Allergen immunotherapy for allergic rhinoconjunctivitis: A systematic review and meta-analysis
S. Dhami,Ulugbek Nurmatov,Stefania Arasi,Stefania Arasi,Tahir Mehmood Khan,Miqdad Asaria,Hadar Zaman,Arnav Agarwal,G. Netuveli,Graham Roberts,Graham Roberts,Graham Roberts,Oliver Pfaar,Antonella Muraro,I. J. Ansotegui,Moises A. Calderon,Cemal Cingi,Stephen R. Durham,R. Gerth van Wijk,Susanne Halken,Eckard Hamelmann,Eckard Hamelmann,P W Hellings,Lars Jacobsen,Edward F. Knol,Désirée Larenas-Linnemann,Sandra Y. Lin,Paraskevi Maggina,R. Mösges,H. N. G. Oude Elberink,Giovanni Battista Pajno,Ruby Panwankar,Elide A. Pastorello,Martin Penagos,Constantinos Pitsios,Giuseppina Rotiroti,Frans Timmermans,Olympia Tsilochristou,Eva-Maria Varga,Carsten B. Schmidt-Weber,Jamie Wilkinson,Andrew James Williams,Margitta Worm,Lewei Zhang,Aziz Sheikh +44 more
TLDR
A systematic review to assess the effectiveness, cost‐effectiveness, and safety of AIT in the management of allergic rhinoconjunctivitis found it to be effective, cost-effective, and safe.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. 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 Methods: We searched nine international biomedical databases for published, in-progress, and unpublished evidence.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.read more
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Journal ArticleDOI
EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis
Graham Roberts,Graham Roberts,Graham Roberts,Oliver Pfaar,Cezmi A. Akdis,I. J. Ansotegui,Stephen R. Durham,R. Gerth van Wijk,Susanne Halken,Désirée Larenas-Linnemann,Ruby Pawankar,Constantinos Pitsios,Aziz Sheikh,Margitta Worm,Stefania Arasi,Stefania Arasi,Moises A. Calderon,Cemal Cingi,S. Dhami,Jean-Luc Fauquert,Eckard Hamelmann,P W Hellings,Lars Jacobsen,Edward F. Knol,Sandra Y. Lin,P. Maggina,Ralph Mösges,J. N. G. Oude Elberink,Giovanni B. Pajno,Elideanna Pastorello,Martin Penagos,G. Rotiroti,Carsten B. Schmidt-Weber,Frans Timmermans,Olympia Tsilochristou,Eva-Maria Varga,Jamie Wilkinson,Andrew James Williams,Lewei Zhang,Ioana Agache,E. Angier,Montserrat Fernandez-Rivas,Marek Jutel,Steffen Lau,R. van Ree,Dermot Ryan,Gunter J. Sturm,Antonella Muraro +47 more
TL;DR: In general, broad evidence for the clinical efficacy of AIT for AR exists but a product‐specific evaluation of evidence is recommended, and SCIT and SLIT are recommended for both seasonal and perennial AR for its short‐term benefit.
Journal ArticleDOI
Mechanisms of allergen immunotherapy for inhaled allergens and predictive biomarkers.
TL;DR: Understanding mechanisms underlying induction and persistence of tolerance should identify predictive biomarkers of clinical response and discover novel and more effective strategies for immunotherapy.
Journal ArticleDOI
EAACI guidelines on allergen immunotherapy: Prevention of allergy
Susanne Halken,Désirée Larenas-Linnemann,Graham Roberts,Graham Roberts,Graham Roberts,Moises A. Calderon,Elisabeth Angier,Oliver Pfaar,Dermot Ryan,Ioana Agache,Ignacio J. Ansotegui,Stefania Arasi,Stefania Arasi,George Du Toit,Montserrat Fernandez-Rivas,Roy Geerth van Wijk,Marek Jutel,Jörg Kleine-Tebbe,Susanne Lau,Paolo Maria Matricardi,Giovanni B. Pajno,Nikolaos G. Papadopoulos,Nikolaos G. Papadopoulos,Martin Penagos,Alexandra F. Santos,Gunter J. Sturm,Frans Timmermans,R. van Ree,Eva-Maria Varga,Ulrich Wahn,Maria Kristiansen,Sangeeta Dhami,Aziz Sheikh,Antonella Muraro +33 more
TL;DR: It is recommended that a 3‐year course of subcutaneous or sublingual AIT can be recommended for children and adolescents with moderate‐to‐severe allergic rhinitis to prevent asthma for up to 2 years post‐AIT in addition to its sustained effect on AR symptoms and medication.
Journal ArticleDOI
EAACI Allergen Immunotherapy User's Guide.
Montserrat Alvaro-Lozano,Cezmi A. Akdis,Mübeccel Akdis,Cherry Alviani,Cherry Alviani,Cherry Alviani,Elisabeth Angier,Stefania Arasi,Lisa Arzt-Gradwohl,Domingo Barber,Domingo Barber,Raphaëlle Bazire,Ozlem Cavkaytar,Pasquale Comberiati,Pasquale Comberiati,Stephanie Dramburg,Stephen R. Durham,Aarif O. Eifan,Leandra Forchert,Susanne Halken,Max Kirtland,Umut Can Kucuksezer,Janice A. Layhadi,Paolo Maria Matricardi,Antonella Muraro,Cevdet Ozdemir,Giovanni Battista Pajno,Oliver Pfaar,Ekaterina Potapova,Carmen Riggioni,Graham Roberts,Graham Roberts,Graham Roberts,Pablo Rodríguez del Río,Mohamed H. Shamji,Gunter J. Sturm,Marta Vazquez-Ortiz +36 more
TL;DR: This user's guide reviews current knowledge and aims to provide clinical guidance to healthcare professionals taking care of children undergoing allergen immunotherapy to improve the patient's adherence to the treatment.
Journal ArticleDOI
Rhinitis 2020: A practice parameter update
TL;DR: Algorithms based on a combination of evidence and expert opinion are provided to guide in the selection of pharmacologic options for intermittent and persistent AR and NAR.
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