Allergen immunotherapy for atopic dermatitis: Systematic review and meta-analysis of benefits and harms
Yepes-Nuñez, Juan José ; Guyatt, Gordon H ; Gómez-Escobar, Luis Guillermo ; Pérez-Herrera, Lucia C ; Chu, Alexandro W L ; Ceccaci, Renata ; Acosta-Madiedo, Ana Sofía ; Wen, Aaron ; Moreno-López, Sergio ; MacDonald, Margaret ... show 10 more
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Authors
Guyatt, Gordon H
Gómez-Escobar, Luis Guillermo
Pérez-Herrera, Lucia C
Chu, Alexandro W L
Ceccaci, Renata
Acosta-Madiedo, Ana Sofía
Wen, Aaron
Moreno-López, Sergio
MacDonald, Margaret
Barrios, Mónica
Chu, Xiajing
Islam, Nazmul
Gao, Ya
Wong, Melanie M
Couban, Rachel
Garcia, Elizabeth
Chapman, Edgardo
Oykhman, Paul
Chen, Lina
Winders, Tonya
Asiniwasis, Rachel Netahe
Boguniewicz, Mark
De Benedetto, Anna
Ellison, Kathy
Frazier, Winfred T
Greenhawt, Matthew
Huynh, Joey
Kim, Elaine
LeBovidge, Jennifer
Lind, Mary Laura
Lio, Peter
Martin, Stephen A
O'Brien, Monica
Ong, Peck Y
Silverberg, Jonathan I
Spergel, Jonathan
Wang, Julie
Wheeler, Kathryn E
Schneider, Lynda
Chu, Derek K
Student Authors
Faculty Advisor
Academic Program
UMass Chan Affiliations
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Publication Date
Keywords
DLQI
GRADE approach
SCORAD
adverse events
aeroallergen
allergen immunotherapy (AIT)
allergy
evidence-based medicine
house dust mite
itch (pruritus)
meta-analysis
multidisciplinary
quality of life
sleep disturbance
subcutaneous immunotherapy (SCIT)
sublingual immunotherapy (SLIT)
systematic review
Subject Area
Embargo Expiration Date
Link to Full Text
Abstract
Background: Atopic dermatitis (AD, eczema) is driven by a combination of skin barrier defects, immune dysregulation, and extrinsic stimuli such as allergens, irritants, and microbes. The role of environmental allergens (aeroallergens) in triggering AD remains unclear.
Objective: We systematically synthesized evidence regarding the benefits and harms of allergen immunotherapy (AIT) for AD.
Methods: As part of the 2022 American Academy of Allergy, Asthma & Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters AD Guideline update, we searched the MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, Global Resource for Eczema Trials, and Web of Science databases from inception to December 2021 for randomized controlled trials comparing subcutaneous immunotherapy (SCIT), sublingual immunotherapy (SLIT), and/or no AIT (placebo or standard care) for guideline panel-defined patient-important outcomes: AD severity, itch, AD-related quality of life (QoL), flares, and adverse events. Raters independently screened, extracted data, and assessed risk of bias in duplicate. We synthesized intervention effects using frequentist and Bayesian random-effects models. The GRADE approach determined the quality of evidence.
Results: Twenty-three randomized controlled trials including 1957 adult and pediatric patients sensitized primarily to house dust mite showed that add-on SCIT and SLIT have similar relative and absolute effects and likely result in important improvements in AD severity, defined as a 50% reduction in SCORing Atopic Dermatitis (risk ratio [95% confidence interval] 1.53 [1.31-1.78]; 26% vs 40%, absolute difference 14%) and QoL, defined as an improvement in Dermatology Life Quality Index by 4 points or more (risk ratio [95% confidence interval] 1.44 [1.03-2.01]; 39% vs 56%, absolute difference 17%; both outcomes moderate certainty). Both routes of AIT increased adverse events (risk ratio [95% confidence interval] 1.61 [1.44-1.79]; 66% with SCIT vs 41% with placebo; 13% with SLIT vs 8% with placebo; high certainty). AIT's effect on sleep disturbance and eczema flares was very uncertain. Subgroup and sensitivity analyses were consistent with the main findings.
Conclusions: SCIT and SLIT to aeroallergens, particularly house dust mite, can similarly and importantly improve AD severity and QoL. SCIT increases adverse effects more than SLIT. These findings support a multidisciplinary and shared decision-making approach to optimally managing AD.
Source
Yepes-Nuñez JJ, Guyatt GH, Gómez-Escobar LG, Pérez-Herrera LC, Chu AWL, Ceccaci R, Acosta-Madiedo AS, Wen A, Moreno-López S, MacDonald M, Barrios M, Chu X, Islam N, Gao Y, Wong MM, Couban R, Garcia E, Chapman E, Oykhman P, Chen L, Winders T, Asiniwasis RN, Boguniewicz M, De Benedetto A, Ellison K, Frazier WT, Greenhawt M, Huynh J, Kim E, LeBovidge J, Lind ML, Lio P, Martin SA, O'Brien M, Ong PY, Silverberg JI, Spergel J, Wang J, Wheeler KE, Schneider L, Chu DK. Allergen immunotherapy for atopic dermatitis: Systematic review and meta-analysis of benefits and harms. J Allergy Clin Immunol. 2023 Jan;151(1):147-158. doi: 10.1016/j.jaci.2022.09.020. Epub 2022 Sep 30. PMID: 36191689.