Allergen immunotherapy for allergic rhinoconjunctivitis: A systematic review and meta‐analysis
2017
Background: The European Academy of Allergy and Clinical Immunology (EAACI) is
in the process of developing Guidelines on Allergen Immunotherapy (AIT) for Allergic
Rhinoconjunctivitis. To inform the development of clinical recommendations, we
undertook a systematic review to assess the effectiveness, cost-effectiveness, and
safety of AIT in the management of allergic rhinoconjunctivitis.
Methods: We searched nine international biomedical databases for published, inprogress,
and unpublished evidence. Studies were independently screened by two
reviewers against predefined eligibility criteria and critically appraised using established
instruments. Our primary outcomes of interest were symptom, medication,
and combined symptom and medication scores. Secondary outcomes of interest
included cost-effectiveness and safety. Data were descriptively summarized and
then quantitatively synthesized using random-effects meta-analyses.
Results: We identified 5960 studies of which 160 studies satisfied our eligibility criteria.
There was a substantial body of evidence demonstrating significant reductions
in standardized mean differences (SMD) of symptom (SMD �0.53, 95% CI �0.63,
�0.42), medication (SMD �0.37, 95% CI �0.49, �0.26), and combined symptom
and medication (SMD �0.49, 95% CI �0.69, �0.30) scores while on treatment that
were robust to prespecified sensitivity analyses. There was in comparison a more
modest body of evidence on effectiveness post-discontinuation of AIT, suggesting a
benefit in relation to symptom scores.
Conclusions: AIT is effective in improving symptom, medication, and combined
symptom and medication scores in patients with allergic rhinoconjunctivitis while on
treatment, and there is some evidence suggesting that these benefits are maintained
in relation to symptom scores after discontinuation of therapy.
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