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

Maria Kristiansen; Sangeeta Dhami; Gopal Netuveli; Susanne Halken; Antonella Muraro; 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; A 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, Antonella Muraro, 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, A Sheikh

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Abstract / Description of output

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: 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 to 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 0.29 to 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 to 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 to 2.18. There was no clear evidence of any longer-term reduction in the risk of sensitization: RR=0.47; 95%CI 0.08 to 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. This article is protected by copyright. All rights reserved.

Original language	English
Journal	Pediatric Allergy and Immunology
Volume	28
Issue number	1
Early online date	12 Dec 2016
DOIs	https://doi.org/10.1111/pai.12661
Publication status	Published - Feb 2017

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Kristiansen, M., Dhami, S., Netuveli, G., Halken, S., Muraro, A., 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). 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: 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 to 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 0.29 to 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 to 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 to 2.18. There was no clear evidence of any longer-term reduction in the risk of sensitization: RR=0.47; 95%CI 0.08 to 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. This article is protected by copyright. All rights reserved.",

author = "Maria Kristiansen and Sangeeta Dhami and Gopal Netuveli and Susanne Halken and Antonella Muraro 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 A Sheikh",

year = "2017",

month = feb,

doi = "10.1111/pai.12661",

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journal = "Pediatric Allergy and Immunology",

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Kristiansen, M, Dhami, S, Netuveli, G, Halken, S, Muraro, A, 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. https://doi.org/10.1111/pai.12661

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 - Muraro, Antonella

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, A

PY - 2017/2

Y1 - 2017/2

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: 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 to 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 0.29 to 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 to 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 to 2.18. There was no clear evidence of any longer-term reduction in the risk of sensitization: RR=0.47; 95%CI 0.08 to 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. This article is protected by copyright. All rights reserved.

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: 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 to 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 0.29 to 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 to 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 to 2.18. There was no clear evidence of any longer-term reduction in the risk of sensitization: RR=0.47; 95%CI 0.08 to 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. This article is protected by copyright. All rights reserved.

U2 - 10.1111/pai.12661

DO - 10.1111/pai.12661

M3 - Article

C2 - 27653623

SN - 0905-6157

VL - 28

JO - Pediatric Allergy and Immunology

JF - Pediatric Allergy and Immunology

IS - 1

ER -

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

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