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Effectiveness and safety of orally administered immunotherapy for food allergies: a systematic review and meta-analysis

Nurmatov, Ulugbek, Deveraux, Graham, Worth, Alison, Healy, Laura and Sheikh, Aziz 2014. Effectiveness and safety of orally administered immunotherapy for food allergies: a systematic review and meta-analysis. British Journal of Nutrition 111 , pp. 12-22. 10.1017/S0007114513002353

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Abstract

The aim of using oral and sublingual immunotherapy with food allergies is to enable the safe consumption of foods containing these aller- gens in patients with food allergies. In the present study, a systematic review of intervention studies was undertaken; this involved the searching of eleven international databases for controlled clinical trials. We identified 1152 potentially relevant papers, from which we selected twenty-two reports of twenty-one eligible trials (i.e. eighteen randomised controlled trials and three controlled clinical trials). The meta-analysis revealed a substantially lower risk of reactions to the relevant food allergen in those receiving orally administered immu- notherapy (risk ratios (RR) 0·21, 95 % CI 0·12, 0·38). The meta-analysis of immunological data demonstrated that skin prick test responses to the relevant food allergen significantly decreased with immunotherapy (mean difference 2 2·96 mm, 95 % CI 2 4·48, 2 1·45), while aller- gen-specific IgG4 levels increased by an average of 19·9 (95 % CI 17·1, 22·6) m g/ml. Sensitivity analyses excluding studies at the highest risk of bias and subgroup analyses in relation to specific food allergens and treatment approaches generated comparable summary estimates of effectiveness and immunological changes. Pooling of the safety data revealed an increased risk of local (i.e. minor oropharyngeal/gastro- intestinal) adverse reactions with immunotherapy (RR 1·47, 95 % CI 1·11, 1·95); there was a non-significant increased average risk of systemic adverse reactions with immunotherapy (RR 1·08, 95 % CI 0·97, 1·19). There is strong evidence that orally administered immu- notherapy can induce immunomodulatory changes and thereby promote desensitisation to a range of foods. However, given the paucity of evidence on longer-term safety, effectiveness and cost-effectiveness, orally administered immunotherapy should not be used outside experimental conditions presently.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Cambridge University Press
Date of First Compliant Deposit: 8 June 2016
Date of Acceptance: 19 June 2013
Last Modified: 07 Feb 2019 11:59
URI: http://orca.cf.ac.uk/id/eprint/91600

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