS). Eligible studies were independently assessed by two reviewers against predefined eligibility criteria. The quality of studies was assessed using the Cochrane Risk of Bias tool for RCTs and the Cochrane ACROBAT‐NRS tool for quasi‐RCTs. Random‐effects meta‐analyses were undertaken, with planned subgroup and sensitivity analyses.
Results
We identified 1814 potentially relevant papers from which we selected 31 eligible studies, comprising of 25 RCTs and six NRS, studying a total of 1259 patients. Twenty‐five trials evaluated oral immunotherapy (OIT), five studies investigated sublingual immunotherapy, and one study evaluated epicutaneous immunotherapy. The majority of these studies were in children. Twenty‐seven studies assessed desensitization, and eight studies investigated sustained unresponsiveness postdiscontinuation of AIT. Meta‐analyses demonstrated a substantial benefit in terms of desensitization (risk ratio (RR) = 0.16, 95% CI 0.10, 0.26) and suggested, but did not confirm sustained unresponsiveness (RR = 0.29, 95% CI 0.08, 1.13). Only one study reported on disease‐specific quality of life (QoL), which reported no comparative results between OIT and control group. Meta‐analyses revealed that the risk of experiencing a systemic adverse reaction was higher in those receiving AIT, with a more marked increase in the risk of local adverse reactions. Sensitivity analysis excluding those studies judged to be at high risk of bias demonstrated the robustness of summary estimates of effectiveness and safety of AIT for food allergy. None of the studies reported data on health economic analyses.
Conclusions
AIT may be effective in raising the threshold of reactivity to a range of foods in children with IgE‐mediated food allergy whilst receiving (i.e. desensitization) and post‐discontinuation of AIT. It is, however, associated with a modest increased risk in serious systemic adverse reactions and a substantial increase in minor local adverse reactions. More data are needed in relation to adults, long term effects, the impact on QoL and the cost‐effectiveness of AIT. |
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| AbstractList | Abstract
Background
The European Academy of Allergy and Clinical Immunology (
EAACI
) is developing Guidelines for Allergen Immunotherapy (
AIT
) for IgE‐mediated Food Allergy. To inform the development of clinical recommendations, we sought to critically assess evidence on the effectiveness, safety and cost‐effectiveness of
AIT
in the management of food allergy.
Methods
We undertook a systematic review and meta‐analysis that involved searching nine international electronic databases for randomized controlled trials (
RCT
s) and nonrandomized studies (
NRS
). Eligible studies were independently assessed by two reviewers against predefined eligibility criteria. The quality of studies was assessed using the Cochrane Risk of Bias tool for
RCT
s and the Cochrane
ACROBAT
‐
NRS
tool for quasi‐
RCT
s. Random‐effects meta‐analyses were undertaken, with planned subgroup and sensitivity analyses.
Results
We identified 1814 potentially relevant papers from which we selected 31 eligible studies, comprising of 25
RCT
s and six
NRS
, studying a total of 1259 patients. Twenty‐five trials evaluated oral immunotherapy (
OIT
), five studies investigated sublingual immunotherapy, and one study evaluated epicutaneous immunotherapy. The majority of these studies were in children. Twenty‐seven studies assessed desensitization, and eight studies investigated sustained unresponsiveness postdiscontinuation of
AIT
. Meta‐analyses demonstrated a substantial benefit in terms of desensitization (risk ratio (
RR
) = 0.16, 95%
CI
0.10, 0.26) and suggested, but did not confirm sustained unresponsiveness (
RR
= 0.29, 95%
CI
0.08, 1.13). Only one study reported on disease‐specific quality of life (QoL), which reported no comparative results between
OIT
and control group. Meta‐analyses revealed that the risk of experiencing a systemic adverse reaction was higher in those receiving
AIT
, with a more marked increase in the risk of local adverse reactions. Sensitivity analysis excluding those studies judged to be at high risk of bias demonstrated the robustness of summary estimates of effectiveness and safety of
AIT
for food allergy. None of the studies reported data on health economic analyses.
