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Specific allergen immunotherapy for the treatment of atopic eczema: a Cochrane systematic review

Tam, HH; Calderon, MA; Manikam, L; Nankervis, H; Nunez, IG; Williams, HC; Durham, SR; (2016) Specific allergen immunotherapy for the treatment of atopic eczema: a Cochrane systematic review. Allergy , 71 (9) pp. 1345-1356. 10.1111/all.12932. Green open access

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Abstract

Background Specific allergen immunotherapy (SIT) is an effective allergy treatment, but it is unclear whether SIT is effective for atopic eczema (AE). We undertook a systematic review to assess SIT efficacy and safety for treating AE. Methods We searched databases, ongoing clinical trials registers, and conference proceedings up to July 2015. Randomized controlled trials (RCTs) of SIT using standardized allergen extracts, compared with placebo/control, for treating AE in patients with allergic sensitization were eligible. Results We identified 12 eligible trials with 733 participants. Interventions included subcutaneous (six trials), sublingual (four trials), oral or intradermal SIT in children/adults allergic to house dust mite (10 trials), grass pollen or other inhalants. Risk of bias was moderate, with high loss to follow‐up and nonblinding as the main concerns. For our primary outcomes, three studies (208 participants) reported no significant difference – patient‐reported global disease severity improvement RR 0.75 (95% CI 0.45, 1.26); and eczema symptoms mean difference −0.74 on a 20‐point scale (95% CI −1.98, 0.50). Two studies (85 participants) reported a significant difference – SIT improved global disease severity RR 2.85 (95% CI 1.02, 7.96); and itch mean difference −4.20 on a 10‐point scale (95% CI −3.69, −4.71). Meta‐analysis was limited due to extreme statistical heterogeneity. For some secondary outcomes, meta‐analyses showed benefits for SIT, for example investigator‐rated improvement in eczema severity RR 1.48 (95% CI 1.16, 1.88; six trials, 262 participants). We found no evidence of adverse effects. The overall quality of evidence was low. Conclusion We found no consistent evidence that SIT is effective for treating AE, but due to the low quality of evidence further research is needed to establish whether SIT has a role in AE treatment.

Type: Article
Title: Specific allergen immunotherapy for the treatment of atopic eczema: a Cochrane systematic review
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/all.12932
Publisher version: https://doi.org/10.1111/all.12932
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Science & Technology, Life Sciences & Biomedicine, Allergy, Immunology, atopic eczema, eczema, immunotherapy, systematic review, MITE-SENSITIZED CHILDREN, SUBLINGUAL IMMUNOTHERAPY, DERMATOPHAGOIDES-PTERONYSSINUS, DOUBLE-BLIND, CONTROLLED-TRIAL, DERMATITIS, EFFICACY, HYPOSENSITIZATION, DISEASE, SAFETY
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Epidemiology and Public Health
URI: https://discovery.ucl.ac.uk/id/eprint/10056590
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