Dow University of Health Sciences, Karachi, Pakistan.
Department of Dermatology, Al-Mustafa Hospital and Rajput General Hospital, Karachi, Pakistan.
Clin Rev Allergy Immunol. 2024 Apr;66(2):125-137. doi: 10.1007/s12016-024-08990-8. Epub 2024 Mar 25.
Peanut allergy is a leading cause of severe food reactions. This meta-analysis evaluates the efficacy and safety of epicutaneous immunotherapy (EPIT) compared to placebo for peanut-allergic individuals. After prospectively registering on PROSPERO, we searched three databases (PubMed, Google Scholar, and Cochrane CENTRAL) and 2 trial registries till September 2023. Analysis was conducted via RevMan where data was computed using risk ratios (RR). The Cochrane Risk of Bias tool and GRADE criteria were used to appraise and evaluate the evidence. From 4927 records, six multicenter randomized placebo-controlled trials comprising 1453 participants were included. The 250 µg EPIT group had a significant increase in successful desensitization compared to placebo (RR: 2.13 (95% C.I: 1.72, 2.64), P < 0.01, I = 0%), while the 100 µg EPIT group did not (RR: 1.54 (95% C.I: 0.92, 2.58), P = 0.10, I = 0%) (moderate certainty evidence). Moreover, there was a significant increase in local (RR: 1.69 (95% C.I: 1.06, 2.68), P = 0.03, I = 89%) and systemic adverse events (RR: 1.75 (95% C.I: 1.14, 2.69), P = 0.01, I = 0%) with EPIT. Additionally, individuals administered EPIT have an increased probability of requiring rescue medications like epinephrine (RR: 1.91 (95% C.I: 1.12, 3.28), P = 0.02, I = 0%) and topical corticosteroids (RR: 1.49 (95% C.I: 1.29, 1.73), P < 0.01, I = 0%) to treat adverse events. The association of adverse events post-treatment including anaphylaxis (RR: 2.31 (95% C.I: 1.00, 5.33), P = 0.05, I = 36%), skin/subcutaneous disorders like erythema or vesicles (RR: 0.93 (95% C.I: 0.79, 1.08), P = 0.33, I = 0%), and respiratory disorders like dyspnea or wheezing (RR: 0.94 (95% C.I: 0.77, 1.15), P = 0.55, I = 0%) with EPIT is inconclusive. EPIT, although effective in desensitization, is linked to an increased risk of adverse events. PROSPERO registration: CRD42023466600.
花生过敏是严重食物过敏反应的主要原因。本荟萃分析评估了与安慰剂相比，经皮免疫治疗（EPIT）在花生过敏个体中的疗效和安全性。在 PROSPERO 前瞻性注册后，我们检索了三个数据库（PubMed、Google Scholar 和 Cochrane CENTRAL）和 2 个试验注册处，检索截至 2023 年 9 月。使用 RevMan 进行分析，使用风险比（RR）计算数据。使用 Cochrane 偏倚风险工具和 GRADE 标准评估和评价证据。从 4927 条记录中，纳入了 6 项多中心随机安慰剂对照试验，共 1453 名参与者。与安慰剂相比，250μg EPIT 组的脱敏成功率显著增加（RR：2.13（95%置信区间：1.72，2.64），P<0.01，I=0%），而 100μg EPIT 组则没有（RR：1.54（95%置信区间：0.92，2.58），P=0.10，I=0%）（中等确定性证据）。此外，EPIT 组局部（RR：1.69（95%置信区间：1.06，2.68），P=0.03，I=89%）和全身不良事件（RR：1.75（95%置信区间：1.14，2.69），P=0.01，I=0%）的发生率显著增加。此外，接受 EPIT 治疗的个体需要使用肾上腺素等救援药物（RR：1.91（95%置信区间：1.12，3.28），P=0.02，I=0%）和局部皮质类固醇（RR：1.49（95%置信区间：1.29，1.73），P<0.01，I=0%）的可能性增加，以治疗不良事件。治疗后不良事件的相关性，包括过敏反应（RR：2.31（95%置信区间：1.00，5.33），P=0.05，I=36%）、皮肤/皮下疾病（如红斑或水疱）（RR：0.93（95%置信区间：0.79，1.08），P=0.33，I=0%）和呼吸系统疾病（如呼吸困难或喘息）（RR：0.94（95%置信区间：0.77，1.15），P=0.55，I=0%）与 EPIT 之间的相关性尚无定论。EPIT 虽然有效脱敏，但与不良事件风险增加有关。PROSPERO 注册：CRD42023466600。
