Allergen immunotherapy for IgE-mediated food allergy: a systematic review and meta-analysis

被引:327
|
作者
Nurmatov, U. [1 ]
Dhami, S. [2 ]
Arasi, S. [3 ,4 ]
Pajno, G. B. [3 ]
Fernandez-Rivas, M. [5 ]
Muraro, A. [6 ]
Roberts, G. [7 ,8 ,9 ]
Akdis, C. [10 ]
Alvaro-Lozano, M. [11 ]
Beyer, K. [12 ,13 ]
Bindslev-Jensen, C. [14 ,15 ]
Burks, W. [16 ]
du Toit, G. [17 ,18 ]
Ebisawa, M. [19 ]
Eigenmann, P. [20 ,21 ]
Knol, E. [22 ,23 ]
Makela, M. [24 ]
Nadeau, K. C. [25 ]
O'Mahony, L. [26 ]
Papadopoulos, N. [27 ]
Poulsen, L. K. [28 ]
Sackesen, C. [29 ]
Sampson, H. [30 ]
Santos, A. F. [31 ]
van Ree, R. [32 ]
Timmermans, F. [33 ]
Sheikh, A. [34 ]
机构
[1] Cardiff Univ, Sch Med, Div Populat Med Neuadd Meirionnydd, Cardiff, S Glam, Wales
[2] Evidence Based Hlth Care Ltd, Edinburgh, Midlothian, Scotland
[3] Univ Messina, Allergy Unit, Dept Pediat, Messina, Italy
[4] Charite, Dept Pediat Pneumol & Immunol, Mol Allergol & Immunomodulat, Berlin, Germany
[5] Hosp Clin San Carlos, IdISSC, Dept Allergy, Madrid, Spain
[6] Padua Gen Univ Hosp, Food Allergy Referral Ctr Veneto Reg, Dept Women & Child Hlth, Padua, Italy
[7] St Marys Hosp, David Hide Asthma & Allergy Res Ctr, Newport, Isle Of Wlght, England
[8] Univ Southampton, NIHR Resp Biomedial Res Unit, Southampton, Hants, England
[9] Univ Southampton, Fac Med, Southampton, Hants, England
[10] Swiss Inst Allergy & Asthma Res, Davos Pl, Davos, Switzerland
[11] Univ Barcelona, Hosp St Joan, Paediat Allergy & Clin Immunol Sect, Barcelona, Spain
[12] Charite, Pediat Pneumol & Immunol, Berlin, Germany
[13] Icahn Sch Med Mt Sinai, New York, NY 10029 USA
[14] Odense Univ Hosp, Dept Dermatol, Odense, Denmark
[15] Odense Univ Hosp, Allergy Ctr, Odense, Denmark
[16] Univ North Carolina Chapel Hill, Sch Med, Dept Pediat, Chapel Hill, NC USA
[17] St Thomas NHS Fdn Trust, Kings Coll London, MRC, Dept Paediat Allergy,Div Asthma Allergy & Lung Bi, London, England
[18] St Thomas NHS Fdn Trust, Kings Coll London, Ctr Allerg Mech Asthma, London, England
[19] Sagamihara Natl Hosp, Clin Res Ctr Allergy & Rheumatol, Dept Allergy, Sagamihara, Kanagawa, Japan
[20] Univ Geneva, Univ Hosp Geneva, Geneva, Switzerland
[21] Univ Geneva, Med Sch, Geneva, Switzerland
[22] Univ Med Ctr, Dept Immunol, Utrecht, Netherlands
[23] Univ Med Ctr, Dept Dermatol & Allergol, Utrecht, Netherlands
[24] Helsinki Univ Hosp, Skin & Allergy Hosp, Helsinki, Finland
[25] Stanford Univ, Dept Pediat, Div Immunol Allergy & Rheumatol, Stanford, CA 94305 USA
[26] Univ Zurich, Swiss Inst Allergy & Asthma Res SIAF, Davos, Switzerland
[27] Univ Athens, Pediat Clin 2, Dept Allergy, Athens, Greece
[28] Copenhagen Univ Hosp, Dept Allergy Clin, Gentofte, Denmark
[29] Koc Univ Hosp, Dept Pediat Allergist, Istanbul, Turkey
[30] Mt Sinai Hosp, WAO, New York, NY 10029 USA
[31] Guys & St Thomas Hosp NHS Fdn Trust, Kings Coll London, Div Asthma Allergy & Lung Biol, Dept Paediat Allergy, London, England
[32] Acad Med Ctr, Dept Otorhinolaryngol, Amsterdam, Netherlands
[33] Nederlands Anafylaxis Netwerk European Anaphylaxi, Dordrecht, Netherlands
[34] Univ Edinburgh, Usher Inst Populat Hlth Sci & Informat, Ctr Med Informat, Allergy & Resp Res Grp, Edinburgh, Midlothian, Scotland
关键词
allergen immunotherapy; food allergy; safety; desensitization; sustained unresponsiveness; ORAL TOLERANCE INDUCTION; COWS MILK ALLERGY; DOUBLE-BLIND; SUBLINGUAL IMMUNOTHERAPY; PEANUT ALLERGY; EGG ALLERGY; ANAPHYLACTIC REACTIONS; CHILDREN; DESENSITIZATION; SAFETY;
D O I
10.1111/all.13124
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
Background: The European Academy of Allergy and Clinical Immunology (EAACI) is developing Guidelines for Allergen Immunotherapy (AIT) for IgE-mediated Food Allergy. To inform the development of clinical recommendations, we sought to critically assess evidence on the effectiveness, safety and cost-effectiveness of AIT in the management of food allergy. Methods: We undertook a systematic review and meta-analysis that involved searching nine international electronic databases for randomized controlled trials (RCTs) and nonrandomized studies (NRS). Eligible studies were independently assessed by two reviewers against predefined eligibility criteria. The quality of studies was assessed using the Cochrane Risk of Bias tool for RCTs and the Cochrane ACROBAT-NRS tool for quasi-RCTs. Random-effects meta-analyses were undertaken, with planned subgroup and sensitivity analyses. Results: We identified 1814 potentially relevant papers from which we selected 31 eligible studies, comprising of 25 RCTs and six NRS, studying a total of 1259 patients. Twenty-five trials evaluated oral immunotherapy (OIT), five studies investigated sublingual immunotherapy, and one study evaluated epicutaneous immunotherapy. The majority of these studies were in children. Twenty-seven studies assessed desensitization, and eight studies investigated sustained unresponsiveness postdiscontinuation of AIT. Meta-analyses demonstrated a substantial benefit in terms of desensitization (risk ratio (RR) = 0.16, 95% CI 0.10, 0.26) and suggested, but did not confirm sustained unresponsiveness (RR = 0.29, 95% CI 0.08, 1.13). Only one study reported on disease-specific quality of life (QoL), which reported no comparative results between OIT and control group. Meta-analyses revealed that the risk of experiencing a systemic adverse reaction was higher in those receiving AIT, with a more marked increase in the risk of local adverse reactions. Sensitivity analysis excluding those studies judged to be at high risk of bias demonstrated the robustness of summary estimates of effectiveness and safety of AIT for food allergy. None of the studies reported data on health economic analyses. Conclusions: AIT may be effective in raising the threshold of reactivity to a range of foods in children with IgE-mediated food allergy whilst receiving (i.e. desensitization) and post-discontinuation of AIT. It is, however, associated with a modest increased risk in serious systemic adverse reactions and a substantial increase in minor local adverse reactions. More data are needed in relation to adults, long term effects, the impact on QoL and the cost-effectiveness of AIT.
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收藏
页码:1133 / 1147
页数:15
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