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Efficacy and safety of allergen immunotherapy for IgE-mediated food allergy: systematic review and meta-analysis
  • +20
  • Debra de Silva,
  • Pablo Rodriguez del Rio,
  • Nicolette w Jong,
  • Ekaterina Khaleva,
  • C. Singh,
  • Anna Nowak-Wegrzyn,
  • Antonella Muraro,
  • Philippe Bégin,
  • Giovanni Pajno,
  • Alessandro Fiocchi,
  • Angel Sanchez San,
  • Carla Jones,
  • Caroline Nilsson,
  • Carsten Bindslev-Jensen,
  • Gary Wong,
  • Hugh Sampson,
  • Kirsten Beyer,
  • Mary Jane Marchisotto,
  • Montserrat Fernandez-Rivas,
  • Rosan Meyer,
  • Susanne Lau,
  • Ulugbek Nurmatov,
  • Graham Roberts
Debra de Silva
The Evidence Centre England

Corresponding Author:[email protected]

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Pablo Rodriguez del Rio
Hospital Infantil Universitario Nino Jesus
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Nicolette w Jong
University Medical Centre Rotterdam the Netherlands
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Ekaterina Khaleva
University of Southampton Faculty of Medicine
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C. Singh
The Evidence Centre New Zealand
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Anna Nowak-Wegrzyn
NYU Langone Health
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Antonella Muraro
Padua University Hospital Italy
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Philippe Bégin
Univerisite de Montreal Canada
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Giovanni Pajno
Policlinico Hospital-University of Messina Italy
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Alessandro Fiocchi
Ospedale Pediatrico Bambino Gesu
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Angel Sanchez San
AEPNAA Spanish Association for People with Food and Latex Allergy Spain
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Carla Jones
Allergy UK England
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Caroline Nilsson
Karolinska Institutet and Sachs´ Children and Youth Hospital Sweden
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Carsten Bindslev-Jensen
Odense Universitetshospital
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Gary Wong
Chinese University of Hong Kong Hong Kong
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Hugh Sampson
Icahn School of Medicine at Mount Sinai Department of Medicine
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Kirsten Beyer
Charite Universitatsmedizin Berlin
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Mary Jane Marchisotto
European Academy of Allergy and Clinical Immunology
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Montserrat Fernandez-Rivas
Hospital Clínico San Carlos Spain
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Rosan Meyer
Imperial College London
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Susanne Lau
Charite Universitatsmedizin Berlin
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Ulugbek Nurmatov
Cardiff University
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Graham Roberts
University of Southampton Faculty of Medicine
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Background There is substantial interest in allergen-specific immunotherapy in food allergy. We systematically reviewed its efficacy and safety. Methods We searched six bibliographic databases from 1946 to 30 April 2021 for randomised controlled trials about immunotherapy alone or with biologicals in IgE-mediated food allergy confirmed by oral food challenge. We pooled the data using random-effects meta-analysis. Results We included 36 trials with 2,126 participants, mainly children. Oral immunotherapy increased tolerance whilst on therapy for peanut (RR 9.9, 95% CI 4.5. to 21.4, high certainty); cow’s milk (RR 5.7, 1.9 to 16.7, moderate certainty) and hen’s egg allergy (RR 8.9, 4.4 to 18, moderate certainty). The number needed to treat to increase tolerance to a single dose of 300mg or 1000mg peanut protein was 2. In peanut allergy, oral immunotherapy did not increase adverse reactions (RR 1.1, 1.0 to 1.2, low certainty) or severe reactions (RR 1,6, 0.7 to 3.5, low certainty). It may increase adverse reactions in cow’s milk (RR 3.9, 2.1 to 7.5, low certainty) and hen’s egg allergy (RR 7.0, 2.4 to 19.8, moderate certainty), but reactions tended to be mild and gastrointestinal. Epicutaneous immunotherapy increased tolerance whilst on therapy for peanut (RR 2.6, 1.8 to 3.8, moderate certainty). Results were unclear for other allergies and administration routes. Conclusions Oral immunotherapy improves tolerance whilst on therapy and is probably safe in peanut, cow’s milk and hen’s egg allergy. However, our review found little about whether this improves quality of life, is sustained or cost-effective.
02 Nov 2021Submitted to Allergy
09 Nov 2021Submission Checks Completed
09 Nov 2021Assigned to Editor
15 Nov 2021Reviewer(s) Assigned
29 Nov 2021Review(s) Completed, Editorial Evaluation Pending
30 Nov 2021Editorial Decision: Revise Minor
08 Dec 20211st Revision Received
08 Dec 2021Submission Checks Completed
08 Dec 2021Assigned to Editor
10 Dec 2021Reviewer(s) Assigned
17 Dec 2021Review(s) Completed, Editorial Evaluation Pending
19 Dec 2021Editorial Decision: Accept