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Allergen immunotherapy for allergic rhinoconjunctivitis: A systematic review and meta-analysis

Allergen immunotherapy for allergic rhinoconjunctivitis: A systematic review and meta-analysis
Allergen immunotherapy for allergic rhinoconjunctivitis: A systematic review and meta-analysis
BACKGROUND:

The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis. To inform the development of clinical recommendations, we undertook a systematic review to assess the effectiveness, cost-effectiveness, and safety of AIT in the management of allergic rhinoconjunctivitis.

METHODS:

We searched nine international biomedical databases for published, in-progress, and unpublished evidence. Studies were independently screened by two reviewers against predefined eligibility criteria and critically appraised using established instruments. Our primary outcomes of interest were symptom, medication, and combined symptom and medication scores. Secondary outcomes of interest included cost-effectiveness and safety. Data were descriptively summarized and then quantitatively synthesized using random-effects meta-analyses.

RESULTS:

We identified 5960 studies of which 160 studies satisfied our eligibility criteria. There was a substantial body of evidence demonstrating significant reductions in standardized mean differences (SMD) of symptom (SMD -0.53, 95% CI -0.63, -0.42), medication (SMD -0.37, 95% CI -0.49, -0.26), and combined symptom and medication (SMD -0.49, 95% CI -0.69, -0.30) scores while on treatment that were robust to prespecified sensitivity analyses. There was in comparison a more modest body of evidence on effectiveness post-discontinuation of AIT, suggesting a benefit in relation to symptom scores.

CONCLUSIONS:

AIT is effective in improving symptom, medication, and combined symptom and medication scores in patients with allergic rhinoconjunctivitis while on treatment, and there is some evidence suggesting that these benefits are maintained in relation to symptom scores after discontinuation of therapy.
0105-4538
1597-1631
Dhami, S.
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Nurmatov, U.
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Zaman, H.
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Agarwal, A.
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Ansotegui, I.J.
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Calderon, M.A.
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Cingi, Cemal
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Durham, S.
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Halken, S.
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Hellings, P.
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Lin, S.
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Maggina, P.
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Mosges, R.
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Oude Elberink, H.
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Pajno, G.
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Panwankar, R.
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Pastorello, E.
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Penagos, M.
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Pitsios, C.
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Timmermans, F.
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Tsilochristou, O.
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Varga, Eva-Maria
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Schmidt-Weber, C.
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Wilkinson, J.
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Williams, A.
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Worm, M.
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Zhang, L.
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Sheikh, A.
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Dhami, S.
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Nurmatov, U.
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Arasi, S.
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Khan, T.
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Asaria, M.
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Zaman, H.
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Agarwal, A.
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Netuveli, G.
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Roberts, G.
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Pfaar, O.
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Muraro, A.
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Ansotegui, I.J.
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Calderon, M.A.
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Cingi, Cemal
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Durham, S.
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Gerth van Wijk, R.
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Halken, S.
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Jacobsen, L.
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Lin, S.
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Maggina, P.
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Mosges, R.
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Oude Elberink, H.
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Pajno, G.
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Panwankar, R.
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Pitsios, C.
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Rotiroti, G.
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Timmermans, F.
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Tsilochristou, O.
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Varga, Eva-Maria
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Schmidt-Weber, C.
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Wilkinson, J.
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Williams, A.
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Worm, M.
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Zhang, L.
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Sheikh, A.
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Dhami, S., Nurmatov, U., Arasi, S., Khan, T., Asaria, M., Zaman, H., Agarwal, A., Netuveli, G., Roberts, G., Pfaar, O., Muraro, A., Ansotegui, I.J., Calderon, M.A., Cingi, Cemal, Durham, S., Gerth van Wijk, R., Halken, S., Hamelmann, E., Hellings, P., Jacobsen, L., Knol, E., Larenas-Linnemann, D., Lin, S., Maggina, P., Mosges, R., Oude Elberink, H., Pajno, G., Panwankar, R., Pastorello, E., Penagos, M., Pitsios, C., Rotiroti, G., Timmermans, F., Tsilochristou, O., Varga, Eva-Maria, Schmidt-Weber, C., Wilkinson, J., Williams, A., Worm, M., Zhang, L. and Sheikh, A. (2017) Allergen immunotherapy for allergic rhinoconjunctivitis: A systematic review and meta-analysis. Allergy, 72 (11), 1597-1631. (doi:10.1111/all.13201).

Record type: Article

Abstract

BACKGROUND:

The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis. To inform the development of clinical recommendations, we undertook a systematic review to assess the effectiveness, cost-effectiveness, and safety of AIT in the management of allergic rhinoconjunctivitis.

METHODS:

We searched nine international biomedical databases for published, in-progress, and unpublished evidence. Studies were independently screened by two reviewers against predefined eligibility criteria and critically appraised using established instruments. Our primary outcomes of interest were symptom, medication, and combined symptom and medication scores. Secondary outcomes of interest included cost-effectiveness and safety. Data were descriptively summarized and then quantitatively synthesized using random-effects meta-analyses.

RESULTS:

We identified 5960 studies of which 160 studies satisfied our eligibility criteria. There was a substantial body of evidence demonstrating significant reductions in standardized mean differences (SMD) of symptom (SMD -0.53, 95% CI -0.63, -0.42), medication (SMD -0.37, 95% CI -0.49, -0.26), and combined symptom and medication (SMD -0.49, 95% CI -0.69, -0.30) scores while on treatment that were robust to prespecified sensitivity analyses. There was in comparison a more modest body of evidence on effectiveness post-discontinuation of AIT, suggesting a benefit in relation to symptom scores.

CONCLUSIONS:

AIT is effective in improving symptom, medication, and combined symptom and medication scores in patients with allergic rhinoconjunctivitis while on treatment, and there is some evidence suggesting that these benefits are maintained in relation to symptom scores after discontinuation of therapy.

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Accepted/In Press date: 4 May 2017
e-pub ahead of print date: 14 July 2017
Published date: November 2017

Identifiers

Local EPrints ID: 416100
URI: http://eprints.soton.ac.uk/id/eprint/416100
DOI: doi:10.1111/all.13201
ISSN: 0105-4538
PURE UUID: de0c93b2-b82e-4424-881b-515dc1aeff65
ORCID for G. Roberts: ORCID iD orcid.org/0000-0003-2252-1248

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Date deposited: 03 Dec 2017 17:30
Last modified: 16 Mar 2024 05:39

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Contributors

Author: S. Dhami
Author: U. Nurmatov
Author: S. Arasi
Author: T. Khan
Author: M. Asaria
Author: H. Zaman
Author: A. Agarwal
Author: G. Netuveli
Author: G. Roberts ORCID iD
Author: O. Pfaar
Author: A. Muraro
Author: I.J. Ansotegui
Author: M.A. Calderon
Author: Cemal Cingi
Author: S. Durham
Author: R. Gerth van Wijk
Author: S. Halken
Author: E. Hamelmann
Author: P. Hellings
Author: L. Jacobsen
Author: E. Knol
Author: D. Larenas-Linnemann
Author: S. Lin
Author: P. Maggina
Author: R. Mosges
Author: H. Oude Elberink
Author: G. Pajno
Author: R. Panwankar
Author: E. Pastorello
Author: M. Penagos
Author: C. Pitsios
Author: G. Rotiroti
Author: F. Timmermans
Author: O. Tsilochristou
Author: Eva-Maria Varga
Author: C. Schmidt-Weber
Author: J. Wilkinson
Author: A. Williams
Author: M. Worm
Author: L. Zhang
Author: A. Sheikh

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