Efficacy and Safety of Subcutaneous Immunotherapy for Local Allergic Rhinitis: A Meta-Analysis of Randomized Controlled Trials

Abstract

Background Subcutaneous immunotherapy (SCIT) has been used for treating local allergic rhinitis (LAR) patients. However, the clinical efficacy and safety were still questioned. Objective This study was designed to estimate the efficacy and safety of SCIT for treating LAR patients through meta-analysis. Methods We systemically searched MEDLINE, Cochrane Library, and Embase publications. Randomized, double-blind, clinical trials for the efficacy and safety of Allergen Immunotherapy (AIT) for LAR were included. A meta-analysis of 4 clinical endpoints (combined symptom and medication scores [CSMS], symptom scores [SS], medication scores [MS] and rhinoconjunctivitis quality of life questionnaire [RQLQ]) and adverse events (AEs)) was performed after bias and heterogeneity assessments. The immunologic response results were summarized. Results Four RCTs with 134 patients were included. Four studies for analyzing primary outcomes (CSMS, SS, MS) and AEs, three for RQLQ results. The results indicated an important significant difference between SCIT and placebo groups, list as follows: CSMS (SMD = −2.42, 95% CI: −3.60 to −1.25, P < .0001), SS (SMD = −2.08, 95% CI −3.68 to −0.48, P = .01), MS (SMD = −1.43, 95% CI: −2.65 to −0.21, P = 0.02), RQLQ (SMD = −0.70, 95% CI −1.29 to −0.12, P = .02), Local AEs (RR = 4.13, 95% CI 1.08 to 15.77, P = .04). For immunologic response, significantly increased serum sIgG4 levels and improvements of allergen tolerance was observed after SCIT. Conclusions Our meta-analysis suggests that SCIT has a significant effect on improving symptoms and reducing medicine consumption for LAR patients. Larger and multicenter clinical trials are needed to clarify the safety and long-term efficacy.

Allergen immunotherapy in MASK‐air users in real‐life: Results of a Bayesian mixed‐effects model

“…Several hypotheses can be postulated to explain this finding, including (i) real differences in the efficacy or effectiveness of AIT, (ii) differences in the mode of administration for each AIT type (with SLIT‐tablet, contrary to SCIT, being administered at home and on a daily basis), (iii) differences in the time needed for the various types of AIT to achieve effectiveness, (iv) differences on the baseline symptoms of patients, and (v) the greater diversity of SCIT products compared to SLIT formulations (which may also explain the heterogeneity observed in the meta‐analyses of SCIT trials). 34 , 35 Therefore, conclusions cannot be made on the efficacy or effectiveness of AIT, as several limitations exist (as outlined above). For instance, users under AIT tend to be more closely followed by their physicians and demonstrate a higher adherence to physicians' recommendations (the so‐called ‘Hawthorne effect’ as one component of unspecific treatment effects in AIT 34 ).…”

“…Taking into account the selection of patients and the nature of observational mHealth studies, this study suggests that grass pollen allergic patients under SLIT‐tablet report less severe symptoms than those under no AIT. Several hypotheses can be postulated to explain this finding, including (i) real differences in the efficacy or effectiveness of AIT, (ii) differences in the mode of administration for each AIT type (with SLIT‐tablet, contrary to SCIT, being administered at home and on a daily basis), (iii) differences in the time needed for the various types of AIT to achieve effectiveness, (iv) differences on the baseline symptoms of patients, and (v) the greater diversity of SCIT products compared to SLIT formulations (which may also explain the heterogeneity observed in the meta‐analyses of SCIT trials) 34,35 . Therefore, conclusions cannot be made on the efficacy or effectiveness of AIT, as several limitations exist (as outlined above).…”

Assessment of Effect of Subcutaneous Immunotherapy on the Quality of Life of Allergic Rhinitis Children

“…Quality of life increased after SCIT was administered, and it remained higher than it was at the study's outset. In addition, a meta-analysis of randomized controlled trials by Zhu et al (16) included a total of 134 participants over 4 publications found that the SCIT group improved on quality-of-life questionnaires significantly than the placebo group.…”

Update on pathomechanisms and treatments in allergic rhinitis

“…Thus, more head‐to‐head studies are needed to investigate the differences between SLIT and SCIT, which may aid in selection of a personalized therapy method. In addition to SAR and perennial AR, SCIT has also been shown to improve the symptoms and reduce medicine consumption in LAR 103–105 . However, larger and multicenter clinical trials are still needed to clarify its safety and long‐term efficacy.…”

“…In addition to SAR and perennial AR, SCIT has also been shown to improve the symptoms and reduce medicine consumption in LAR. [103][104][105] However, larger and multicenter clinical trials are still needed to clarify its safety and long-term efficacy.…”