Allergen immunotherapy for allergic asthma: a systematic review and meta-analysis

Sangeeta Dhami; Artemisia Kakourou; Felix Asamoah; Ioana Agache; Susanne Lau; Jutel Marek; Antonella Muraro; Graham Roberts; Cezmi A Akdis; Matteo Bonini; Ozlem Cavkaytar; Breda Flood; Pawel Gajdanowicz; Kenji Izuhara; Ömer Kalayci; Ralph Mosges; Oscar Palomares; Oliver Pfaar; Sylwia Smolinska; Milena Sokolowska; Miqdad Asaria; Gopal Netuveli; Hader Zaman; Ather Akhlaq; Aziz Sheikh

doi:10.1111/all.13208

Allergen immunotherapy for allergic asthma: a systematic review and meta-analysis

Sangeeta Dhami, Artemisia Kakourou, Felix Asamoah, Ioana Agache, Susanne Lau, Jutel Marek, Antonella Muraro, Graham Roberts, Cezmi A Akdis, Matteo Bonini, Ozlem Cavkaytar, Breda Flood, Pawel Gajdanowicz, Kenji Izuhara, Ömer Kalayci, Ralph Mosges, Oscar Palomares, Oliver Pfaar, Sylwia Smolinska, Milena SokolowskaMiqdad Asaria, Gopal Netuveli, Hader Zaman, Ather Akhlaq, Aziz Sheikh

Research output: Contribution to journal › Literature review › peer-review

Abstract / Description of output

BACKGROUND: To inform the development of the European Academy of Allergy and Clinical Immunonology's (EAACI) Guidelines on Allergen Immunotherapy (AIT) for allergic asthma, we assessed the evidence on the effectiveness, cost-effectiveness and safety of AIT.

METHODS: We performed a systematic review, which involved searching nine databases. Studies were screened against pre-defined eligibility criteria and critically appraised using established instruments. Data were synthesized using random-effects meta-analyses.

RESULTS: 98 studies satisfied the inclusion criteria. Short-term symptom scores were reduced with a standardized mean difference (SMD) of -1.11 (95%CI -1.66, -0.56). This was robust to a pre-specified sensitivity analyses, but there was evidence suggestive of publication bias. Short-term medication scores were reduced SMD -1.21 (95%CI -1.87, -0.54), again with evidence of potential publication bias. There was no reduction in short-term combined medication and symptom scores SMD 0.17 (95%CI -0.23, 0.58), but one study showed a beneficial long-term effect. For secondary outcomes subcutaneous immunotherapy (SCIT) improved quality of life and decreased allergen specific airways hyperreactivity (AHR) but this was not the case for sub-lingual immunotherapy (SLIT). There were no consistent effects on asthma control, exacerbations, lung function, and non-specific AHR. AIT resulted in a modest increased risk of adverse events (AEs). Although relatively uncommon, systemic AEs were more frequent with SCIT; however no fatalities were reported. The limited evidence on cost-effectiveness was mainly available for sublingual immunotherapy (SLIT) and this suggested that SLIT is likely to be cost-effective.

CONCLUSIONS: AIT can achieve substantial reductions in short-term symptom and medication scores in allergic asthma. It was however associated with a modest increased risk of systemic and local AEs. More data are needed in relation to secondary outcomes, longer-term effectiveness and cost-effectiveness. This article is protected by copyright. All rights reserved.

Original language	English
Journal	Allergy
Early online date	19 May 2017
DOIs	https://doi.org/10.1111/all.13208
Publication status	E-pub ahead of print - 19 May 2017

Keywords / Materials (for Non-textual outputs)

Journal Article
Review

Access to Document

10.1111/all.13208

Dhami_et_al-2017-AllergyAccepted author manuscript, 0.98 MB

Cite this

Dhami, S., Kakourou, A., Asamoah, F., Agache, I., Lau, S., Marek, J., Muraro, A., Roberts, G., Akdis, C. A., Bonini, M., Cavkaytar, O., Flood, B., Gajdanowicz, P., Izuhara, K., Kalayci, Ö., Mosges, R., Palomares, O., Pfaar, O., Smolinska, S., ... Sheikh, A. (2017). Allergen immunotherapy for allergic asthma: a systematic review and meta-analysis. Allergy. Advance online publication. https://doi.org/10.1111/all.13208

