Allergen immunotherapy and/or biologicals for IgE‐mediated food allergy: A systematic review and meta‐analysis
Debra de Silva, Pablo Rodríguez del Río, Nicolette W. de Jong, Ekaterina Khaleva, Chris Singh, Anna Nowak‐Węgrzyn, Antonella Muraro, Philippe Bégin, Giovanni Battista Pajno, Alessandro Fiocchi, Ángel Sánchez, Carla Jones, Caroline Nilsson, Carsten Bindslev‐Jensen, Gary Wong, Hugh A. Sampson, Kirsten Beyer, M. J. Marchisotto, Montserrat Fernández‐Rivas, Rosan Meyer, Susanne Lau, Ulugbek Nurmatov, Graham Roberts, the GALEN Food Allergy Guidelines Group
Abstract
BACKGROUND: There is substantial interest in immunotherapy and biologicals in IgE-mediated food allergy. METHODS: We searched six databases for randomized controlled trials about immunotherapy alone or with biologicals (to April 2021) or biological monotherapy (to September 2021) in food allergy confirmed by oral food challenge. We pooled the data using random-effects meta-analysis. RESULTS: We included 36 trials about immunotherapy with 2126 mainly child participants. Oral immunotherapy increased tolerance whilst on therapy for peanut (RR 9.9, 95% CI 4.5.-21.4, high certainty); cow's milk (RR 5.7, 1.9-16.7, moderate certainty) and hen's egg allergy (RR 8.9, 4.4-18, moderate certainty). The number needed to treat to increase tolerance to a single dose of 300 mg or 1000 mg peanut protein was 2. Oral immunotherapy did not increase adverse reactions (RR 1.1, 1.0-1.2, low certainty) or severe reactions in peanut allergy (RR 1,6, 0.7-3.5, low certainty), but may increase (mild) adverse reactions in cow's milk (RR 3.9, 2.1-7.5, low certainty) and hen's egg allergy (RR 7.0, 2.4-19.8, moderate certainty). Epicutaneous immunotherapy increased tolerance whilst on therapy for peanut (RR 2.6, 1.8-3.8, moderate certainty). Results were unclear for other allergies and administration routes. There were too few trials of biologicals alone (3) or with immunotherapy (1) to draw conclusions. CONCLUSIONS: Oral immunotherapy improves tolerance whilst on therapy and is probably safe in peanut, cow's milk and hen's egg allergy. More research is needed about quality of life, cost and biologicals.