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01.12.2017 | Review | Ausgabe 1/2017 Open Access

Clinical and Translational Allergy 1/2017

Allergen immunotherapy for allergic rhinoconjunctivitis: a systematic overview of systematic reviews

Zeitschrift:
Clinical and Translational Allergy > Ausgabe 1/2017
Autoren:
Ulugbek Nurmatov, Sangeeta Dhami, Stefania Arasi, Graham Roberts, Oliver Pfaar, Antonella Muraro, Ignacio J. Ansotegui, Moises Calderon, Cemal Cingi, Stephen Durham, Roy Gerth van Wijk, Susanne Halken, Eckard Hamelmann, Peter Hellings, Lars Jacobsen, Edward Knol, Desiree Larenas-Linnemann, Sandra Y. Lin, Vivian Maggina, Hanneke Oude-Elberink, Giovanni Pajno, Ruby Panwankar, Elideanna Pastorello, Constantinos Pitsios, Giuseppina Rotiroti, Frans Timmermans, Olympia Tsilochristou, Eva-Maria Varga, Jamie Wilkinson, Andrew Williams, Margitta Worm, Luo Zhang, Aziz Sheikh
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Electronic supplementary material

The online version of this article (doi:10.​1186/​s13601-017-0159-6) contains supplementary material, which is available to authorized users.

Abstract

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.
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