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

Sangeeta Dhami; Ulugbek Nurmatov; Stefania Arasi; Tahir Khan; Miqdad Asaria; Hadar Zaman; Arnav Agarwal; Gopal Netuveli; Graham Roberts; Oliver Pfaar; Antonella Muraro; Ignacio J Ansotegui; Moises Calderon; Cemal Cingi; Stephen Durham; Ronald Gerth van Wijk; Susanne Halken; Eckard Hamelmann; Peter Hellings; Lars Jacobsen; Edward Knol; Desiree Larenas Linnemann; Sandra Lin; Paraskevi Maggina; Ralph Mösges; Hanneke Oude Elberink; Giovanni Pajno; Ruby Panwankar; Elide Pastorello; Martin Penagos; Constantinos Pitsios; Giuseppina Rotiroti; Frans Timmermans; Olympia Tsilochristou; Eva-Maria Varga; Carsten Schmidt-Weber; Jamie Wilkinson; Andrew Williams; Margitta Worm; Luo Zhang; Aziz Sheikh

doi:10.1111/all.13201

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

Sangeeta Dhami, Ulugbek Nurmatov, Stefania Arasi, Tahir Khan, Miqdad Asaria, Hadar Zaman, Arnav Agarwal, Gopal Netuveli, Graham Roberts, Oliver Pfaar, Antonella Muraro, Ignacio J Ansotegui, Moises Calderon, Cemal Cingi, Stephen Durham, Ronald Gerth van Wijk, Susanne Halken, Eckard Hamelmann, Peter Hellings, Lars JacobsenEdward Knol, Desiree Larenas Linnemann, Sandra Lin, Paraskevi Maggina, Ralph Mösges, Hanneke Oude Elberink, Giovanni Pajno, Ruby Panwankar, Elide Pastorello, Martin Penagos, Constantinos Pitsios, Giuseppina Rotiroti, Frans Timmermans, Olympia Tsilochristou, Eva-Maria Varga, Carsten Schmidt-Weber, Jamie Wilkinson, Andrew Williams, Margitta Worm, Luo Zhang, Aziz Sheikh

Centre for Health Economics

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

Abstract

BACKGROUND: The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis. In order 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allergic rhinoconjunctivitis METHODS: We searched 15 international biomedical databases for published, in progress and unpublished evidence. Studies were independently screened by two reviewers against pre-defined 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 5932 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 whilst on treatment that were robust to pre-specified sensitivity analyses. There was in comparison a more modest body of evidence on effectiveness post-discontinuation of AIT, this 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 whilst on treatment, and there is some evidence suggesting that these benefits are maintained in relation to symptom scores after discontinuation of therapy. This article is protected by copyright. All rights reserved.

Original language	English
Journal	Allergy
DOIs	https://doi.org/10.1111/all.13201
Publication status	Published - 11 May 2017

Bibliographical note

This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details

Keywords

Journal Article
Review

Access to Document

10.1111/all.13201

Dhami_et_al-2017-Allergy
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Cite this

Dhami, S., Nurmatov, U., Arasi, S., Khan, T., Asaria, M., Zaman, H., Agarwal, A., Netuveli, G., Roberts, G., Pfaar, O., Muraro, A., Ansotegui, I. J., Calderon, M., Cingi, C., Durham, S., van Wijk, R. G., Halken, S., Hamelmann, E., Hellings, P., ... Sheikh, A. (2017). Allergen immunotherapy for allergic rhinoconjunctivitis: a systematic review and meta-analysis. Allergy. https://doi.org/10.1111/all.13201

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abstract = "BACKGROUND: The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis. In order 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 15 international biomedical databases for published, in progress and unpublished evidence. Studies were independently screened by two reviewers against pre-defined 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 5932 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 whilst on treatment that were robust to pre-specified sensitivity analyses. There was in comparison a more modest body of evidence on effectiveness post-discontinuation of AIT, this 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 whilst on treatment, and there is some evidence suggesting that these benefits are maintained in relation to symptom scores after discontinuation of therapy. This article is protected by copyright. All rights reserved.",

keywords = "Journal Article, Review",

author = "Sangeeta Dhami and Ulugbek Nurmatov and Stefania Arasi and Tahir Khan and Miqdad Asaria and Hadar Zaman and Arnav Agarwal and Gopal Netuveli and Graham Roberts and Oliver Pfaar and Antonella Muraro and Ansotegui, {Ignacio J} and Moises Calderon and Cemal Cingi and Stephen Durham and {van Wijk}, {Ronald Gerth} and Susanne Halken and Eckard Hamelmann and Peter Hellings and Lars Jacobsen and Edward Knol and Linnemann, {Desiree Larenas} and Sandra Lin and Paraskevi Maggina and Ralph M{\"o}sges and Elberink, {Hanneke Oude} and Giovanni Pajno and Ruby Panwankar and Elide Pastorello and Martin Penagos and Constantinos Pitsios and Giuseppina Rotiroti and Frans Timmermans and Olympia Tsilochristou and Eva-Maria Varga and Carsten Schmidt-Weber and Jamie Wilkinson and Andrew Williams and Margitta Worm and Luo Zhang and Aziz Sheikh",

