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Allergen immunotherapy for allergic rhinoconjunctivitis: a systematic overview of systematic reviews

Allergen immunotherapy for allergic rhinoconjunctivitis: a systematic overview of systematic reviews
Allergen immunotherapy for allergic rhinoconjunctivitis: a systematic overview of systematic reviews
Background
The European Academy of Allergy and Clinical Immunology (EAACI) is developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis (ARC). To inform the development of recommendations, we sought to critically assess the systematic review evidence on the effectiveness, safety and cost-effectiveness of AIT for ARC.

Methods
We undertook a systematic overview, which involved searching nine international biomedical databases from inception to October 31, 2015. Studies were independently screened by two reviewers against pre-defined eligibility criteria and critically appraised using the Critical Appraisal Skills Programme (CASP) Systematic Review Checklist for systematic reviews. Data were descriptively synthesized.

Results
Our searches yielded a total of 5932 potentially eligible studies, from which 17 systematic reviews met our inclusion criteria. Eight of these were judged to be of high, five moderate and three low quality. These reviews suggested that, in carefully selected patients, subcutaneous (SCIT) and sublingual (SLIT) immunotherapy resulted in significant reductions in symptom scores and medication requirements. Serious adverse outcomes were rare for both SCIT and SLIT. Two systematic reviews reported some evidence of potential cost savings associated with use of SCIT and SLIT.

Conclusions
We found moderate-to-strong evidence that SCIT and SLIT can, in appropriately selected patients, reduce symptoms and medication requirements in patients with ARC with reassuring safety data. This evidence does however need to be interpreted with caution, particularly given the heterogeneity in the populations, allergens and protocols studied. There is a lack of data on the relative effectiveness, cost-effectiveness and safety of SCIT and SLIT. We are now systematically reviewing all the primary studies, including recent evidence that has not been incorporated into the published systematic reviews.
Allergy, Allergen immunotherapy, Allergic rhinitis, Allergic rhinoconjuctivitis, Hay fever, Rhinitis
2045-7022
Nurmatov, Ulugbek
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Dhami, Sangeeta
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Arasi, Stefania
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Roberts, Graham
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Pfaar, Oliver
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Muraro, Antonella
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Ansotegui, Ignacio J.
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Calderon, Moises
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Cingi, Cemal
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Durham, Stephen
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van Wijk, Roy Gerth
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Halken, Susanne
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Hamelmann, Eckard
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Hellings, Peter
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Jacobsen, Lars
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Knol, Edward
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Larenas-Linnemann, Desiree
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Lin, Sandra Y.
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Maggina, Vivian
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Oude-Elberink, Hanneke
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Pajno, Giovanni
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Panwankar, Ruby
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Pastorello, Elideanna
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Pitsios, Constantinos
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Rotiroti, Giuseppina
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Timmermans, Frans
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Tsilochristou, Olympia
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Varga, Eva-Maria
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Wilkinson, Jamie
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Williams, Andrew
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Worm, Margitta
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Zhang, Luo
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Sheikh, Aziz
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Nurmatov, Ulugbek
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Dhami, Sangeeta
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Arasi, Stefania
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Roberts, Graham
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Pfaar, Oliver
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Muraro, Antonella
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Ansotegui, Ignacio J.
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Calderon, Moises
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Cingi, Cemal
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Durham, Stephen
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van Wijk, Roy Gerth
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Halken, Susanne
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Hamelmann, Eckard
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Hellings, Peter
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Jacobsen, Lars
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Knol, Edward
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Larenas-Linnemann, Desiree
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Lin, Sandra Y.
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Maggina, Vivian
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Oude-Elberink, Hanneke
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Pajno, Giovanni
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Panwankar, Ruby
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Pastorello, Elideanna
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Pitsios, Constantinos
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Rotiroti, Giuseppina
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Timmermans, Frans
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Tsilochristou, Olympia
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Varga, Eva-Maria
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Wilkinson, Jamie
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Williams, Andrew
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Worm, Margitta
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Zhang, Luo
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Sheikh, Aziz
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Nurmatov, Ulugbek, Dhami, Sangeeta, Arasi, Stefania, Roberts, Graham, Pfaar, Oliver, Muraro, Antonella, Ansotegui, Ignacio J., Calderon, Moises, Cingi, Cemal, Durham, Stephen, van Wijk, Roy Gerth, Halken, Susanne, Hamelmann, Eckard, Hellings, Peter, Jacobsen, Lars, Knol, Edward, Larenas-Linnemann, Desiree, Lin, Sandra Y., Maggina, Vivian, Oude-Elberink, Hanneke, Pajno, Giovanni, Panwankar, Ruby, Pastorello, Elideanna, Pitsios, Constantinos, Rotiroti, Giuseppina, Timmermans, Frans, Tsilochristou, Olympia, Varga, Eva-Maria, Wilkinson, Jamie, Williams, Andrew, Worm, Margitta, Zhang, Luo and Sheikh, Aziz (2017) Allergen immunotherapy for allergic rhinoconjunctivitis: a systematic overview of systematic reviews. Clinical and Translational Allergy, 7, [24]. (doi:10.1186/s13601-017-0159-6).

