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Allergen immunotherapy for insect venom allergy: a systematic review and meta-analysis

Allergen immunotherapy for insect venom allergy: a systematic review and meta-analysis
Allergen immunotherapy for insect venom allergy: a systematic review and meta-analysis
Background: The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing the EAACI Guidelines on Allergen Immunotherapy (AIT) for the management of insect venom allergy. To inform this process, we sought to assess the effectiveness, cost-effectiveness and safety of AIT in the management of insect venom allergy.

Methods: We undertook a systematic review, which involved searching 15 international biomedical databases for published and unpublished evidence. Studies were independently screened and critically appraised using established instruments. Data were descriptively summarized and, where possible meta-analysed.

Results: Our searches identified a total of 16,917 potentially eligible studies of which 17 satisfied our inclusion criteria. The available evidence was limited both in volume and quality, but suggested that venom immunotherapy (VIT) could substantially reduce the risk of subsequent severe systemic sting reactions (OR=0.08, 95% CI 0.03 to 0.26); meta-analysis showed that it also improved disease specific quality of life (risk difference=1.41, 95% CI 1.04 to 1.79). Adverse effects were experienced in both the build-up and maintenance phases, but most were mild with no fatalities being reported. The very limited evidence found on modeling cost-effectiveness suggested that VIT was likely to be cost-effective in those at high risk of repeated systemic sting reactions and/or impaired quality of life.

Conclusions: The limited available evidence suggested that VIT is effective in reducing severe subsequent systemic sting reactions and in improving disease specific quality of life. VIT proved to be safe and no fatalities were recorded in the studies included in this review. The cost-effectiveness of VIT needs to be established.
0105-4538
1-50
Dhami, Sangeeta
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Zaman, Hadar
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Varga, Eva-Maria
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Sturm, Gunter
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Muraro, Antonella
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Akdis, Cezmi A.
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Antolin-Amerigo, Dario
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Bilo, M. Beatrice
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Bokanovic, Danijela
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Calderon, Moises A.
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Cichocka-Jarosz, Ewa
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Oude Elberink, Joanna N.G.
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Gawlik, Radoslaw
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Jakob, Thilo
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Kosnik, Mitja
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Lange, Joanna
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Mingomataj, Ervin
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Mitsias, Dimitris I.
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Mosbech, Holger
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Ollert, Markus
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Pfaar, Oliver
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Pitsios, Contantinos
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Pravettoni, Valerio
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Ayse Sin, Betul
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Netuveli, Gopal
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Sheikh, Aziz
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Dhami, Sangeeta
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Zaman, Hadar
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Varga, Eva-Maria
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Sturm, Gunter
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Muraro, Antonella
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Akdis, Cezmi A.
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Antolin-Amerigo, Dario
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Bilo, M. Beatrice
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Bokanovic, Danijela
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Calderon, Moises A.
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Cichocka-Jarosz, Ewa
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Oude Elberink, Joanna N.G.
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Gawlik, Radoslaw
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Jakob, Thilo
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Kosnik, Mitja
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Lange, Joanna
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Mingomataj, Ervin
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Mitsias, Dimitris I.
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Mosbech, Holger
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Ollert, Markus
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Pfaar, Oliver
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Pitsios, Contantinos
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Pravettoni, Valerio
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Roberts, Graham
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Rueff, Franziska
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Ayse Sin, Betul
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Netuveli, Gopal
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Sheikh, Aziz
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Dhami, Sangeeta, Zaman, Hadar and Varga, Eva-Maria et al. (2016) Allergen immunotherapy for insect venom allergy: a systematic review and meta-analysis. Allergy, 1-50. (doi:10.1111/all.13077).

Record type: Article

Abstract

Background: The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing the EAACI Guidelines on Allergen Immunotherapy (AIT) for the management of insect venom allergy. To inform this process, we sought to assess the effectiveness, cost-effectiveness and safety of AIT in the management of insect venom allergy.

Methods: We undertook a systematic review, which involved searching 15 international biomedical databases for published and unpublished evidence. Studies were independently screened and critically appraised using established instruments. Data were descriptively summarized and, where possible meta-analysed.

Results: Our searches identified a total of 16,917 potentially eligible studies of which 17 satisfied our inclusion criteria. The available evidence was limited both in volume and quality, but suggested that venom immunotherapy (VIT) could substantially reduce the risk of subsequent severe systemic sting reactions (OR=0.08, 95% CI 0.03 to 0.26); meta-analysis showed that it also improved disease specific quality of life (risk difference=1.41, 95% CI 1.04 to 1.79). Adverse effects were experienced in both the build-up and maintenance phases, but most were mild with no fatalities being reported. The very limited evidence found on modeling cost-effectiveness suggested that VIT was likely to be cost-effective in those at high risk of repeated systemic sting reactions and/or impaired quality of life.

Conclusions: The limited available evidence suggested that VIT is effective in reducing severe subsequent systemic sting reactions and in improving disease specific quality of life. VIT proved to be safe and no fatalities were recorded in the studies included in this review. The cost-effectiveness of VIT needs to be established.

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SR_Venom_allergy_revised_6Oct2016.docx - Accepted Manuscript
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Accepted/In Press date: 3 November 2016
e-pub ahead of print date: 6 November 2016
Organisations: Clinical & Experimental Sciences

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Local EPrints ID: 404057
URI: https://eprints.soton.ac.uk/id/eprint/404057
ISSN: 0105-4538
PURE UUID: e582e5bc-e682-4c97-a2eb-23b2b4be8075

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Date deposited: 20 Dec 2016 11:21
Last modified: 03 Dec 2019 06:25

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Contributors

Author: Sangeeta Dhami
Author: Hadar Zaman
Author: Eva-Maria Varga
Author: Gunter Sturm
Author: Antonella Muraro
Author: Cezmi A. Akdis
Author: Dario Antolin-Amerigo
Author: M. Beatrice Bilo
Author: Danijela Bokanovic
Author: Moises A. Calderon
Author: Ewa Cichocka-Jarosz
Author: Joanna N.G. Oude Elberink
Author: Radoslaw Gawlik
Author: Thilo Jakob
Author: Mitja Kosnik
Author: Joanna Lange
Author: Ervin Mingomataj
Author: Dimitris I. Mitsias
Author: Holger Mosbech
Author: Markus Ollert
Author: Oliver Pfaar
Author: Contantinos Pitsios
Author: Valerio Pravettoni
Author: Graham Roberts
Author: Franziska Rueff
Author: Betul Ayse Sin
Author: Gopal Netuveli
Author: Aziz Sheikh

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