Conclusions
AIT
may be effective in raising the threshold of reactivity to a range of foods in children with IgE‐mediated food allergy whilst receiving (i.e. desensitization) and post‐discontinuation of
AIT
. It is, however, associated with a modest increased risk in serious systemic adverse reactions and a substantial increase in minor local adverse reactions. More data are needed in relation to adults, long term effects, the impact on QoL and the cost‐effectiveness of
AIT
. BackgroundThe European Academy of Allergy and Clinical Immunology (EAACI) is developing Guidelines for Allergen Immunotherapy (AIT) for IgE-mediated Food Allergy. To inform the development of clinical recommendations, we sought to critically assess evidence on the effectiveness, safety and cost-effectiveness of AIT in the management of food allergy.MethodsWe undertook a systematic review and meta-analysis that involved searching nine international electronic databases for randomized controlled trials (RCTs) and nonrandomized studies (NRS). Eligible studies were independently assessed by two reviewers against predefined eligibility criteria. The quality of studies was assessed using the Cochrane Risk of Bias tool for RCTs and the Cochrane ACROBAT-NRS tool for quasi-RCTs. Random-effects meta-analyses were undertaken, with planned subgroup and sensitivity analyses.ResultsWe identified 1814 potentially relevant papers from which we selected 31 eligible studies, comprising of 25 RCTs and six NRS, studying a total of 1259 patients. Twenty-five trials evaluated oral immunotherapy (OIT), five studies investigated sublingual immunotherapy, and one study evaluated epicutaneous immunotherapy. The majority of these studies were in children. Twenty-seven studies assessed desensitization, and eight studies investigated sustained unresponsiveness postdiscontinuation of AIT. Meta-analyses demonstrated a substantial benefit in terms of desensitization (risk ratio (RR) = 0.16, 95% CI 0.10, 0.26) and suggested, but did not confirm sustained unresponsiveness (RR = 0.29, 95% CI 0.08, 1.13). Only one study reported on disease-specific quality of life (QoL), which reported no comparative results between OIT and control group. Meta-analyses revealed that the risk of experiencing a systemic adverse reaction was higher in those receiving AIT, with a more marked increase in the risk of local adverse reactions. Sensitivity analysis excluding those studies judged to be at high risk of bias demonstrated the robustness of summary estimates of effectiveness and safety of AIT for food allergy. None of the studies reported data on health economic analyses.ConclusionsAIT may be effective in raising the threshold of reactivity to a range of foods in children with IgE-mediated food allergy whilst receiving (i.e. desensitization) and post-discontinuation of AIT. It is, however, associated with a modest increased risk in serious systemic adverse reactions and a substantial increase in minor local adverse reactions. More data are needed in relation to adults, long term effects, the impact on QoL and the cost-effectiveness of AIT. The European Academy of Allergy and Clinical Immunology (EAACI) is developing Guidelines for Allergen Immunotherapy (AIT) for IgE-mediated Food Allergy. To inform the development of clinical recommendations, we sought to critically assess evidence on the effectiveness, safety and cost-effectiveness of AIT in the management of food allergy. We undertook a systematic review and meta-analysis that involved searching nine international electronic databases for randomized controlled trials (RCTs) and nonrandomized studies (NRS). Eligible studies were independently assessed by two reviewers against predefined eligibility criteria. The quality of studies was assessed using the Cochrane Risk of Bias tool for RCTs and the Cochrane ACROBAT-NRS tool for quasi-RCTs. Random-effects meta-analyses were undertaken, with planned subgroup and sensitivity analyses. We identified 1814 potentially relevant papers from which we selected 31 eligible studies, comprising of 25 RCTs and six NRS, studying a total of 1259 patients. Twenty-five trials evaluated oral immunotherapy (OIT), five studies investigated sublingual immunotherapy, and one study evaluated epicutaneous immunotherapy. The majority of these studies were in children. Twenty-seven studies assessed desensitization, and eight studies investigated sustained unresponsiveness postdiscontinuation of AIT. Meta-analyses demonstrated a substantial benefit in terms of