Dhami, S., Kakourou, A., Asamoah, F., Agache, I., Lau, S., Jutel, M., Muraro, A., Roberts, G., Akdis, C. A., Bonini, M., Cavkaytar, O., Flood, B., Gajdanowicz, P., Izuhara, K., Kalayci, O., Mosges, R., Palomares, O., Pfaar, O., Smolinska, S., Sokolowska, M., Asaria, M., Netuveli, G., Zaman, H., Akhlaq, A. and Sheikh, A. (2017). Allergen immunotherapy for allergic asthma: A systematic review and meta-analysis. Allergy, 72 (12). S. 1825 - 1849. HOBOKEN: WILEY. ISSN 1398-9995

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Abstract

BackgroundTo inform the development of the European Academy of Allergy and Clinical Immunology's (EAACI) Guidelines on Allergen Immunotherapy (AIT) for allergic asthma, we assessed the evidence on the effectiveness, cost-effectiveness and safety of AIT. MethodsWe performed a systematic review, which involved searching nine databases. Studies were screened against predefined eligibility criteria and critically appraised using established instruments. Data were synthesized using random-effects meta-analyses. Results98 studies satisfied the inclusion criteria. Short-term symptom scores were reduced with a standardized mean difference (SMD) of -1.11 (95% CI -1.66, -0.56). This was robust to a prespecified sensitivity analyses, but there was evidence suggestive of publication bias. Short-term medication scores were reduced SMD -1.21 (95% CI -1.87, -0.54), again with evidence of potential publication bias. There was no reduction in short-term combined medication and symptom scores SMD 0.17 (95% CI -0.23, 0.58), but one study showed a beneficial long-term effect. For secondary outcomes, subcutaneous immunotherapy (SCIT) improved quality of life and decreased allergen-specific airway hyperreactivity (AHR), but this was not the case for sublingual immunotherapy (SLIT). There were no consistent effects on asthma control, exacerbations, lung function, and nonspecific AHR. AIT resulted in a modest increased risk of adverse events (AEs). Although relatively uncommon, systemic AEs were more frequent with SCIT; however no fatalities were reported. The limited evidence on cost-effectiveness was mainly available for sublingual immunotherapy (SLIT) and this suggested that SLIT is likely to be cost-effective. ConclusionsAIT can achieve substantial reductions in short-term symptom and medication scores in allergic asthma. It was however associated with a modest increased risk of systemic and local AEs. More data are needed in relation to secondary outcomes, longer-term effectiveness and cost-effectiveness.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Dhami, S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kakourou, A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Asamoah, F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Agache, I.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lau, S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jutel, M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Muraro, A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Roberts, G.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Akdis, C. A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bonini, M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cavkaytar, O.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Flood, B.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gajdanowicz, P.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Izuhara, K.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kalayci, O.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mosges, R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Palomares, O.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pfaar, O.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Smolinska, S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sokolowska, M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Asaria, M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Netuveli, G.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zaman, H.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Akhlaq, A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sheikh, A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-209684
DOI: 10.1111/all.13208
Journal or Publication Title: Allergy
Volume: 72
Number: 12
Page Range: S. 1825 - 1849
Date: 2017
Publisher: WILEY
Place of Publication: HOBOKEN
ISSN: 1398-9995
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
HOUSE-DUST-MITE; DERMATOPHAGOIDES-PTERONYSSINUS EXTRACT; DOUBLE-BLIND TRIAL; STANDARDIZED SPECIFIC IMMUNOTHERAPY; GRASS-POLLEN IMMUNOTHERAPY; CAT-INDUCED ASTHMA; SUBLINGUAL IMMUNOTHERAPY; SEASONAL ASTHMA; PHARMACOLOGICAL-TREATMENT; ALTERNARIA-ALTERNATAMultiple languages
Allergy; ImmunologyMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/20968

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