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

Felix Asamoah^#^{1

2

3}, Artemisia Kakourou^#⁴, Sangeeta Dhami⁵, Susanne Lau⁶, Ioana Agache⁷, Antonella Muraro⁸, Graham Roberts^{9

10

11}, Cezmi Akdis¹², Matteo Bonini¹³, Ozlem Cavkaytar¹⁴, Breda Flood¹⁵, Kenji Izuhara¹⁶, Marek Jutel¹⁷, Ömer Kalayci¹⁸, Oliver Pfaar^{19

20}, Aziz Sheikh²¹

Affiliations

¹ Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, London, UK.
² Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
³ Neonatal Unit, Homerton University Hospital NHS Foundation Trust, London, UK.
⁴ Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
⁵ Evidence-Based Health Care Ltd, Edinburgh, UK.
⁶ Charite Medical University, Berlin, Germany.
⁷ Department of Allergy and Clinical Immunology, Faculty of Medicine, Transylvania University Brasov, Brasov, Romania.
⁸ Food Allergy Referral Centre Veneto Region, University Hospital of Padua, Padua, Italy.
⁹ The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK.
¹⁰ NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and Faculty of Medicine, University of Southampton , Southampton, UK.
¹¹ Faculty of Medicine, University of Southampton, Southampton, UK.
¹² Swiss Institute for Allergy and Asthma Research, Davos, Switzerland.
¹³ Sapienza University Rome, Rome, Italy.
¹⁴ Department of Allergy and Clinical Immunology, Sami Ulus Maternity and Children Training and Research Hospital, Ankara, Turkey.
¹⁵ European Federation of Allergy and Airways Diseases Patients Association, Brussels, Belgium.
¹⁶ Saga Medical School, Saga, Japan.
¹⁷ Wroclaw Medical University, Wrocław, Poland.
¹⁸ Hacettepe University, Ankara, Turkey.
¹⁹ Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
²⁰ Center for Rhinology and Allergology, Wiesbaden, Germany.
²¹ Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.

^# Contributed equally.

PMID: 28775845
PMCID: PMC5539638
DOI: 10.1186/s13601-017-0160-0

Review

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

Felix Asamoah et al. Clin Transl Allergy. 2017.

. 2017 Aug 2:7:25.

doi: 10.1186/s13601-017-0160-0. eCollection 2017.

Authors

Affiliations

¹ Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, London, UK.
² Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
³ Neonatal Unit, Homerton University Hospital NHS Foundation Trust, London, UK.
⁴ Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
⁵ Evidence-Based Health Care Ltd, Edinburgh, UK.
⁶ Charite Medical University, Berlin, Germany.
⁷ Department of Allergy and Clinical Immunology, Faculty of Medicine, Transylvania University Brasov, Brasov, Romania.
⁸ Food Allergy Referral Centre Veneto Region, University Hospital of Padua, Padua, Italy.
⁹ The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK.
¹⁰ NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and Faculty of Medicine, University of Southampton , Southampton, UK.
¹¹ Faculty of Medicine, University of Southampton, Southampton, UK.
¹² Swiss Institute for Allergy and Asthma Research, Davos, Switzerland.
¹³ Sapienza University Rome, Rome, Italy.
¹⁴ Department of Allergy and Clinical Immunology, Sami Ulus Maternity and Children Training and Research Hospital, Ankara, Turkey.
¹⁵ European Federation of Allergy and Airways Diseases Patients Association, Brussels, Belgium.
¹⁶ Saga Medical School, Saga, Japan.
¹⁷ Wroclaw Medical University, Wrocław, Poland.
¹⁸ Hacettepe University, Ankara, Turkey.
¹⁹ Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
²⁰ Center for Rhinology and Allergology, Wiesbaden, Germany.
²¹ Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.

^# Contributed equally.

PMID: 28775845
PMCID: PMC5539638
DOI: 10.1186/s13601-017-0160-0

Abstract

Background: There is clinical uncertainty about the effectiveness and safety of allergen immunotherapy (AIT) for the treatment of allergic asthma.

Objectives: To undertake a systematic overview of the effectiveness, cost-effectiveness and safety of AIT for the treatment of allergic asthma.

Methods: We searched nine electronic databases from inception to October 31, 2015. Systematic reviews were independently screened by two reviewers against pre-defined eligibility criteria and critically appraised using the Critical Appraisal Skills Programme quality assessment tool for systematic reviews. Data were descriptively and thematically synthesized.

Results: We identified nine eligible systematic reviews; these focused on delivery of AIT through the following routes: subcutaneous (SCIT; n = 3); sublingual (SLIT; n = 4); and both SCIT and SLIT (n = 2). This evidence found that AIT delivered by SCIT and SLIT can improve medication and symptom scores and measures of bronchial hyper-reactivity. The impact on measures of lung function or asthma control was however less clear. We found no systematic review level evidence on the cost-effectiveness of SCIT or SLIT. SLIT had a favorable safety profile when compared to SCIT, particularly in relation to the risk of systemic reactions.

Conclusions: AIT has the potential to achieve reductions in symptom and medication scores, but there is no clear or consistent evidence that measures of lung function can be improved. Bearing in mind the limitations of synthesizing evidence from systematic reviews and the fact that these reviews include mainly dated studies, a systematic review of current primary studies is now needed to update this evidence base, estimate the effectiveness of AIT on asthma outcomes and to investigate the relative effectiveness, cost-effectiveness and safety of SCIT and SLIT.

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References

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

Affiliations

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

Authors

Affiliations

Abstract

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References

Publication types

Grants and funding

LinkOut - more resources

Full Text Sources

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