Allergen-Specific Immunotherapy for the Treatment of Allergic Rhinoconjunctivitis and/or Asthma: Comparative Effectiveness Review - Research Review - Final | AHRQ Effective Health Care Program
New AHRQ Review Finds Allergen-Specific Immunotherapy Safe and Effective for Treating Nasal Allergies and Mild Asthma
At least a moderate level of evidence exists to support the use of allergen-specific immunotherapy as a safe and effective treatment for nasal allergies and mild asthma in adults and children, according to a new AHRQ research review. The review’s findings also appeared in the March 27 issue of the Journal of the American Medical Association (JAMA). The immunotherapy was either injected under the skin (subcutaneous) or placed under the tongue (sublingual). The review found a high strength of evidence that subcutaneous allergen-specific immunotherapy reduced asthma, nasal, and conjunctivitis symptoms, lowered the use of asthma medications, and improved quality of life. A moderate strength of evidence was found to support the use of subcutaneous immunotherapy for reducing the need for rhinoconjunctivitis medication. Strong evidence was found for sublingual immunotherapy to reduce asthma symptoms; moderate evidence was shown for reduced nasal and conjunctivitis symptoms and medication usage and improved allergy-specific quality of life. Currently, no FDA-approved sublingual forms of immunotherapy are available, although researchers and physicians are exploring the off-label use of subcutaneous aqueous allergens for sublingual desensitization. Evidence to support the use of allergen-specific immunotherapy in children is somewhat weaker than evidence supporting its use in adults. Select to access the AHRQ research review, Allergen-Specific Immunotherapy for the Treatment of Allergic Rhinoconjunctivitis and/or Asthma. Select to access the JAMA study abstract on PubMed.®
JAMA. 2013 Mar 27;309(12):1278-88. doi: 10.1001/jama.2013.2049.
Sublingual immunotherapy for the treatment of allergic rhinoconjunctivitis and asthma: a systematic review.
SourceDepartment of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. firstname.lastname@example.org
IMPORTANCE:Allergic rhinitis affects up to 40% of the US population. To desensitize allergic individuals, subcutaneous injection immunotherapy or sublingual immunotherapy may be administered. In the United States, sublingual immunotherapy is not approved by the Food and Drug Administration. However, some US physicians use aqueous allergens, off-label, for sublingual desensitization.
OBJECTIVE:To systematically review the effectiveness and safety of aqueous sublingual immunotherapy for allergic rhinoconjunctivitis and asthma.
EVIDENCE ACQUISITION:The databases of MEDLINE, EMBASE, LILACS, and the Cochrane Central Register of Controlled Trials were searched through December 22, 2012. English-language randomized controlled trials were included if they compared sublingual immunotherapy with placebo, pharmacotherapy, or other sublingual immunotherapy regimens and reported clinical outcomes. Studies of sublingual immunotherapy that are unavailable in the United States and for which a related immunotherapy is unavailable in the United States were excluded. Paired reviewers selected articles and extracted the data. The strength of the evidence for each comparison and outcome was graded based on the risk of bias (scored on allocation, concealment of intervention, incomplete data, sponsor company involvement, and other bias), consistency, magnitude of effect, and the directness of the evidence.
RESULTS:Sixty-three studies with 5131 participants met the inclusion criteria. Participants' ages ranged from 4 to 74 years. Twenty studies (n = 1814 patients) enrolled only children. The risk of bias was medium in 43 studies (68%). Strong evidence supports that sublingual immunotherapy improves asthma symptoms, with 8 of 13 studies reporting greater than 40% improvement vs the comparator. Moderate evidence supports that sublingual immunotherapy use decreases rhinitis or rhinoconjunctivitis symptoms, with 9 of 36 studies demonstrating greater than 40% improvement vs the comparator. Medication use for asthma and allergies decreased by more than 40% in 16 of 41 studies of sublingual immunotherapy with moderate grade evidence. Moderate evidence supports that sublingual immunotherapy improves conjunctivitis symptoms (13 studies), combined symptom and medication scores (20 studies), and disease-specific quality of life (8 studies). Local reactions were frequent, but anaphylaxis was not reported.
CONCLUSIONS AND RELEVANCE:The overall evidence provides a moderate grade level of evidence to support the effectiveness of sublingual immunotherapy for the treatment of allergic rhinitis and asthma, but high-quality studies are still needed to answer questions regarding optimal dosing strategies. There were limitations in the standardization of adverse events reporting, but no life-threatening adverse events were noted in this review.
- The following popper user interface control may not be accessible. Tab to the next button to revert the control to an accessible version.Destroy user interface controlIs sublingual immunotherapy ready for use in the United States? [JAMA. 2013]
- [PubMed - indexed for MEDLINE]
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