Record type: Review

Abstract

Background
The European Academy of Allergy and Clinical Immunology (EAACI) is developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis (ARC). To inform the development of recommendations, we sought to critically assess the systematic review evidence on the effectiveness, safety and cost-effectiveness of AIT for ARC.

Methods
We undertook a systematic overview, which involved searching nine international biomedical databases from inception to October 31, 2015. Studies were independently screened by two reviewers against pre-defined eligibility criteria and critically appraised using the Critical Appraisal Skills Programme (CASP) Systematic Review Checklist for systematic reviews. Data were descriptively synthesized.

Results
Our searches yielded a total of 5932 potentially eligible studies, from which 17 systematic reviews met our inclusion criteria. Eight of these were judged to be of high, five moderate and three low quality. These reviews suggested that, in carefully selected patients, subcutaneous (SCIT) and sublingual (SLIT) immunotherapy resulted in significant reductions in symptom scores and medication requirements. Serious adverse outcomes were rare for both SCIT and SLIT. Two systematic reviews reported some evidence of potential cost savings associated with use of SCIT and SLIT.

Conclusions
We found moderate-to-strong evidence that SCIT and SLIT can, in appropriately selected patients, reduce symptoms and medication requirements in patients with ARC with reassuring safety data. This evidence does however need to be interpreted with caution, particularly given the heterogeneity in the populations, allergens and protocols studied. There is a lack of data on the relative effectiveness, cost-effectiveness and safety of SCIT and SLIT. We are now systematically reviewing all the primary studies, including recent evidence that has not been incorporated into the published systematic reviews.

Text
s13601-017-0159-6 - Version of Record
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More information

Accepted/In Press date: 17 June 2017
Published date: 8 August 2017
Keywords: Allergy, Allergen immunotherapy, Allergic rhinitis, Allergic rhinoconjuctivitis, Hay fever, Rhinitis

Identifiers

Local EPrints ID: 431286
URI: http://eprints.soton.ac.uk/id/eprint/431286
ISSN: 2045-7022
PURE UUID: a2906007-1308-40f1-a7c6-d3e4e4b5d81e
ORCID for Graham Roberts: ORCID iD orcid.org/0000-0003-2252-1248

Catalogue record

Date deposited: 29 May 2019 16:30
Last modified: 22 Nov 2021 02:52

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Contributors

Author: Ulugbek Nurmatov
Author: Sangeeta Dhami
Author: Stefania Arasi
Author: Graham Roberts ORCID iD
Author: Oliver Pfaar
Author: Antonella Muraro
Author: Ignacio J. Ansotegui
Author: Moises Calderon
Author: Cemal Cingi
Author: Stephen Durham
Author: Roy Gerth van Wijk
Author: Susanne Halken
Author: Eckard Hamelmann
Author: Peter Hellings
Author: Lars Jacobsen
Author: Edward Knol
Author: Desiree Larenas-Linnemann
Author: Sandra Y. Lin
Author: Vivian Maggina
Author: Hanneke Oude-Elberink
Author: Giovanni Pajno
Author: Ruby Panwankar
Author: Elideanna Pastorello
Author: Constantinos Pitsios
Author: Giuseppina Rotiroti
Author: Frans Timmermans
Author: Olympia Tsilochristou
Author: Eva-Maria Varga
Author: Jamie Wilkinson
Author: Andrew Williams
Author: Margitta Worm
Author: Luo Zhang
Author: Aziz Sheikh

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