Efficacy of Subcutaneous and Sublingual Immunotherapy for House Dust Mite Allergy: A Network Meta-Analysis-Based Comparison.

Abstract

BACKGROUND:

Meta-analyses comparing the efficacy of sublingual immunotherapy (SLIT) and subcutaneous immunotherapy (SCIT) for house dust mite allergy are lacking.

OBJECTIVE:

To compare the efficacy of SLIT drops, SLIT tablets, and SCIT in patients with perennial allergic rhinitis through network analysis.

METHODS:

Frequentist network meta-analyses estimated the standardized mean difference (SMD) across the three immunotherapy modalities on allergic rhinitis symptom and medication score data from double-blind randomized clinical trials. Random effects models were investigated.

RESULTS:

We included 26 double-blind randomized clinical trials in this meta-analysis for the symptom score and 18 for the medication score. In the direct pairwise meta-analysis, a significant reduction of the symptom score was observed for all immunotherapy modalities compared with the placebo: pooled SMDs of -0.461 (95% confidence interval [CI], -0.795 to -0.127) for SLIT drop, -0.329 (95% CI, -0.426 to -0.231) for SLIT tablet, and -1.669 (95% CI, -2.753 to -0.585) for SCIT. For the medication score, a significant reduction was observed for all modalities. In network meta-analysis, the clinical efficacy of SCIT based on the symptom score was greater than for SLIT drop or SLIT tablet (SMD: -0.697, 95% CI, -1.105 to -0.288; and SMD: -0.819, 95% CI, -1.242 to -0.397). However, there was no significant difference in the symptom score between SLIT drop and SLIT tablet.

CONCLUSIONS:

This study demonstrated the clinical efficacy of all house dust mite immunotherapy modalities and suggests that SCIT may be more effective than SLIT drops or tablets in controlling symptoms of allergic rhinitis.

• Authors: Jin Youp Kim, Myoung-Jin Jang, Dong-Young Kim, Seok-Won Park, Doo Hee Han
• Journal: The journal of allergy and clinical immunology. In practice (J Allergy Clin Immunol Pract) Vol. 9 Issue 12 Pg. 4450-4458.e6 (12 2021) ISSN: 2213-2201 [Electronic] United States
• PMID: 34464748 (Publication Type: Journal Article, Meta-Analysis)
• Copyright: Copyright © 2021 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Chemical References

• Allergens

Topics

• Allergens
• Animals
• Desensitization, Immunologic
• Humans
• Injections, Subcutaneous
• Network Meta-Analysis
• Pyroglyphidae
• Randomized Controlled Trials as Topic
• Rhinitis, Allergic (therapy)
• Rhinitis, Allergic, Perennial
• Sublingual Immunotherapy
• Treatment Outcome