PMID- 28543086 OWN - NLM STAT- MEDLINE DCOM- 20180621 LR - 20220408 IS - 1398-9995 (Electronic) IS - 0105-4538 (Linking) VI - 72 IP - 12 DP - 2017 Dec TI - Allergen immunotherapy for allergic asthma: A systematic review and meta-analysis. PG - 1825-1848 LID - 10.1111/all.13208 [doi] AB - BACKGROUND: To inform the development of the European Academy of Allergy and Clinical Immunology'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 predefined 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 prespecified 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 airway hyperreactivity (AHR), but this was not the case for sublingual immunotherapy (SLIT). There were no consistent effects on asthma control, exacerbations, lung function, and nonspecific 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. CI - (c) 2017 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd. FAU - Dhami, S AU - Dhami S AUID- ORCID: 0000-0002-2823-3258 AD - Evidence-Based Health Care Ltd, Edinburgh, UK. FAU - Kakourou, A AU - Kakourou A AD - Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece. FAU - Asamoah, F AU - Asamoah F AD - Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. FAU - Agache, I AU - Agache I AD - Faculty of Medicine, Department of Allergy and Clinical Immunology, Transylvania University Brasov, Brasov, Romania. FAU - Lau, S AU - Lau S AD - Department of Pediatric Pneumology and Immunology, Charite Universitatsmedizin, Berlin, Germany. FAU - Jutel, M AU - Jutel M AD - Wroclaw Medical University, Wroclaw, Poland. AD - ALL-MED Medical Research Institute, Wroclaw, Poland. FAU - Muraro, A AU - Muraro A AD - Food Allergy Referral Centre Veneto Region, University Hospital of Padua, Padua, Italy. FAU - Roberts, G AU - Roberts G AD - The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, UK. AD - NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK. AD - Faculty of Medicine, University of Southampton, Southampton, UK. FAU - Akdis, C A AU - Akdis CA AD - Swiss Institute for Allergy and Asthma Research, Christine Kuhne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland. FAU - Bonini, M AU - Bonini M AD - National Heart and Lung Institute, Imperial College London, London, UK. FAU - Cavkaytar, O AU - Cavkaytar O AD - Department of Allergy and Clinical Immunology, Sami Ulus Women's & Children's Diseases Training and Research Hospital, Ankara, Turkey. AD - Department of Pediatric Allergy and Immunology, Ulus Women's & Children's Diseases Training and Research Hospital, Ankara, Turkey. FAU - Flood, B AU - Flood B AD - European Federation of Allergy and Airways Diseases Patients Association, Brussels, Belgium. FAU - Gajdanowicz, P AU - Gajdanowicz P AD - Wroclaw Medical University, Wroclaw, Poland. FAU - Izuhara, K AU - Izuhara K AD - Saga Medical School, Nabeshima, Japan. FAU - Kalayci, O AU - Kalayci O AD - Hacettepe University, Ankara, Turkey. FAU - Mosges, R AU - Mosges R AD - Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Koln, Germany. FAU - Palomares, O AU - Palomares O AD - Department of Biochemistry and Molecular Biology, Complutense University of Madrid, Madrid, Spain. FAU - Pfaar, O AU - Pfaar O AUID- ORCID: 0000-0003-4374-9639 AD - Department of Otorhinolaryngology, Head and Neck Surgery, Universitatsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. AD - Center for Rhinology and Allergology, Wiesbaden, Germany. FAU - Smolinska, S AU - Smolinska S AD - Wroclaw Medical University, Wroclaw, Poland. AD - ALL-MED Medical Research Institute, Wroclaw, Poland. FAU - Sokolowska, M AU - Sokolowska M AD - Swiss Institute for Allergy and Asthma Research, Christine Kuhne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland. FAU - Asaria, M AU - Asaria M AUID- ORCID: 0000-0002-3538-4417 AD - Centre for Health Economics, University of York, York, UK. FAU - Netuveli, G AU - Netuveli G AD - Institute for Health and Human Development, University of East London, London, UK. FAU - Zaman, H AU - Zaman H AD - Bradford School of Pharmacy, Bradford, UK. FAU - Akhlaq, A AU - Akhlaq A AD - Health and Hospital Management, Institute of Business Management, Karachi, Pakistan. FAU - Sheikh, A AU - Sheikh A AD - Asthma UK Centre for Applied Research, The University of Edinburgh, Edinburgh, UK. LA - eng GR - G1000758/MRC_/Medical Research Council/United Kingdom PT - Journal Article PT - Meta-Analysis PT - Review PT - Systematic Review DEP - 20170706 PL - Denmark TA - Allergy JT - Allergy JID - 7804028 RN - 0 (Allergens) SB - IM MH - Allergens/*immunology MH - Asthma/diagnosis/*immunology/*therapy MH - Cost-Benefit Analysis MH - *Desensitization, Immunologic/adverse effects/methods MH - Humans MH - Injections, Subcutaneous MH - Quality of Life MH - Randomized Controlled Trials as Topic MH - Respiratory Function Tests MH - Sublingual Immunotherapy MH - Symptom Assessment MH - Time Factors MH - Treatment Outcome OTO - NOTNLM OT - allergen immunotherapy OT - allergic asthma OT - cost-effectiveness OT - effectiveness OT - safety EDAT- 2017/05/26 06:00 MHDA- 2018/06/22 06:00 CRDT- 2017/05/26 06:00 PHST- 2017/05/15 00:00 [accepted] PHST- 2017/05/26 06:00 [pubmed] PHST- 2018/06/22 06:00 [medline] PHST- 2017/05/26 06:00 [entrez] AID - 10.1111/all.13208 [doi] PST - ppublish SO - Allergy. 2017 Dec;72(12):1825-1848. doi: 10.1111/all.13208. Epub 2017 Jul 6.