Efficacy of allergen-specific immunotherapy for atopic dermatitis: A systematic review and meta-analysis of randomized controlled trials

• Published in: Journal of allergy and clinical immunology Vol. 132; no. 1; pp. 110 - 117
• Main Authors: Bae, Jung Min, Choi, Yoon Young, Park, Chang Ook, Chung, Kee Yang, Lee, Kwang Hoon
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2013; Elsevier; Elsevier Limited
• Subjects: Allergen-specific immunotherapy; Allergies; Allergy and Immunology; atopic dermatitis; Bias; Biological and medical sciences; children; Dermatitis; Dermatitis, Atopic - therapy; Desensitization, Immunologic - adverse effects; Drug therapy; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; immunotherapy; long term effects; Medical sciences; meta-analysis; odds ratio; patients; placebos; randomized clinical trials; Randomized Controlled Trials as Topic; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Studies; subcutaneous immunotherapy; sublingual immunotherapy; systematic review; RCT; SLIT; OR; Allergen-specific immunotherapy; subcutaneous immunotherapy; meta-analysis; atopic dermatitis; sublingual immunotherapy; systematic review; SCIT; SIT; Randomized controlled trial; Specific immunotherapy; Odds ratio; Allergy; Immunopathology; Skin disease; Desensitization; Subcutaneous; Treatment efficiency; Evidence-based practice; Sublingual administration; Systematic review; Evidence-based medicine; Atopy; Metaanalysis; Immunology; Treatment; Atopic dermatitis; Immunotherapy
• ISSN: 0091-6749; 1097-6825; 1097-6825
• DOI: 10.1016/j.jaci.2013.02.044

Allergen-specific immunotherapy (allergen-SIT) is the only treatment directed at the cause of IgE-mediated allergic diseases. However, there is controversy over the use of SIT for patients with atopic dermatitis. We performed a systematic review and meta-analysis to assess the efficacy of SIT for patients with atopic dermatitis. We performed manual searches of reference lists and computerized searches of the MEDLINE, EMBASE, CINAHL, Web of Science, and Cochrane databases (through December 10, 2012) for randomized controlled trials that compared SIT with placebo for patients with atopic dermatitis. The outcome of interest was a dichotomous variable, in terms of treatment success; a meta-analysis was performed by using a random-effects analysis. Subgroup analyses were carried out to evaluate the effects of long-term treatment (more than 1 year), SIT for severe atopic dermatitis, SIT for children, and subcutaneous and sublingual administration of immunotherapy. We analyzed 8 randomized controlled trials that comprised a total of 385 subjects. We found that SIT has a significant positive effect on atopic dermatitis (odds ratio [OR], 5.35; 95% CI, 1.61-17.77; number needed to treat, 3; 95% CI, 2-9). SIT also showed significant efficacy in long-term treatment (OR, 6.42; 95% CI, 1.50-27.52) for patients with severe atopic dermatitis (OR, 3.13; 95% CI, 1.31-7.48), and when administered subcutaneously (OR, 4.27; 95% CI, 1.36-13.39). A meta-analysis provides moderate-level evidence for the efficacy of SIT against atopic dermatitis. However, these findings are based on an analysis of a small number of randomized controlled trials, with considerable heterogeneity among trials.