note = "This is an author-produced version of the published paper. Uploaded in accordance with the publisher{\textquoteright}s self-archiving policy. Further copying may not be permitted; contact the publisher for details",

year = "2017",

month = may,

day = "11",

doi = "10.1111/all.13201",

language = "English",

journal = "Allergy",

issn = "0105-4538",

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Dhami, S, Nurmatov, U, Arasi, S, Khan, T, Asaria, M, Zaman, H, Agarwal, A, Netuveli, G, Roberts, G, Pfaar, O, Muraro, A, Ansotegui, IJ, Calderon, M, Cingi, C, Durham, S, van Wijk, RG, Halken, S, Hamelmann, E, Hellings, P, Jacobsen, L, Knol, E, Linnemann, DL, Lin, S, Maggina, P, Mösges, R, Elberink, HO, Pajno, G, Panwankar, R, Pastorello, E, Penagos, M, Pitsios, C, Rotiroti, G, Timmermans, F, Tsilochristou, O, Varga, E-M, Schmidt-Weber, C, Wilkinson, J, Williams, A, Worm, M, Zhang, L & Sheikh, A 2017, 'Allergen immunotherapy for allergic rhinoconjunctivitis: a systematic review and meta-analysis', Allergy. https://doi.org/10.1111/all.13201

TY - JOUR

T1 - Allergen immunotherapy for allergic rhinoconjunctivitis

T2 - a systematic review and meta-analysis

AU - Dhami, Sangeeta

AU - Nurmatov, Ulugbek

AU - Arasi, Stefania

AU - Khan, Tahir

AU - Asaria, Miqdad

AU - Zaman, Hadar

AU - Agarwal, Arnav

AU - Netuveli, Gopal

AU - Roberts, Graham

AU - Pfaar, Oliver

AU - Muraro, Antonella

AU - Ansotegui, Ignacio J

AU - Calderon, Moises

AU - Cingi, Cemal

AU - Durham, Stephen

AU - van Wijk, Ronald Gerth

AU - Halken, Susanne

AU - Hamelmann, Eckard

AU - Hellings, Peter

AU - Jacobsen, Lars

AU - Knol, Edward

AU - Linnemann, Desiree Larenas

AU - Lin, Sandra

AU - Maggina, Paraskevi

AU - Mösges, Ralph

AU - Elberink, Hanneke Oude

AU - Pajno, Giovanni

AU - Panwankar, Ruby

AU - Pastorello, Elide

AU - Penagos, Martin

AU - Pitsios, Constantinos

AU - Rotiroti, Giuseppina

AU - Timmermans, Frans

AU - Tsilochristou, Olympia

AU - Varga, Eva-Maria

AU - Schmidt-Weber, Carsten

AU - Wilkinson, Jamie

AU - Williams, Andrew

AU - Worm, Margitta

AU - Zhang, Luo

AU - Sheikh, Aziz

N1 - This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details

PY - 2017/5/11

Y1 - 2017/5/11

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. In order 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 15 international biomedical databases for published, in progress and unpublished evidence. Studies were independently screened by two reviewers against pre-defined 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 5932 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 whilst on treatment that were robust to pre-specified sensitivity analyses. There was in comparison a more modest body of evidence on effectiveness post-discontinuation of AIT, this 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 whilst on treatment, and there is some evidence suggesting that these benefits are maintained in relation to symptom scores after discontinuation of therapy. This article is protected by copyright. All rights reserved.

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. In order 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 15 international biomedical databases for published, in progress and unpublished evidence. Studies were independently screened by two reviewers against pre-defined 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 5932 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 whilst on treatment that were robust to pre-specified sensitivity analyses. There was in comparison a more modest body of evidence on effectiveness post-discontinuation of AIT, this 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 whilst on treatment, and there is some evidence suggesting that these benefits are maintained in relation to symptom scores after discontinuation of therapy. This article is protected by copyright. All rights reserved.

KW - Journal Article

KW - Review

U2 - 10.1111/all.13201

DO - 10.1111/all.13201

M3 - Article

C2 - 28493631

SN - 0105-4538

JO - Allergy

JF - Allergy

ER -