@article{bf10a522b3af4fa390392010ddf4767e,

title = "Allergen immunotherapy for allergic asthma: a systematic review and meta-analysis",

abstract = "BACKGROUND: To inform the development of the European Academy of Allergy and Clinical Immunonology's (EAACI) Guidelines on Allergen Immunotherapy (AIT) for allergic asthma, we assessed the evidence on the effectiveness, cost-effectiveness and safety of AIT.METHODS: We performed a systematic review, which involved searching nine databases. Studies were screened against pre-defined eligibility criteria and critically appraised using established instruments. Data were synthesized using random-effects meta-analyses.RESULTS: 98 studies satisfied the inclusion criteria. Short-term symptom scores were reduced with a standardized mean difference (SMD) of -1.11 (95%CI -1.66, -0.56). This was robust to a pre-specified sensitivity analyses, but there was evidence suggestive of publication bias. Short-term medication scores were reduced SMD -1.21 (95%CI -1.87, -0.54), again with evidence of potential publication bias. There was no reduction in short-term combined medication and symptom scores SMD 0.17 (95%CI -0.23, 0.58), but one study showed a beneficial long-term effect. For secondary outcomes subcutaneous immunotherapy (SCIT) improved quality of life and decreased allergen specific airways hyperreactivity (AHR) but this was not the case for sub-lingual immunotherapy (SLIT). There were no consistent effects on asthma control, exacerbations, lung function, and non-specific AHR. AIT resulted in a modest increased risk of adverse events (AEs). Although relatively uncommon, systemic AEs were more frequent with SCIT; however no fatalities were reported. The limited evidence on cost-effectiveness was mainly available for sublingual immunotherapy (SLIT) and this suggested that SLIT is likely to be cost-effective.CONCLUSIONS: AIT can achieve substantial reductions in short-term symptom and medication scores in allergic asthma. It was however associated with a modest increased risk of systemic and local AEs. More data are needed in relation to secondary outcomes, longer-term effectiveness and cost-effectiveness. This article is protected by copyright. All rights reserved.",

keywords = "Journal Article, Review",

author = "Sangeeta Dhami and Artemisia Kakourou and Felix Asamoah and Ioana Agache and Susanne Lau and Jutel Marek and Antonella Muraro and Graham Roberts and Akdis, {Cezmi A} and Matteo Bonini and Ozlem Cavkaytar and Breda Flood and Pawel Gajdanowicz and Kenji Izuhara and {\"O}mer Kalayci and Ralph Mosges and Oscar Palomares and Oliver Pfaar and Sylwia Smolinska and Milena Sokolowska and Miqdad Asaria and Gopal Netuveli and Hader Zaman and Ather Akhlaq and Aziz Sheikh",

year = "2017",

month = may,

day = "19",

doi = "10.1111/all.13208",

language = "English",

journal = "Allergy",

issn = "0105-4538",

publisher = "Wiley-Blackwell",

}

Dhami, S, Kakourou, A, Asamoah, F, Agache, I, Lau, S, Marek, J, Muraro, A, Roberts, G, Akdis, CA, Bonini, M, Cavkaytar, O, Flood, B, Gajdanowicz, P, Izuhara, K, Kalayci, Ö, Mosges, R, Palomares, O, Pfaar, O, Smolinska, S, Sokolowska, M, Asaria, M, Netuveli, G, Zaman, H, Akhlaq, A & Sheikh, A 2017, 'Allergen immunotherapy for allergic asthma: a systematic review and meta-analysis', Allergy. https://doi.org/10.1111/all.13208