desensitization (risk ratio (RR) = 0.16, 95% CI 0.10, 0.26) and suggested, but did not confirm sustained unresponsiveness (RR = 0.29, 95% CI 0.08, 1.13). Only one study reported on disease-specific quality of life (QoL), which reported no comparative results between OIT and control group. Meta-analyses revealed that the risk of experiencing a systemic adverse reaction was higher in those receiving AIT, with a more marked increase in the risk of local adverse reactions. Sensitivity analysis excluding those studies judged to be at high risk of bias demonstrated the robustness of summary estimates of effectiveness and safety of AIT for food allergy. None of the studies reported data on health economic analyses. AIT may be effective in raising the threshold of reactivity to a range of foods in children with IgE-mediated food allergy whilst receiving (i.e. desensitization) and post-discontinuation of AIT. It is, however, associated with a modest increased risk in serious systemic adverse reactions and a substantial increase in minor local adverse reactions. More data are needed in relation to adults, long term effects, the impact on QoL and the cost-effectiveness of AIT. Background The European Academy of Allergy and Clinical Immunology (EAACI) is developing Guidelines for Allergen Immunotherapy (AIT) for IgE‐mediated Food Allergy. To inform the development of clinical recommendations, we sought to critically assess evidence on the effectiveness, safety and cost‐effectiveness of AIT in the management of food allergy. Methods We undertook a systematic review and meta‐analysis that involved searching nine international electronic databases for randomized controlled trials (RCTs) and nonrandomized studies (NRS). Eligible studies were independently assessed by two reviewers against predefined eligibility criteria. The quality of studies was assessed using the Cochrane Risk of Bias tool for RCTs and the Cochrane ACROBAT‐NRS tool for quasi‐RCTs. Random‐effects meta‐analyses were undertaken, with planned subgroup and sensitivity analyses. Results We identified 1814 potentially relevant papers from which we selected 31 eligible studies, comprising of 25 RCTs and six NRS, studying a total of 1259 patients. Twenty‐five trials evaluated oral immunotherapy (OIT), five studies investigated sublingual immunotherapy, and one study evaluated epicutaneous immunotherapy. The majority of these studies were in children. Twenty‐seven studies assessed desensitization, and eight studies investigated sustained unresponsiveness postdiscontinuation of AIT. Meta‐analyses demonstrated a substantial benefit in terms of desensitization (risk ratio (RR) = 0.16, 95% CI 0.10, 0.26) and suggested, but did not confirm sustained unresponsiveness (RR = 0.29, 95% CI 0.08, 1.13). Only one study reported on disease‐specific quality of life (QoL), which reported no comparative results between OIT and control group. Meta‐analyses revealed that the risk of experiencing a systemic adverse reaction was higher in those receiving AIT, with a more marked increase in the risk of local adverse reactions. Sensitivity analysis excluding those studies judged to be at high risk of bias demonstrated the robustness of summary estimates of effectiveness and safety of AIT for food allergy. None of the studies reported data on health economic analyses. Conclusions AIT may be effective in raising the threshold of reactivity to a range of foods in children with IgE‐mediated food allergy whilst receiving (i.e. desensitization) and post‐discontinuation of AIT. It is, however, associated with a modest increased risk in serious systemic adverse reactions and a substantial increase in minor local adverse reactions. More data are needed in relation to adults, long term effects, the impact on QoL and the cost‐effectiveness of AIT. |
| Author | Akdis, C. Papadopoulos, N. Dhami, S. Roberts, G. Knol, E. Arasi, S. Nadeau, K. C. Santos, A. F. Makela, M. Beyer, K. Toit, G. Poulsen, L. K. Fernandez‐Rivas, M. Sampson, H. Timmermans, F. Burks, W. Bindslev‐Jensen, C. Ebisawa, M. Muraro, A. Sackesen, C. Sheikh, A. Eigenmann, P. Nurmatov, U. Alvaro‐Lozano, M. O'Mahony, L. Pajno, G. B. Ree, R. |
