变应性鼻结膜炎的变应原免疫治疗：系统评价的系统概述
Allergen immunotherapy for allergic rhinoconjunctivitis: a systematic overview of systematic reviews.
作者信息
Nurmatov Ulugbek, Dhami Sangeeta, Arasi Stefania, Roberts Graham, Pfaar Oliver, Muraro Antonella, Ansotegui Ignacio J, Calderon Moises, Cingi Cemal, Durham Stephen, van Wijk Roy Gerth, Halken Susanne, Hamelmann Eckard, Hellings Peter, Jacobsen Lars, Knol Edward, Larenas-Linnemann Desiree, Lin Sandra Y, Maggina Vivian, Oude-Elberink Hanneke, Pajno Giovanni, Panwankar Ruby, Pastorello Elideanna, Pitsios Constantinos, Rotiroti Giuseppina, Timmermans Frans, Tsilochristou Olympia, Varga Eva-Maria, Wilkinson Jamie, Williams Andrew, Worm Margitta, Zhang Luo, Sheikh Aziz
机构信息
Division of Population Medicine, School of Medicine, Cardiff University, Wales, UK.
Evidence-Based Health Care Ltd, Edinburgh, UK.
出版信息
Clin Transl Allergy. 2017 Aug 8;7:24. doi: 10.1186/s13601-017-0159-6. eCollection 2017.
BACKGROUND
The European Academy of Allergy and Clinical Immunology (EAACI) is developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis (ARC). To inform the development of recommendations, we sought to critically assess the systematic review evidence on the effectiveness, safety and cost-effectiveness of AIT for ARC.
METHODS
We undertook a systematic overview, which involved searching nine international biomedical databases from inception to October 31, 2015. Studies were independently screened by two reviewers against pre-defined eligibility criteria and critically appraised using the Critical Appraisal Skills Programme (CASP) Systematic Review Checklist for systematic reviews. Data were descriptively synthesized.
RESULTS
Our searches yielded a total of 5932 potentially eligible studies, from which 17 systematic reviews met our inclusion criteria. Eight of these were judged to be of high, five moderate and three low quality. These reviews suggested that, in carefully selected patients, subcutaneous (SCIT) and sublingual (SLIT) immunotherapy resulted in significant reductions in symptom scores and medication requirements. Serious adverse outcomes were rare for both SCIT and SLIT. Two systematic reviews reported some evidence of potential cost savings associated with use of SCIT and SLIT.
CONCLUSIONS
We found moderate-to-strong evidence that SCIT and SLIT can, in appropriately selected patients, reduce symptoms and medication requirements in patients with ARC with reassuring safety data. This evidence does however need to be interpreted with caution, particularly given the heterogeneity in the populations, allergens and protocols studied. There is a lack of data on the relative effectiveness, cost-effectiveness and safety of SCIT and SLIT. We are now systematically reviewing all the primary studies, including recent evidence that has not been incorporated into the published systematic reviews.
背景
欧洲变态反应和临床免疫学会（EAACI）正在制定变应原免疫疗法（AIT）治疗变应性鼻结膜炎（ARC）的指南。为了为指南建议的制定提供依据，我们试图严格评估关于AIT治疗ARC的有效性、安全性和成本效益的系统评价证据。
方法
我们进行了一项系统综述，检索了9个国际生物医学数据库，检索时间从建库至2015年10月31日。由两名评审员根据预先确定的纳入标准独立筛选研究，并使用批判性评价技能计划（CASP）系统评价清单对系统评价进行严格评价。对数据进行描述性综合分析。
结果
我们的检索共得到5932项可能符合条件的研究，其中17项系统评价符合我们的纳入标准。其中8项被判定为高质量，5项为中等质量，3项为低质量。这些综述表明，在精心挑选的患者中，皮下免疫疗法（SCIT）和舌下免疫疗法（SLIT）可显著降低症状评分和药物需求。SCIT和SLIT的严重不良后果均很少见。两项系统评价报告了一些证据，表明使用SCIT和SLIT可能节省成本。
结论
我们发现中到强的证据表明，在适当选择的患者中，SCIT和SLIT可以减轻ARC患者的症状并减少药物需求，且安全性数据令人放心。然而，这一证据需要谨慎解读，尤其是考虑到所研究的人群、变应原和方案存在异质性。关于SCIT和SLIT的相对有效性、成本效益和安全性的数据不足。我们目前正在系统评价所有的原始研究，包括尚未纳入已发表系统评价的最新证据。
Zotero 插件