Evidence-Based Health Care Ltd, Edinburgh, UK.
Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
Allergy. 2017 Dec;72(12):1825-1848. doi: 10.1111/all.13208. Epub 2017 Jul 6.
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.
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.
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.
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.
为了为欧洲过敏与临床免疫学会（EAACI）的变应原免疫疗法（AIT）治疗过敏性哮喘指南的制定提供信息，我们评估了 AIT 的有效性、成本效益和安全性证据。
我们进行了系统评价，其中包括搜索九个数据库。根据预先确定的纳入标准筛选研究，并使用既定工具进行批判性评估。使用随机效应荟萃分析综合数据。
98 项研究符合纳入标准。短期症状评分降低，标准化均数差（SMD）为-1.11（95%置信区间-1.66，-0.56）。这一结果在预先指定的敏感性分析中是稳健的，但存在提示发表偏倚的证据。短期药物评分降低 SMD-1.21（95%置信区间-1.87，-0.54），同样存在潜在的发表偏倚证据。短期联合药物和症状评分无降低 SMD 0.17（95%置信区间-0.23，0.58），但一项研究显示出长期有益的效果。对于次要结局，皮下免疫疗法（SCIT）改善了生活质量并降低了过敏原特异性气道高反应性（AHR），但舌下免疫疗法（SLIT）并非如此。对哮喘控制、加重、肺功能和非特异性 AHR 没有一致的影响。AIT 导致不良反应（AE）的风险适度增加。尽管相对罕见，但全身性 AE 更常见于 SCIT；然而，没有报告死亡事件。关于成本效益的有限证据主要可用于舌下免疫疗法（SLIT），这表明 SLIT 可能具有成本效益。
AIT 可在过敏性哮喘中实现短期症状和药物评分的显著降低。然而，它与全身性和局部 AE 风险适度增加相关。需要更多关于次要结局、长期有效性和成本效益的数据。
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