Allergen immunotherapy and/or biologicals for IgE-mediated food allergy: a systematic review and meta-analysis
Allergen immunotherapy and/or biologicals for IgE-mediated food allergy: a systematic review and meta-analysis
Background: there is substantial interest in immunotherapy and biologicals in IgE-mediated food allergy.
Methods: we searched six databases for randomized controlled trials about immunotherapy alone or with biologicals (to April 2021) or biological monotherapy (to September 2021) in food allergy confirmed by oral food challenge. We pooled the data using random-effects meta-analysis.
Results: we included 36 trials about immunotherapy with 2126 mainly child participants. Oral immunotherapy increased tolerance whilst on therapy for peanut (RR 9.9, 95% CI 4.5.–21.4, high certainty); cow's milk (RR 5.7, 1.9–16.7, moderate certainty) and hen's egg allergy (RR 8.9, 4.4–18, moderate certainty). The number needed to treat to increase tolerance to a single dose of 300 mg or 1000 mg peanut protein was 2. Oral immunotherapy did not increase adverse reactions (RR 1.1, 1.0–1.2, low certainty) or severe reactions in peanut allergy (RR 1,6, 0.7–3.5, low certainty), but may increase (mild) adverse reactions in cow's milk (RR 3.9, 2.1–7.5, low certainty) and hen's egg allergy (RR 7.0, 2.4–19.8, moderate certainty). Epicutaneous immunotherapy increased tolerance whilst on therapy for peanut (RR 2.6, 1.8–3.8, moderate certainty). Results were unclear for other allergies and administration routes. There were too few trials of biologicals alone (3) or with immunotherapy (1) to draw conclusions.
Conclusions: oral immunotherapy improves tolerance whilst on therapy and is probably safe in peanut, cow's milk and hen's egg allergy. More research is needed about quality of life, cost and biologicals.
1852-1862
de Silva, Debra
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Rodríguez Del Río, Pablo
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de Jong, Nicolette W
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Khaleva, Ekaterina
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Singh, Chris
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Nowak-Wegrzyn, Anna
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Muraro, Antonella
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Begin, Philippe
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Pajno, Giovanni
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Fiocchi, Alessandro
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Sanchez, Angel
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Jones, Carla
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Nilsson, Caroline
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Bindslev-Jensen, Carsten
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Wong, Gary
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Sampson, Hugh
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Beyer, Kirsten
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Marchisotto, Mary-Jane
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Fernandez Rivas, Montserrat
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Meyer, Rosan
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Lau, Susanne
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Nurmatov, Ulugbek
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Roberts, Graham
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June 2022
de Silva, Debra
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Rodríguez Del Río, Pablo
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de Jong, Nicolette W
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Khaleva, Ekaterina
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Singh, Chris
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Nowak-Wegrzyn, Anna
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Muraro, Antonella
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Begin, Philippe
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Pajno, Giovanni
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Fiocchi, Alessandro
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Sanchez, Angel
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Jones, Carla
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Nilsson, Caroline
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Bindslev-Jensen, Carsten
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Wong, Gary
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Sampson, Hugh
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Beyer, Kirsten
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Marchisotto, Mary-Jane
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Fernandez Rivas, Montserrat
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Meyer, Rosan
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Lau, Susanne
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Nurmatov, Ulugbek
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Roberts, Graham
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de Silva, Debra, Rodríguez Del Río, Pablo, de Jong, Nicolette W, Khaleva, Ekaterina, Singh, Chris, Nowak-Wegrzyn, Anna, Muraro, Antonella, Begin, Philippe, Pajno, Giovanni, Fiocchi, Alessandro, Sanchez, Angel, Jones, Carla, Nilsson, Caroline, Bindslev-Jensen, Carsten, Wong, Gary, Sampson, Hugh, Beyer, Kirsten, Marchisotto, Mary-Jane, Fernandez Rivas, Montserrat, Meyer, Rosan, Lau, Susanne, Nurmatov, Ulugbek and Roberts, Graham
(2022)
Allergen immunotherapy and/or biologicals for IgE-mediated food allergy: a systematic review and meta-analysis.
Allergy, 77 (6), .
(doi:10.1111/all.15211).
Abstract
Background: there is substantial interest in immunotherapy and biologicals in IgE-mediated food allergy.
Methods: we searched six databases for randomized controlled trials about immunotherapy alone or with biologicals (to April 2021) or biological monotherapy (to September 2021) in food allergy confirmed by oral food challenge. We pooled the data using random-effects meta-analysis.
Results: we included 36 trials about immunotherapy with 2126 mainly child participants. Oral immunotherapy increased tolerance whilst on therapy for peanut (RR 9.9, 95% CI 4.5.–21.4, high certainty); cow's milk (RR 5.7, 1.9–16.7, moderate certainty) and hen's egg allergy (RR 8.9, 4.4–18, moderate certainty). The number needed to treat to increase tolerance to a single dose of 300 mg or 1000 mg peanut protein was 2. Oral immunotherapy did not increase adverse reactions (RR 1.1, 1.0–1.2, low certainty) or severe reactions in peanut allergy (RR 1,6, 0.7–3.5, low certainty), but may increase (mild) adverse reactions in cow's milk (RR 3.9, 2.1–7.5, low certainty) and hen's egg allergy (RR 7.0, 2.4–19.8, moderate certainty). Epicutaneous immunotherapy increased tolerance whilst on therapy for peanut (RR 2.6, 1.8–3.8, moderate certainty). Results were unclear for other allergies and administration routes. There were too few trials of biologicals alone (3) or with immunotherapy (1) to draw conclusions.
Conclusions: oral immunotherapy improves tolerance whilst on therapy and is probably safe in peanut, cow's milk and hen's egg allergy. More research is needed about quality of life, cost and biologicals.
Text
Allergy - 2022 - de Silva - Allergen immunotherapy and or biologicals for IgE‐mediated food allergy A systematic review
More information
Accepted/In Press date: 19 December 2021
e-pub ahead of print date: 9 January 2022
Published date: June 2022
Additional Information:
Funding Information:
The Global Allergy and Asthma European Network (GA2LEN) contributed funding towards the systematic review process. Authors and contributors volunteered their time.
Publisher Copyright:
© 2022 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.
Identifiers
Local EPrints ID: 454376
URI: http://eprints.soton.ac.uk/id/eprint/454376
ISSN: 0105-4538
PURE UUID: 3b03fa00-e283-4e99-917b-caff2e5c7fec
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Date deposited: 08 Feb 2022 17:41
Last modified: 17 Mar 2024 04:02
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Contributors
Author:
Debra de Silva
Author:
Pablo Rodríguez Del Río
Author:
Nicolette W de Jong
Author:
Ekaterina Khaleva
Author:
Chris Singh
Author:
Anna Nowak-Wegrzyn
Author:
Antonella Muraro
Author:
Philippe Begin
Author:
Giovanni Pajno
Author:
Alessandro Fiocchi
Author:
Angel Sanchez
Author:
Carla Jones
Author:
Caroline Nilsson
Author:
Carsten Bindslev-Jensen
Author:
Gary Wong
Author:
Hugh Sampson
Author:
Kirsten Beyer
Author:
Mary-Jane Marchisotto
Author:
Montserrat Fernandez Rivas
Author:
Rosan Meyer
Author:
Susanne Lau
Author:
Ulugbek Nurmatov
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