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

Ulugbek Nurmatov¹, Sangeeta Dhami², Stefania Arasi^{3

4}, Graham Roberts^{5

6}, Oliver Pfaar^{7

8}, Antonella Muraro⁹, Ignacio J Ansotegui¹⁰, Moises Calderon¹¹, Cemal Cingi¹², Stephen Durham¹¹, Roy Gerth van Wijk¹³, Susanne Halken¹⁴, Eckard Hamelmann¹⁵, Peter Hellings¹⁶, Lars Jacobsen¹⁷, Edward Knol¹⁸, Desiree Larenas-Linnemann¹⁹, Sandra Y Lin²⁰, Vivian Maggina²¹, Hanneke Oude-Elberink²², Giovanni Pajno³, Ruby Panwankar²³, Elideanna Pastorello²⁴, Constantinos Pitsios²⁵, Giuseppina Rotiroti²⁶, Frans Timmermans²⁷, Olympia Tsilochristou²⁸, Eva-Maria Varga²⁸, Jamie Wilkinson²⁹, Andrew Williams³⁰, Margitta Worm³¹, Luo Zhang³², Aziz Sheikh³³

Affiliations

¹ Division of Population Medicine, School of Medicine, Cardiff University, Wales, UK.
² Evidence-Based Health Care Ltd, Edinburgh, UK.
³ Allergy Unit - Department of Pediatrics, University of Messina, Via Consolare Valeria - Gazzi, Messina, Italy.
⁴ Molecular Allergology and Immunomodulation-Department of Pediatric Pneumology and Immunology, Charité Medical University, Augustenburger Platz 1, Berlin, Germany.
⁵ The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport Isle of Wight, UK.
⁶ NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and Faculty of Medicine, University of Southampton, Southampton, UK.
⁷ Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
⁸ Center for Rhinology and Allergology, Wiesbaden, Germany.
⁹ Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy.
¹⁰ Hospital Quiron Bizkair, Bilbao, Spain.
¹¹ National Heart and Lung Institute, Imperial College, London, UK.
¹² Department of ENT, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey.
¹³ Section of Allergology, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.
¹⁴ Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
¹⁵ Children's Center Bethel, EvKB, Bieledelf and Allergy Center, Buhr-University, Bochum, Germany.
¹⁶ Laboratory of Experimental Immunology, University Hospitals Leuven, Louvain, Belgium.
¹⁷ ALCAllergy Learning and Consulting, Copenhagen, Denmark.
¹⁸ University Medical Center, Utrecht, The Netherlands.
¹⁹ Hospital Medica Sur, Mexico City, Mexico.
²⁰ Department of Otolaryngology-Head & Neck Surgery, John Hopkins, Baltimore, MD USA.
²¹ Allergy and Clinical Immunology Unit, 2nd Department of Pediatrics, University of Athens, P&A Kiriakou Children's Hospital, Athens, Greece.
²² Department of Allergology, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
²³ Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
²⁴ University of Milano, Milan, Italy.
²⁵ Medical School, University of Cyprus, Nicosia, Cyprus.
²⁶ The Royal National Throat, Nose and Ear Hospital, University College London, London, UK.
²⁷ Netherlands Anafylaxis Network, Dordrecht, The Netherlands.
²⁸ Department of Paediatrics, Respiratory and Allergic Disease Division, Medical University Graz, Graz, Austria.
²⁹ Pharmaceutical Group of the European Union, Brussels, Belgium.
³⁰ Guy's and St Thomas' NHS Foundation Trust, London, UK.
³¹ Charitie-Universitatsmedizin, Berlin, Germany.
³² Beijing Institute of Otolaryngology, Beijing, China.
³³ Allergy and Respiratory Research Group, The University of Edinburgh, Edinburgh, UK.

PMID: 28794855
PMCID: PMC5547534
DOI: 10.1186/s13601-017-0159-6

Review

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

Ulugbek Nurmatov et al. Clin Transl Allergy. 2017.

. 2017 Aug 8:7:24.

doi: 10.1186/s13601-017-0159-6. eCollection 2017.

Authors

Affiliations

¹ Division of Population Medicine, School of Medicine, Cardiff University, Wales, UK.
² Evidence-Based Health Care Ltd, Edinburgh, UK.
³ Allergy Unit - Department of Pediatrics, University of Messina, Via Consolare Valeria - Gazzi, Messina, Italy.
⁴ Molecular Allergology and Immunomodulation-Department of Pediatric Pneumology and Immunology, Charité Medical University, Augustenburger Platz 1, Berlin, Germany.
⁵ The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport Isle of Wight, UK.
⁶ NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and Faculty of Medicine, University of Southampton, Southampton, UK.
⁷ Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
⁸ Center for Rhinology and Allergology, Wiesbaden, Germany.
⁹ Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy.
¹⁰ Hospital Quiron Bizkair, Bilbao, Spain.
¹¹ National Heart and Lung Institute, Imperial College, London, UK.
¹² Department of ENT, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey.
¹³ Section of Allergology, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.
¹⁴ Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
¹⁵ Children's Center Bethel, EvKB, Bieledelf and Allergy Center, Buhr-University, Bochum, Germany.
¹⁶ Laboratory of Experimental Immunology, University Hospitals Leuven, Louvain, Belgium.
¹⁷ ALCAllergy Learning and Consulting, Copenhagen, Denmark.
¹⁸ University Medical Center, Utrecht, The Netherlands.
¹⁹ Hospital Medica Sur, Mexico City, Mexico.
²⁰ Department of Otolaryngology-Head & Neck Surgery, John Hopkins, Baltimore, MD USA.
²¹ Allergy and Clinical Immunology Unit, 2nd Department of Pediatrics, University of Athens, P&A Kiriakou Children's Hospital, Athens, Greece.
²² Department of Allergology, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
²³ Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
²⁴ University of Milano, Milan, Italy.
²⁵ Medical School, University of Cyprus, Nicosia, Cyprus.
²⁶ The Royal National Throat, Nose and Ear Hospital, University College London, London, UK.
²⁷ Netherlands Anafylaxis Network, Dordrecht, The Netherlands.
²⁸ Department of Paediatrics, Respiratory and Allergic Disease Division, Medical University Graz, Graz, Austria.
²⁹ Pharmaceutical Group of the European Union, Brussels, Belgium.
³⁰ Guy's and St Thomas' NHS Foundation Trust, London, UK.
³¹ Charitie-Universitatsmedizin, Berlin, Germany.
³² Beijing Institute of Otolaryngology, Beijing, China.
³³ Allergy and Respiratory Research Group, The University of Edinburgh, Edinburgh, UK.

PMID: 28794855
PMCID: PMC5547534
DOI: 10.1186/s13601-017-0159-6

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.

Keywords: Allergen immunotherapy; Allergic rhinitis; Allergic rhinoconjuctivitis; Allergy; Hay fever; Rhinitis.

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References

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

Affiliations

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

Authors

Affiliations

Abstract

Figures

References

Publication types

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Miscellaneous