Universität zu Köln

Moesges, Ralph, Valero Santiago, Antonio, Allekotte, Silke, Jahed, Nilufar, Astvatsatourov, Anatoli, Sager, Angelika and Sanchez-Lopez, Jaime ORCID: 0000-0003-3600-8138 (2019). Subcutaneous immunotherapy with depigmented-polymerized allergen extracts: a systematic review and meta-analysis. Clin. Transl. Allergy, 9. LONDON: BMC. ISSN 2045-7022

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Abstract

BackgroundDouble-blind, placebo-controlled trials (DBPCTs) have confirmed the efficacy of allergen-specific immunotherapy (AIT) with depigmented-polymerized allergen extracts (DPAEs). This systematic review evaluates the efficacy of AIT using different allergens in different severity stages of rhinoconjunctivitis with or without asthma in the pollen studies and asthma and rhinitis in the house dust mite studies in comparison to placebo.MethodsWe used MEDLINE, Embase, CENTRAL and LILACS databases to review DBPCTs published until July 2016. The combined symptom and medication score (cSMS) served as primary endpoint. The total rhinoconjunctivitis symptom score (RCSS) and total score in Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) were secondary efficacy endpoints. Solicited local and systemic adverse events were secondary safety endpoints. We assumed a random effects model with standardized mean differences (SMDs) or mean differences as summary statistics. In a subgroup analysis, we classified the studies following the GINA (Global Initiative for Asthma) and ARIA (Allergic Rhinitis and its Impact on Asthma) guidelines for rhinoconjunctivitis and asthma severity.ResultsSix DBPCTs in pollen and 2 trials in house dust mites (HDM) were selected. Patients (N=915) with intermittent or mild persistent asthma were included in 3 (37.5%) and 5 (62.5%) trials, respectively. Two (25%) HDM studies included patients with moderate persistent asthma, 4 trials patients with moderate-to-severe rhinoconjunctivitis. Treatment periods ranged from 12 to 24months. AIT with DPAEs yielded significantly lower cSMS (SMD: 1.9, 95% CI: 0.9-2.8) and RQLQ (SMD: 0.3, 95% CI: 0.1-0.5) values than did placebo. An exploratory analysis of cSMS and RCSS suggested that the efficacy of AIT treatment with DPAEs was higher in trials including patients with more severe rhinoconjunctivitis and asthma. A publication bias was not detected. Heterogeneity between individual studies was explained by differences in severity. Patients receiving DPAEs did not experience a significantly higher risk of local (OR: 1.55, 95% CI: 0.86-2.79) or systemic reactions (OR: 1.94, 95% CI: 0.98-3.84).ConclusionsCompared to placebo, AIT with DPAEs is effective in patients with pollen- or HDM-induced rhinoconjunctivitis with or without allergic asthma and improves health-related quality of life. It does not differ significantly in safety and tolerability.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Moesges, Ralph UNSPECIFIED UNSPECIFIED UNSPECIFIED Valero Santiago, Antonio UNSPECIFIED UNSPECIFIED UNSPECIFIED Allekotte, Silke UNSPECIFIED UNSPECIFIED UNSPECIFIED Jahed, Nilufar UNSPECIFIED UNSPECIFIED UNSPECIFIED Astvatsatourov, Anatoli UNSPECIFIED UNSPECIFIED UNSPECIFIED Sager, Angelika UNSPECIFIED UNSPECIFIED UNSPECIFIED Sanchez-Lopez, Jaime UNSPECIFIED orcid.org/0000-0003-3600-8138 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-138137
DOI:	10.1186/s13601-019-0268-5
Journal or Publication Title:	Clin. Transl. Allergy
Volume:	9
Date:	2019
Publisher:	BMC
Place of Publication:	LONDON
ISSN:	2045-7022
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language DOUBLE-BLIND; SUBLINGUAL IMMUNOTHERAPY; POLLEN EXTRACT; DERMATOPHAGOIDES-PTERONYSSINUS; THERAPEUTIC VACCINES; CLINICAL-TRIALS; RHINOCONJUNCTIVITIS; RHINITIS; SAFETY; EFFICACY Multiple languages Allergy Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/13813