TY - JOUR
T1 - Allergen immunotherapy for allergic rhinoconjunctivitis
T2 - A systematic review and meta-analysis
AU - Dhami, S.
AU - Nurmatov, U.
AU - Arasi, S.
AU - Khan, T.
AU - Asaria, M.
AU - Zaman, H.
AU - Agarwal, A.
AU - Netuveli, G.
AU - Roberts, G.
AU - Pfaar, O.
AU - Muraro, A.
AU - Ansotegui, I. J.
AU - Calderon, M.
AU - Cingi, C.
AU - Durham, S.
AU - van Wijk, R. Gerth
AU - Halken, S.
AU - Hamelmann, E.
AU - Hellings, P.
AU - Jacobsen, L.
AU - Knol, E.
AU - Larenas-Linnemann, D.
AU - Lin, S.
AU - Maggina, P.
AU - Mösges, R.
AU - Oude Elberink, H.
AU - Pajno, G.
AU - Panwankar, R.
AU - Pastorello, E.
AU - Penagos, M.
AU - Pitsios, C.
AU - Rotiroti, G.
AU - Timmermans, F.
AU - Tsilochristou, O.
AU - Varga, E. M.
AU - Schmidt-Weber, C.
AU - Wilkinson, J.
AU - Williams, A.
AU - Worm, M.
AU - Zhang, L.
AU - Sheikh, A.
N1 - Funding Information:
Meda, Stada, UCB, and Nuvo; grants from ASIT biotech, Leti, Optima, bitop AG, Hulka, and Ursapharm; grants and personal fees from Bencard and Stallergenes; grants, personal fees, and nonfinancial support from Lofarma; nonfinancial support from Roxall, Atmos, Bionorica, Otonomy, and Ferrero; and personal fees and nonfinancial support from Novartis, outside the submitted work. H. Oude-Elberlink reports grants from ALK-Abelló during the conduct of the study. G. Pajno reports grants from Stallergenes during the conduct of the study. M. Penagos reports personal fees from Stallergenes and ALK, outside the submitted work. G. Rotiroti reports personal fees from ALK-Abelló, outside the submitted work. C. Schmidt-Weber reports grants from Allergopharma and Leti and honorarium from PLS-Design, Allergopharma, and Leti; is a member of scientific advisory board for Leti; holds shares in PLS-Design; and hopes to develop a patent. A. Williams reports other grants from ALK-Abelló (UK) and Diagenics Ltd (UK), outside the submitted work; and travel expenses for education meetings from the EAACI & BSACI. M. Worm reports grants from Allergopharma, Novartis, Stallergenes, Medic Pharma, and ALK-Abelló. A. Sheikh reports grants from the EAACI during the conduct of the study. T. Khan, H. Zaman, A. Agarwal, G. Netuveli, C. Cingi, P. Hellings, E. Knol, S. Lin, V. Mag-gina, R. Panwanker, E. Pastorello, C. Pitsios, F. Timmermans, O. Tsilochristou, E. Varga, J. Wilkinson, and L. Zhang have nothing to disclose.
Funding Information:
The EAACI Rhinoconjunctivitis AIT Taskforce would like to thank Daniela Brombin for her administrative assistance and Stefan Kuzmiak and Zakariya Sheikh for their assistance with information technology support for the activity. Funding information EAACI and BM4SIT project (grant number 601763) in the European Union's Seventh Framework Programme FP7.
Funding Information:
S. Dhami reports grants from EAACI to carry out the review, during the conduct of the study. U. Nurmatov, S. Arasi, and M. Asaria report payment from Evidence-Based Health Care Ltd during the conduct of the study. G. Roberts has a patent issued: “Use of sublingual immunotherapy to prevent the development of allergy in at risk infants”; and his university has received payments for the activities he has undertaken: giving expert advice to ALK, and presenting at company symposia for ALK, Allergen Therapeutics, and Meda, and serving as a member of an Independent Data Monitoring Committee for Merck. O. Pfaar reports grants and personal fees from ALK-Abelló, Allergopharma, Stallergenes Greer, HAL-Allergy Holding B.V./HAL-Allergie GmbH, Bencard Allergie GmbH/Allergy Therapeutics, Lofarma, Biotech Tools S.A., Laboratorios LETI/LETI Pharma, and Anergis S.A.; grants from Biomay, Nuvo, and Circassia; and personal fees from MEDA Pharma, Sanofi US Services, Mobile Chamber Experts (a GA2LEN Partner), Novartis Pharma and Pohl-Boskamp, outside the submitted work. A. Muraro reports personal fees from Novartis, Meda, and Mylan, outside the submitted work. IJ. Ansotegui reports personal fees from SANOFI, Bayer, Pfizer, FAES FARMA, MIT FARMA, HIKMA, Menarini, and Bial Aristegui, outside the submitted work. M. Calderon has received honorarium in advisory boards for ALK and Hal-Allergy and served as a speaker for ALK, Merck, and Stallergenes Greer. S. Durham reports grants from Regeneron (USA), Biotech Tools, ALK (Denmark), Food Standards Agency (UK), and National Institute of Health Research (UK) and personal fees from Anergis (Switzerland), Circassia (UK), Bio-may (Austria), Merck, Allergy Therapeutics (UK), ALK (Hørsholm, Denmark), med update GmbH (Germany), and Allergy Therapeutics, outside the submitted work. R. Gerth van Wijk reports personal fees from ALK-Abelló, Circassia, and Allergopharma, during the conduct of the study. S. Halken reports personal fees from ALK-Abelló and from different companies, for example, Meda, Stallergenes, Allergopharma, and ALK-Abelló, outside the submitted work. E. Hamelmann is giving lectures in industry symposia and takes part in advisory board meetings for the following companies: Boehringer Ingelheim, Novartis, ALK, HAL-Allergy, Bencard, Stallergenes, Leti Pharma, and SymbioPharm. L. Jacobsen reports personal fees from EAMG, outside the submitted work. D. Larenas-Linnemann has no influence in the presented paper. R. Mosges reports personal fees from ALK, Allergopharma, Allergy Therapeutics, Friulchem, Hexal, Servier, Klosterfrau, Bayer, FAES, GSK, MSD, Johnson&Johnson,
Publisher Copyright:
© 2017 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.
PY - 2017
Y1 - 2017
N2 - 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, in-progress, 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.
AB - 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, in-progress, 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.
KW - allergen
KW - allergen immunotherapy
KW - allergic rhinoconjunctivitis
KW - subcutaneous
KW - sublingual
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U2 - 10.1111/all.13201
DO - 10.1111/all.13201
M3 - Review article
C2 - 28493631
AN - SCOPUS:85023623258
VL - 72
SP - 1597
EP - 1631
JO - Allergy: European Journal of Allergy and Clinical Immunology
JF - Allergy: European Journal of Allergy and Clinical Immunology
SN - 0105-4538
IS - 11
ER -