| Author_xml | – sequence: 1 givenname: U. surname: Nurmatov fullname: Nurmatov, U. organization: Cardiff University – sequence: 2 givenname: S. orcidid: 0000-0002-2823-3258 surname: Dhami fullname: Dhami, S. email: sangeetadhami@hotmail.com organization: Evidence‐Based Health Care Ltd – sequence: 3 givenname: S. surname: Arasi fullname: Arasi, S. organization: Charité Medical University – sequence: 4 givenname: G. B. surname: Pajno fullname: Pajno, G. B. organization: University of Messina – sequence: 5 givenname: M. surname: Fernandez‐Rivas fullname: Fernandez‐Rivas, M. organization: IdISSC – sequence: 6 givenname: A. surname: Muraro fullname: Muraro, A. organization: Padua General University Hospital – sequence: 7 givenname: G. surname: Roberts fullname: Roberts, G. organization: University of Southampton – sequence: 8 givenname: C. surname: Akdis fullname: Akdis, C. organization: Swiss Institute for Allergy and Asthma Research – sequence: 9 givenname: M. surname: Alvaro‐Lozano fullname: Alvaro‐Lozano, M. organization: Universitat de Barcelona – sequence: 10 givenname: K. surname: Beyer fullname: Beyer, K. organization: Icahn School of Medicine at Mount Sinai – sequence: 11 givenname: C. surname: Bindslev‐Jensen fullname: Bindslev‐Jensen, C. organization: Odense University Hospital – sequence: 12 givenname: W. surname: Burks fullname: Burks, W. organization: University of North Carolina at Chapel Hill – sequence: 13 givenname: G. surname: Toit fullname: Toit, G. organization: St Thomas NHS Foundation Trust – sequence: 14 givenname: M. surname: Ebisawa fullname: Ebisawa, M. organization: Sagamihara National Hospital – sequence: 15 givenname: P. surname: Eigenmann fullname: Eigenmann, P. organization: University Hospitals of Geneva and Medical School of the University of Geneva – sequence: 16 givenname: E. surname: Knol fullname: Knol, E. organization: University Medical Center – sequence: 17 givenname: M. surname: Makela fullname: Makela, M. organization: Helsinki University Hospital – sequence: 18 givenname: K. C. orcidid: 0000-0002-2146-2955 surname: Nadeau fullname: Nadeau, K. C. organization: Stanford University – sequence: 19 givenname: L. orcidid: 0000-0003-4705-3583 surname: O'Mahony fullname: O'Mahony, L. organization: University of Zurich – sequence: 20 givenname: N. surname: Papadopoulos fullname: Papadopoulos, N. organization: University of Athens – sequence: 21 givenname: L. K. surname: Poulsen fullname: Poulsen, L. K. organization: Copenhagen University Hospital – sequence: 22 givenname: C. surname: Sackesen fullname: Sackesen, C. organization: Koç University Hospital – sequence: 23 givenname: H. surname: Sampson fullname: Sampson, H. organization: World Allergy Organization (WAO) – sequence: 24 givenname: A. F. surname: Santos fullname: Santos, A. F. organization: Guy's and St Thomas’ Hospital NHS Foundation Trust – sequence: 25 givenname: R. surname: Ree fullname: Ree, R. organization: Academic Medical Center – sequence: 26 givenname: F. surname: Timmermans fullname: Timmermans, F. organization: Nederlands Anafylaxis Netwerk – European Anaphylaxis Taskforce – sequence: 27 givenname: A. surname: Sheikh fullname: Sheikh, A. organization: The University of Edinburgh |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/28058751$$D View this record in MEDLINE/PubMed |
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The European Academy of Allergy and Clinical Immunology (EAACI) is developing Guidelines for Allergen Immunotherapy (AIT) for IgE‐mediated Food... The European Academy of Allergy and Clinical Immunology (EAACI) is developing Guidelines for Allergen Immunotherapy (AIT) for IgE-mediated Food Allergy. To... Abstract Background The European Academy of Allergy and Clinical Immunology ( EAACI ) is developing Guidelines for Allergen Immunotherapy ( AIT ) for... BackgroundThe European Academy of Allergy and Clinical Immunology (EAACI) is developing Guidelines for Allergen Immunotherapy (AIT) for IgE-mediated Food... |
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| SubjectTerms | allergen immunotherapy Allergens Allergens - administration & dosage Allergens - immunology Animals Bias Children Clinical trials Cost analysis Data processing Desensitization Desensitization, Immunologic - methods Evidence-based medicine Food - adverse effects Food allergies food allergy Food Hypersensitivity - immunology Food Hypersensitivity - therapy Humans Immunoglobulin E Immunoglobulin E - immunology Immunology Immunotherapy Long term effects Meta-analysis Odds Ratio Oral administration Peanuts Quality of Life Risk assessment safety Sensitivity analysis Side effects Sublingual Immunotherapy sustained unresponsiveness Systematic review Treatment Outcome |
| Title | Allergen immunotherapy for IgE‐mediated food allergy: a systematic review and meta‐analysis |
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