Allergen immunotherapy for the prevention of allergy: a systematic review and meta-analysis

Maria Kristiansen; Sangeeta Dhami; Gopal Netuveli; Susanne Halken; Muraro Antonella; Graham Roberts; Desiree Larenas-Linnemann; Moises A. Calderón; Martin Penagos; George Du Toit; Ignacio J. Ansotegui; Jörg Kleine-Tebbe; Susanne Lau; Paolo Maria Matricardi; Giovanni Pajno; Nikolaos G. Papadopoulos; Oliver Pfaar; Dermot Ryan; Alexandra F.  Santos; Frans Timmermanns; Ulrich Wahn; Aziz Sheikh

doi:10.1111/pai.12661

Allergen immunotherapy for the prevention of allergy: a systematic review and meta-analysis

Maria Kristiansen, Sangeeta Dhami, Gopal Netuveli, Susanne Halken, Muraro Antonella, Graham Roberts, Desiree Larenas-Linnemann, Moises A. Calderón, Martin Penagos, George Du Toit, Ignacio J. Ansotegui, Jörg Kleine-Tebbe, Susanne Lau, Paolo Maria Matricardi, Giovanni Pajno, Nikolaos G. Papadopoulos, Oliver Pfaar, Dermot Ryan, Alexandra F. Santos, Frans TimmermannsUlrich Wahn, Aziz Sheikh

102 Citations (Scopus)

Abstract

Background: There is a need to establish the effectiveness, cost-effectiveness, and safety of allergen immunotherapy (AIT) for the prevention of allergic disease. Methods: Two reviewers independently screened nine international biomedical databases. Studies were quantitatively synthesized using random-effects meta-analyses. Results: A total of 32 studies satisfied the inclusion criteria. Overall, meta-analysis found no conclusive evidence that AIT reduced the risk of developing a first allergic disease over the short term (RR = 0.30; 95% CI: 0.04–2.09) and no randomized controlled evidence was found in relation to its longer-term effects for this outcome. There was, however, a reduction in the short-term risk of those with allergic rhinitis developing asthma (RR = 0.40; 95% CI: 0.30–0.54), with this finding being robust to a pre-specified sensitivity analysis. We found inconclusive evidence that this benefit was maintained over the longer term: RR = 0.62; 95% CI: 0.31–1.23. There was evidence that the risk of new sensitization was reduced over the short term, but this was not confirmed in the sensitivity analysis: RR = 0.72; 95% CI: 0.24–2.18. There was no clear evidence of any longer-term reduction in the risk of sensitization: RR = 0.47; 95% CI: 0.08–2.77. AIT appeared to have an acceptable side effect profile. Conclusions: AIT did not result in a statistically significant reduction in the risk of developing a first allergic disease. There was, however, evidence of a reduced short-term risk of developing asthma in those with allergic rhinitis, but it is unclear whether this benefit was maintained over the longer term. We are unable to comment on the cost-effectiveness of AIT.

Original language	English
Journal	Pediatric Allergy and Immunology
Volume	28
Issue number	1
Pages (from-to)	18–29
Number of pages	12
ISSN	0905-6157
DOIs	https://doi.org/10.1111/pai.12661
Publication status	Published - 1 Feb 2017

Keywords

Faculty of Health and Medical Sciences

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10.1111/pai.12661

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Kristiansen, M., Dhami, S., Netuveli, G., Halken, S., Antonella, M., Roberts, G., Larenas-Linnemann, D., Calderón, M. A., Penagos, M., Du Toit, G., Ansotegui, I. J., Kleine-Tebbe, J., Lau, S., Matricardi, P. M., Pajno, G., Papadopoulos, N. G., Pfaar, O., Ryan, D., Santos, A. F., ... Sheikh, A. (2017). Allergen immunotherapy for the prevention of allergy: a systematic review and meta-analysis. Pediatric Allergy and Immunology, 28(1), 18–29. https://doi.org/10.1111/pai.12661

