Allergen immunotherapy for atopic dermatitis: Systematic review and meta-analysis of benefits and harms
BackgroundAtopic 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. ObjectiveWe systematically synthe...
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| التنسيق: | article |
| منشور في: |
2023
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| الموضوعات: | |
| الوصول للمادة أونلاين: | http://dx.doi.org/10.1016/j.jaci.2022.09.020 https://www.sciencedirect.com/science/article/pii/S0091674922013227 http://hdl.handle.net/10576/44628 |
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| _version_ | 1857415085909082112 |
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| author | Juan José, Yepes-Nuñez |
| author2 | 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. |
| author2_role | author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
| author_facet | Juan José, Yepes-Nuñez 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. |
| author_role | author |
| dc.creator.none.fl_str_mv | Juan José, Yepes-Nuñez 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. |
| dc.date.none.fl_str_mv | 2023-06-21T05:28:10Z 2023-01-31 |
| dc.format.none.fl_str_mv | application/pdf |
| dc.identifier.none.fl_str_mv | http://dx.doi.org/10.1016/j.jaci.2022.09.020 00916749 https://www.sciencedirect.com/science/article/pii/S0091674922013227 http://hdl.handle.net/10576/44628 147-158 1 151 |
| dc.language.none.fl_str_mv | en |
| dc.publisher.none.fl_str_mv | Elsevier |
| dc.rights.none.fl_str_mv | http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess |
| dc.subject.none.fl_str_mv | Atopic dermatitis (atopic eczema) allergy allergen immunotherapy (AIT) aeroallergen house dust mite subcutaneous immunotherapy (SCIT) sublingual immunotherapy (SLIT) systematic review meta-analysis GRADE approach multidisciplinary evidence-based medicine SCORAD DLQI quality of life itch (pruritus) sleep disturbance adverse events |
| dc.title.none.fl_str_mv | Allergen immunotherapy for atopic dermatitis: Systematic review and meta-analysis of benefits and harms |
| dc.type.none.fl_str_mv | Article info:eu-repo/semantics/publishedVersion info:eu-repo/semantics/article |
| description | BackgroundAtopic 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. ObjectiveWe systematically synthesized evidence regarding the benefits and harms of allergen immunotherapy (AIT) for AD. MethodsAs 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. ResultsTwenty-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. ConclusionsSCIT 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. |
| eu_rights_str_mv | openAccess |
| format | article |
| id | qu_b218c049838079fac9f430bdb55a8a97 |
| identifier_str_mv | 00916749 147-158 1 151 |
| language_invalid_str_mv | en |
| network_acronym_str | qu |
| network_name_str | Qatar University repository |
| oai_identifier_str | oai:qspace.qu.edu.qa:10576/44628 |
| publishDate | 2023 |
| publisher.none.fl_str_mv | Elsevier |
| repository.mail.fl_str_mv | |
| repository.name.fl_str_mv | |
| repository_id_str | |
| rights_invalid_str_mv | http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| spelling | Allergen immunotherapy for atopic dermatitis: Systematic review and meta-analysis of benefits and harmsJuan José, Yepes-NuñezGuyatt, Gordon H.Gómez-Escobar, Luis GuillermoPérez-Herrera, Lucia C.Chu, Alexandro W.L.Ceccaci, RenataAcosta-Madiedo, Ana SofíaWen, AaronMoreno-López, SergioMacDonald, MargaretBarrios, MónicaChu, XiajingIslam, NazmulGao, YaWong, Melanie M.Couban, RachelGarcia, ElizabethChapman, EdgardoOykhman, PaulChen, LinaWinders, TonyaAsiniwasis, Rachel NetaheBoguniewicz, MarkDe Benedetto, AnnaEllison, KathyFrazier, Winfred T.Greenhawt, MatthewHuynh, JoeyKim, ElaineLeBovidge, JenniferLind, Mary LauraLio, PeterMartin, Stephen A.O’Brien, MonicaOng, Peck Y.Silverberg, Jonathan I.Spergel, JonathanWang, JulieWheeler, Kathryn E.Schneider, LyndaChu, Derek K.Atopic dermatitis (atopic eczema)allergyallergen immunotherapy (AIT)aeroallergenhouse dust mitesubcutaneous immunotherapy (SCIT)sublingual immunotherapy (SLIT)systematic reviewmeta-analysisGRADE approachmultidisciplinaryevidence-based medicineSCORADDLQIquality of lifeitch (pruritus)sleep disturbanceadverse eventsBackgroundAtopic 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. ObjectiveWe systematically synthesized evidence regarding the benefits and harms of allergen immunotherapy (AIT) for AD. MethodsAs 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. ResultsTwenty-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. ConclusionsSCIT 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.Elsevier2023-06-21T05:28:10Z2023-01-31Articleinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://dx.doi.org/10.1016/j.jaci.2022.09.02000916749https://www.sciencedirect.com/science/article/pii/S0091674922013227http://hdl.handle.net/10576/44628147-1581151enhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:qspace.qu.edu.qa:10576/446282024-07-23T13:53:39Z |
| spellingShingle | Allergen immunotherapy for atopic dermatitis: Systematic review and meta-analysis of benefits and harms Juan José, Yepes-Nuñez Atopic dermatitis (atopic eczema) allergy allergen immunotherapy (AIT) aeroallergen house dust mite subcutaneous immunotherapy (SCIT) sublingual immunotherapy (SLIT) systematic review meta-analysis GRADE approach multidisciplinary evidence-based medicine SCORAD DLQI quality of life itch (pruritus) sleep disturbance adverse events |
| status_str | publishedVersion |
| title | Allergen immunotherapy for atopic dermatitis: Systematic review and meta-analysis of benefits and harms |
| title_full | Allergen immunotherapy for atopic dermatitis: Systematic review and meta-analysis of benefits and harms |
| title_fullStr | Allergen immunotherapy for atopic dermatitis: Systematic review and meta-analysis of benefits and harms |
| title_full_unstemmed | Allergen immunotherapy for atopic dermatitis: Systematic review and meta-analysis of benefits and harms |
| title_short | Allergen immunotherapy for atopic dermatitis: Systematic review and meta-analysis of benefits and harms |
| title_sort | Allergen immunotherapy for atopic dermatitis: Systematic review and meta-analysis of benefits and harms |
| topic | Atopic dermatitis (atopic eczema) allergy allergen immunotherapy (AIT) aeroallergen house dust mite subcutaneous immunotherapy (SCIT) sublingual immunotherapy (SLIT) systematic review meta-analysis GRADE approach multidisciplinary evidence-based medicine SCORAD DLQI quality of life itch (pruritus) sleep disturbance adverse events |
| url | http://dx.doi.org/10.1016/j.jaci.2022.09.020 https://www.sciencedirect.com/science/article/pii/S0091674922013227 http://hdl.handle.net/10576/44628 |