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

Allergen immunotherapy for the prevention of allergy: A systematic review and meta-analysis
Allergen immunotherapy for the prevention of allergy: A systematic review and meta-analysis
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: a total of 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: 0.04-2.09) 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: 0.30-0.54), 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: 0.31-1.23. 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: 0.24-2.18. There was no clear evidence of any longer-term reduction in the risk of sensitization: RR = 0.47; 95% CI: 0.08-2.77. 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.
0905-6157
18-29
Kristiansen, Maria
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Dhami, Sangeeta
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Netuveli, Gopal
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Halken, Susanne
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Muraro, Antonella
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Roberts, Graham
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Larenas-Linnemann, D.
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Calderon, Moises A.
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Penagos, Martin
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Du Toit, George
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Ansotegui, Ignacio J.
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Kleine-Tebbe, Jörg
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Lau, Susanne
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Matricardi, Paolo Maria
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Pajno, Giovanni Battista
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Papadopoulos, Nikolaos G.
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Pfaar, Oliver
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Ryan, Dermot
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Santos, Alexandra
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Timmermans, Frans
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Wahn, Ulrich
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Sheikh, Aziz
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Kristiansen, Maria
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Dhami, Sangeeta
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Netuveli, Gopal
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Halken, Susanne
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Muraro, Antonella
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Roberts, Graham
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Larenas-Linnemann, D.
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Calderon, Moises A.
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Penagos, Martin
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Du Toit, George
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Ansotegui, Ignacio J.
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Kleine-Tebbe, Jörg
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Lau, Susanne
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Matricardi, Paolo Maria
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Pajno, Giovanni Battista
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Papadopoulos, Nikolaos G.
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Pfaar, Oliver
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Ryan, Dermot
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Santos, Alexandra
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Timmermans, Frans
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Wahn, Ulrich
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Sheikh, Aziz
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Kristiansen, Maria, Dhami, Sangeeta, Netuveli, Gopal, Halken, Susanne, Muraro, Antonella, Roberts, Graham, Larenas-Linnemann, D., Calderon, Moises A., Penagos, Martin, Du Toit, George, Ansotegui, Ignacio J., Kleine-Tebbe, Jörg, Lau, Susanne, Matricardi, Paolo Maria, Pajno, Giovanni Battista, Papadopoulos, Nikolaos G., Pfaar, Oliver, Ryan, Dermot, Santos, Alexandra, Timmermans, Frans, Wahn, Ulrich and Sheikh, Aziz (2017) Allergen immunotherapy for the prevention of allergy: A systematic review and meta-analysis. Pediatric Allergy and Immunology, 28, 18-29. (doi:10.1111/pai.12661).

Record type: Article

Abstract

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: a total of 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: 0.04-2.09) 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: 0.30-0.54), 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: 0.31-1.23. 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: 0.24-2.18. There was no clear evidence of any longer-term reduction in the risk of sensitization: RR = 0.47; 95% CI: 0.08-2.77. 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.

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Accepted/In Press date: 17 September 2016
e-pub ahead of print date: 12 December 2016
Published date: 1 February 2017

Identifiers

Local EPrints ID: 413455
URI: http://eprints.soton.ac.uk/id/eprint/413455
ISSN: 0905-6157
PURE UUID: 7c32645e-a914-475b-8328-9205cc4a0c97
ORCID for Graham Roberts: ORCID iD orcid.org/0000-0003-2252-1248

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Date deposited: 24 Aug 2017 16:30
Last modified: 16 Mar 2024 03:44

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Contributors

Author: Maria Kristiansen
Author: Sangeeta Dhami
Author: Gopal Netuveli
Author: Susanne Halken
Author: Antonella Muraro
Author: Graham Roberts ORCID iD
Author: D. Larenas-Linnemann
Author: Moises A. Calderon
Author: Martin Penagos
Author: George Du Toit
Author: Ignacio J. Ansotegui
Author: Jörg Kleine-Tebbe
Author: Susanne Lau
Author: Paolo Maria Matricardi
Author: Giovanni Battista Pajno
Author: Nikolaos G. Papadopoulos
Author: Oliver Pfaar
Author: Dermot Ryan
Author: Alexandra Santos
Author: Frans Timmermans
Author: Ulrich Wahn
Author: Aziz Sheikh

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