Kristiansen, M, Dhami, S, Netuveli, G, Halken, S, Antonella, M, Roberts, G, Larenas-Linnemann, D, Calderón, MA, Penagos, M, Du Toit, G, Ansotegui, IJ, Kleine-Tebbe, J, Lau, S, Matricardi, PM, Pajno, G, Papadopoulos, NG, Pfaar, O, Ryan, D, Santos, AF, Timmermanns, F, Wahn, U & Sheikh, A 2017, 'Allergen immunotherapy for the prevention of allergy: a systematic review and meta-analysis', Pediatric Allergy and Immunology, vol. 28, no. 1, pp. 18–29. https://doi.org/10.1111/pai.12661

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title = "Allergen immunotherapy for the prevention of allergy: a systematic review and meta-analysis",

abstract = "Background: There is a need to establish the effectiveness, cost-effectiveness, and safety of allergen immunotherapy (AIT) for the prevention of allergic disease. Methods: Two reviewers independently screened nine international biomedical databases. Studies were quantitatively synthesized using random-effects meta-analyses. Results: A total of 32 studies satisfied the inclusion criteria. Overall, meta-analysis found no conclusive evidence that AIT reduced the risk of developing a first allergic disease over the short term (RR = 0.30; 95% CI: 0.04–2.09) and no randomized controlled evidence was found in relation to its longer-term effects for this outcome. There was, however, a reduction in the short-term risk of those with allergic rhinitis developing asthma (RR = 0.40; 95% CI: 0.30–0.54), with this finding being robust to a pre-specified sensitivity analysis. We found inconclusive evidence that this benefit was maintained over the longer term: RR = 0.62; 95% CI: 0.31–1.23. There was evidence that the risk of new sensitization was reduced over the short term, but this was not confirmed in the sensitivity analysis: RR = 0.72; 95% CI: 0.24–2.18. There was no clear evidence of any longer-term reduction in the risk of sensitization: RR = 0.47; 95% CI: 0.08–2.77. AIT appeared to have an acceptable side effect profile. Conclusions: AIT did not result in a statistically significant reduction in the risk of developing a first allergic disease. There was, however, evidence of a reduced short-term risk of developing asthma in those with allergic rhinitis, but it is unclear whether this benefit was maintained over the longer term. We are unable to comment on the cost-effectiveness of AIT.",

keywords = "Faculty of Health and Medical Sciences, Immunotherapy, Allergy and Immunology, Systematic review, Meta-analysis",

author = "Maria Kristiansen and Sangeeta Dhami and Gopal Netuveli and Susanne Halken and Muraro Antonella and Graham Roberts and Desiree Larenas-Linnemann and Calder{\'o}n, {Moises A.} and Martin Penagos and {Du Toit}, George and Ansotegui, {Ignacio J.} and J{\"o}rg Kleine-Tebbe and Susanne Lau and Matricardi, {Paolo Maria} and Giovanni Pajno and Papadopoulos, {Nikolaos G.} and Oliver Pfaar and Dermot Ryan and Santos, {Alexandra F.} and Frans Timmermanns and Ulrich Wahn and Aziz Sheikh",

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doi = "10.1111/pai.12661",

language = "English",

volume = "28",

pages = "18–29",

journal = "Pediatric Allergy and Immunology, Supplement",

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TY - JOUR

T1 - Allergen immunotherapy for the prevention of allergy

T2 - a systematic review and meta-analysis

AU - Kristiansen, Maria

AU - Dhami, Sangeeta

AU - Netuveli, Gopal

AU - Halken, Susanne

AU - Antonella, Muraro

AU - Roberts, Graham

AU - Larenas-Linnemann, Desiree

AU - Calderón, Moises A.

AU - Penagos, Martin

AU - Du Toit, George

AU - Ansotegui, Ignacio J.

AU - Kleine-Tebbe, Jörg

AU - Lau, Susanne

AU - Matricardi, Paolo Maria

AU - Pajno, Giovanni

AU - Papadopoulos, Nikolaos G.

