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Review
. 2025 Mar;15(3):e70045.
doi: 10.1002/clt2.70045.

Epicutaneous immunotherapy for food allergy: A systematic review and meta-analysis

Péter Csonka  1   2 , Bohee Lee  3 , Ilari Kuitunen  4   5
Affiliations
Review

Epicutaneous immunotherapy for food allergy: A systematic review and meta-analysis

Péter Csonka et al. Clin Transl Allergy. 2025 Mar.

Abstract

Background: Food allergies pose a global healthcare challenge, underscoring the need for effective interventions. This study evaluated the efficacy and safety of epicutaneous immunotherapy (EPIT) for food allergen desensitisation.

Methods: We conducted a systematic review of randomised controlled trials by searching Ovid EMBASE, PubMed and Scopus in April 2024. Using a random-effects meta-analysis, we evaluated the clinical effectiveness and harms of EPIT, reporting results as risk ratios with 95% confidence intervals (CI).

Results: After screening 460 abstracts and 35 full reports, 11 were included: nine on peanuts and two on cow's milk (CM). Peanut EPIT had a 51.2% treatment response versus 22.4% for placebo (RR 2.16, CI 1.49-3.12; four studies; moderate certainty). The RR for milk EPIT response rate was 1.78 (CI 1.06-3.00; one study). Five peanut studies (1396 patients) reported EPIT-related adverse events (RR 1.39, CI 0.94-2.05; low certainty).

Conclusions: EPIT offers a moderate treatment response with a favourable safety profile and significant improvements in quality of life. Current knowledge of EPIT remains limited, with evidence confined to peanut and CM allergies. There is a lack of research on sustained unresponsiveness achieved through food EPIT.

Keywords: EPIT; allergen immunotherapy; cow's milk; epicutaneous immunotherapy; peanuts.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) flowchart of the study selection process.
FIGURE 2
FIGURE 2
Risk of bias assessments according to the RoB 2.0 tool to (A) objective and (B) subjective outcomes.
FIGURE 3
FIGURE 3
Forest plot of the clinical effectiveness of peanut epicutaneous immunotherapy (EPIT) treatment. Effectiveness calculated as treatment responder and treatment response meaning at least ten‐fold increased in the tolerated peanut dose.
See this image and copyright information in PMC

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