Allergen immunotherapy for IgE-mediated food allergy: a systematic review and meta-analysis

Background: The European Academy of Allergy and Clinical Immunology (EAACI) is developing Guidelines for Allergen Immunotherapy (AIT) for IgE-mediated Food Allergy. To inform the development of clinical recommendations, we sought to critically assess evidence on the effectiveness, safety and cost-effectiveness of AIT in the management of food allergy. Methods: We undertook a systematic review and meta-analysis that involved searching nine international electronic databases for randomized controlled trials (RCTs) and non-randomized studies (NRS). Eligible studies were independently assessed by two reviewers against pre-defined eligibility criteria. The quality of studies was assessed using the Cochrane Risk of Bias tool for RCTs and the Cochrane ACROBAT-NRS tool for quasi-RCTs. Random-effects meta-analyses were undertaken, with planned subgroup and sensitivity analyses. Results: We identified 1814 potentially relevant papers from which we selected 31 eligible studies, comprising of 25 RCTs and six NRS, studying a total of 1259 patients. Twenty-five trials evaluated oral immunotherapy (OIT), five studies investigated sublingual immunotherapy (SLIT) and one study evaluated epicutaneous immunotherapy (EPIT). The majority of these studies were in children. Twenty-seven studies assessed desensitization and nine studies investigated sustained unresponsiveness post-discontinuation of AIT. Meta-analyses demonstrated a substantial benefit in terms of desensitization (risk ratio (RR)=0.19, 95%CI 0.12, 0.29) and sustained unresponsiveness (RR=0.20, 95%CI 0.10, 0.59). Only one study reported on disease-specific quality of life (QoL), which reported no comparative results between OIT and control group. Meta-analyses revealed that the risk of experiencing a systemic adverse reaction was higher in those receiving AIT, with a more marked increase in the risk of local adverse reactions. Sensitivity analysis excluding those studies judged to be at high risk of bias demonstrated the robustness of summary estimates of effectiveness and safety of AIT for food allergy. None of the studies reported data on health economic analyses. Conclusions: AIT may be effective in raising the threshold of reactivity to a range of foods in children with IgE-mediated food allergy whilst receiving (i.e. desensitization) and post-discontinuation of AIT. It is however associated with a modest increased risk in serious systemic adverse reactions and a substantial increase in minor local adverse reactions. More data are needed in relation to adults, the impact on QoL and the cost-effectiveness of AIT

Practice pointer - Consultations for people from minority groups

This article provides practical suggestions on ways to improve communication with people from minority ethnic and faith group

Allergen immunotherapy for allergic asthma: protocol for a systematic review

Background: The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing the EAACI Guidelines for Allergen Immunotherapy (AIT) for Allergic Asthma. We seek to critically assess the effectiveness, cost-effectiveness and safety of AIT in the management of allergic asthma. Methods: We will undertake a systematic review, which will involve searching international biomedical databases for published, in progress and unpublished evidence. Studies will be independently screened against pre-defined eligibility criteria and critically appraised using established instruments. Data will be descriptively and, if possible and appropriate, quantitatively synthesised. Discussion: The findings from this review will be used to inform the development of recommendations for EAACI’s Guidelines on AIT

Allergen immunotherapy for IgE-mediated food allergy: protocol for a systematic review

Background The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing the EAACI Guidelines for Allergen Immunotherapy (AIT) for IgE-mediated food allergy. We seek to critically assess the effectiveness, cost-effectiveness and safety of AIT in IgE-mediated food allergy. Methods We will undertake a systematic review, which will involve searching international biomedical databases for published, in progress and unpublished evidence. Studies will be independently screened against pre-defined eligibility criteria and critically appraised using established instruments. Data will be descriptively and, if possible and appropriate, quantitatively synthesised. Discussion The findings from this review will be used to inform the development of recommendations for EAACI’s Guidelines on AIT

Anaphylaxis in the community: a questionnaire survey of members of the UK Anaphylaxis Campaign

OBJECTIVES: To examine the circumstances, features and management of anaphylaxis in children and adults. DESIGN: Self-completed questionnaire. PARTICIPANTS: The age of participants ranged from 0 to 72 years. SETTING: We analysed data from self-completed questionnaires collected over a 12-year period, i.e. 2001–2013, available to people by phone and, since 2012, for online completion through the Anaphylaxis Campaign. MAIN OUTCOME MEASURE: We analysed data from self-completed questionnaires collected over a 12- year period, i.e. 2001-2013, available to people by phone and, since 2012, for online completion through the Anaphylaxis Campaign RESULTS: In total, 356 questionnaires were submitted, of which 54 did not meet the criteria for anaphylaxis. The remaining 302 anaphylactic reactions originated from 243 individuals; 193 (64%) of these reactions were in children. Approximately half of all reactions occurred at home (n = 148; 49%); 61% (n = 193) of reactions occurred in those reporting a history of asthma, and many (n = 76; 41%) of these individuals had asthma that they classified as being severe. In 57% (n = 173) cases, the respondent reacted to a known allergen. Self-injectable adrenaline (epinephrine) was available in 79% of the cases, and it was only used in 38% of episodes. The usage of self-injected adrenaline was lower in children (30%) than in adults (54%), even though 82% of children had adrenaline available at the time of the reaction compared to 74% of adults. CONCLUSIONS: These data suggest that the majority of anaphylaxis reactions are triggered by exposure to known food allergens and that approximately half of these reactions occur at home. Access to self-injectable adrenaline was sub-optimal and when available it was only used in a minority of cases. Avoiding triggers, access to self-injectable adrenaline and its prompt use in the context of reactions need to be reinforced