AU - Pfaar, Oliver

AU - Ryan, Dermot

AU - Santos, Alexandra F.

AU - Timmermanns, Frans

AU - Wahn, Ulrich

AU - Sheikh, Aziz

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Background: There is a need to establish the effectiveness, cost-effectiveness, and safety of allergen immunotherapy (AIT) for the prevention of allergic disease. Methods: Two reviewers independently screened nine international biomedical databases. Studies were quantitatively synthesized using random-effects meta-analyses. Results: A total of 32 studies satisfied the inclusion criteria. Overall, meta-analysis found no conclusive evidence that AIT reduced the risk of developing a first allergic disease over the short term (RR = 0.30; 95% CI: 0.04–2.09) and no randomized controlled evidence was found in relation to its longer-term effects for this outcome. There was, however, a reduction in the short-term risk of those with allergic rhinitis developing asthma (RR = 0.40; 95% CI: 0.30–0.54), with this finding being robust to a pre-specified sensitivity analysis. We found inconclusive evidence that this benefit was maintained over the longer term: RR = 0.62; 95% CI: 0.31–1.23. There was evidence that the risk of new sensitization was reduced over the short term, but this was not confirmed in the sensitivity analysis: RR = 0.72; 95% CI: 0.24–2.18. There was no clear evidence of any longer-term reduction in the risk of sensitization: RR = 0.47; 95% CI: 0.08–2.77. AIT appeared to have an acceptable side effect profile. Conclusions: AIT did not result in a statistically significant reduction in the risk of developing a first allergic disease. There was, however, evidence of a reduced short-term risk of developing asthma in those with allergic rhinitis, but it is unclear whether this benefit was maintained over the longer term. We are unable to comment on the cost-effectiveness of AIT.

AB - Background: There is a need to establish the effectiveness, cost-effectiveness, and safety of allergen immunotherapy (AIT) for the prevention of allergic disease. Methods: Two reviewers independently screened nine international biomedical databases. Studies were quantitatively synthesized using random-effects meta-analyses. Results: A total of 32 studies satisfied the inclusion criteria. Overall, meta-analysis found no conclusive evidence that AIT reduced the risk of developing a first allergic disease over the short term (RR = 0.30; 95% CI: 0.04–2.09) and no randomized controlled evidence was found in relation to its longer-term effects for this outcome. There was, however, a reduction in the short-term risk of those with allergic rhinitis developing asthma (RR = 0.40; 95% CI: 0.30–0.54), with this finding being robust to a pre-specified sensitivity analysis. We found inconclusive evidence that this benefit was maintained over the longer term: RR = 0.62; 95% CI: 0.31–1.23. There was evidence that the risk of new sensitization was reduced over the short term, but this was not confirmed in the sensitivity analysis: RR = 0.72; 95% CI: 0.24–2.18. There was no clear evidence of any longer-term reduction in the risk of sensitization: RR = 0.47; 95% CI: 0.08–2.77. AIT appeared to have an acceptable side effect profile. Conclusions: AIT did not result in a statistically significant reduction in the risk of developing a first allergic disease. There was, however, evidence of a reduced short-term risk of developing asthma in those with allergic rhinitis, but it is unclear whether this benefit was maintained over the longer term. We are unable to comment on the cost-effectiveness of AIT.

KW - Faculty of Health and Medical Sciences

KW - Immunotherapy

KW - Allergy and Immunology

KW - Systematic review

KW - Meta-analysis

U2 - 10.1111/pai.12661

DO - 10.1111/pai.12661

M3 - Journal article

C2 - 27653623

SN - 0906-5784

VL - 28

SP - 18

EP - 29

JO - Pediatric Allergy and Immunology, Supplement

JF - Pediatric Allergy and Immunology, Supplement

IS - 1

ER -

Allergen immunotherapy for the prevention of allergy: a systematic review and meta-analysis

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