Evidence-Based Health Care Ltd, Edinburgh, UK.
Division of Population Medicine, School of Medicine, Cardiff University, Heath Park, Cardiff, UK.
Allergy. 2017 Nov;72(11):1597-1631. doi: 10.1111/all.13201. Epub 2017 Jul 14.
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.
We searched nine international biomedical databases for published, in-progress, and unpublished evidence.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.
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.
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.
欧洲过敏与临床免疫学会（EAACI）正在制定变应原免疫治疗（AIT）治疗变应性鼻结膜炎的指南。为了为临床建议的制定提供信息，我们进行了一项系统评价，以评估 AIT 在变应性鼻结膜炎管理中的有效性、成本效益和安全性。
我们在九个国际生物医学数据库中搜索了已发表、进行中和未发表的证据。两名评审员根据预先设定的纳入标准独立筛选研究，并使用既定工具对其进行批判性评估。我们感兴趣的主要结局指标是症状、药物和症状与药物联合评分。次要结局指标包括成本效益和安全性。使用随机效应荟萃分析对数据进行描述性总结，然后进行定量综合。
我们共确定了 5960 项研究，其中 160 项研究符合纳入标准。有大量证据表明，标准化均数差（SMD）的症状（SMD-0.53，95%置信区间-0.63，-0.42）、药物（SMD-0.37，95%置信区间-0.49，-0.26）和症状与药物联合（SMD-0.49，95%置信区间-0.69，-0.30）评分有显著降低，且这些结果在预先指定的敏感性分析中是稳健的。相比之下，关于 AIT 停药后疗效的证据则较为有限，表明症状评分有所改善。
AIT 可有效改善变应性鼻结膜炎患者的症状、药物和症状与药物联合评分，且有证据表明，在停止治疗后，这些获益与症状评分相关。