TY - JOUR

T1 - Allergen immunotherapy for allergic asthma

T2 - a systematic review and meta-analysis

AU - Dhami, Sangeeta

AU - Kakourou, Artemisia

AU - Asamoah, Felix

AU - Agache, Ioana

AU - Lau, Susanne

AU - Marek, Jutel

AU - Muraro, Antonella

AU - Roberts, Graham

AU - Akdis, Cezmi A

AU - Bonini, Matteo

AU - Cavkaytar, Ozlem

AU - Flood, Breda

AU - Gajdanowicz, Pawel

AU - Izuhara, Kenji

AU - Kalayci, Ömer

AU - Mosges, Ralph

AU - Palomares, Oscar

AU - Pfaar, Oliver

AU - Smolinska, Sylwia

AU - Sokolowska, Milena

AU - Asaria, Miqdad

AU - Netuveli, Gopal

AU - Zaman, Hader

AU - Akhlaq, Ather

AU - Sheikh, Aziz

PY - 2017/5/19

Y1 - 2017/5/19

N2 - BACKGROUND: To inform the development of the European Academy of Allergy and Clinical Immunonology's (EAACI) Guidelines on Allergen Immunotherapy (AIT) for allergic asthma, we assessed the evidence on the effectiveness, cost-effectiveness and safety of AIT.METHODS: We performed a systematic review, which involved searching nine databases. Studies were screened against pre-defined eligibility criteria and critically appraised using established instruments. Data were synthesized using random-effects meta-analyses.RESULTS: 98 studies satisfied the inclusion criteria. Short-term symptom scores were reduced with a standardized mean difference (SMD) of -1.11 (95%CI -1.66, -0.56). This was robust to a pre-specified sensitivity analyses, but there was evidence suggestive of publication bias. Short-term medication scores were reduced SMD -1.21 (95%CI -1.87, -0.54), again with evidence of potential publication bias. There was no reduction in short-term combined medication and symptom scores SMD 0.17 (95%CI -0.23, 0.58), but one study showed a beneficial long-term effect. For secondary outcomes subcutaneous immunotherapy (SCIT) improved quality of life and decreased allergen specific airways hyperreactivity (AHR) but this was not the case for sub-lingual immunotherapy (SLIT). There were no consistent effects on asthma control, exacerbations, lung function, and non-specific AHR. AIT resulted in a modest increased risk of adverse events (AEs). Although relatively uncommon, systemic AEs were more frequent with SCIT; however no fatalities were reported. The limited evidence on cost-effectiveness was mainly available for sublingual immunotherapy (SLIT) and this suggested that SLIT is likely to be cost-effective.CONCLUSIONS: AIT can achieve substantial reductions in short-term symptom and medication scores in allergic asthma. It was however associated with a modest increased risk of systemic and local AEs. More data are needed in relation to secondary outcomes, longer-term effectiveness and cost-effectiveness. This article is protected by copyright. All rights reserved.

AB - BACKGROUND: To inform the development of the European Academy of Allergy and Clinical Immunonology's (EAACI) Guidelines on Allergen Immunotherapy (AIT) for allergic asthma, we assessed the evidence on the effectiveness, cost-effectiveness and safety of AIT.METHODS: We performed a systematic review, which involved searching nine databases. Studies were screened against pre-defined eligibility criteria and critically appraised using established instruments. Data were synthesized using random-effects meta-analyses.RESULTS: 98 studies satisfied the inclusion criteria. Short-term symptom scores were reduced with a standardized mean difference (SMD) of -1.11 (95%CI -1.66, -0.56). This was robust to a pre-specified sensitivity analyses, but there was evidence suggestive of publication bias. Short-term medication scores were reduced SMD -1.21 (95%CI -1.87, -0.54), again with evidence of potential publication bias. There was no reduction in short-term combined medication and symptom scores SMD 0.17 (95%CI -0.23, 0.58), but one study showed a beneficial long-term effect. For secondary outcomes subcutaneous immunotherapy (SCIT) improved quality of life and decreased allergen specific airways hyperreactivity (AHR) but this was not the case for sub-lingual immunotherapy (SLIT). There were no consistent effects on asthma control, exacerbations, lung function, and non-specific AHR. AIT resulted in a modest increased risk of adverse events (AEs). Although relatively uncommon, systemic AEs were more frequent with SCIT; however no fatalities were reported. The limited evidence on cost-effectiveness was mainly available for sublingual immunotherapy (SLIT) and this suggested that SLIT is likely to be cost-effective.CONCLUSIONS: AIT can achieve substantial reductions in short-term symptom and medication scores in allergic asthma. It was however associated with a modest increased risk of systemic and local AEs. More data are needed in relation to secondary outcomes, longer-term effectiveness and cost-effectiveness. This article is protected by copyright. All rights reserved.

KW - Journal Article

KW - Review

U2 - 10.1111/all.13208

DO - 10.1111/all.13208

M3 - Literature review

C2 - 28543086

SN - 0105-4538

JO - Allergy

JF - Allergy

ER -

Allergen immunotherapy for allergic asthma: a systematic review and meta-analysis

Abstract / Description of output

Keywords / Materials (for Non-textual outputs)

Access to Document

Fingerprint

Cite this