A systematic review of immunotherapy in food allergies found a large benefit from immunotherapy in treatment of any food allergy. In the intervention group 959/1527 (63%) became tolerant to the food previously causing allergy symptoms vs 79/791 (10%) in control group «de Silva D, Rodríguez Del Río P, de Jong NW, ym. A...»1. The follow-up time ranged between 13 and 156 weeks.
The same systematic review found 3/1423 life-threatening adverse reactions in intervention group and 2/796 in control group. Of 1353 patients in the intervention group 99 (7%) received adrenaline during the immunotherapy vs 12/703 (2%) in control group «de Silva D, Rodríguez Del Río P, de Jong NW, ym. A...»1.
The quality of evidence was assessed separately for different food allergies. The quality of evidence was more limited for cow's milk and egg allergies but due to very large effect sizes and consistent findings across food allergies, the overall evidence certainty is high.
| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias |
|---|---|---|---|---|---|
| RCT=randomized controlled trial; SR=systematic review; MA=meta-analysis | |||||
| «de Silva D, Rodríguez Del Río P, de Jong NW, ym. A...»1 | SR/MA | Children with peanut, cow's milk or egg allergy | Oral immunotherapy vs placebo/no immunotherapy | Desensitization, People given adrenaline | low |
| «Chu DK, Wood RA, French S, ym. Oral immunotherapy ...»2 | SR/MA | Children with peanut allergy | Oral immunotherapy vs no oral immunotherapy | Passing of a supervised oral food challenge, Epinephrine use |
low |
| Reference | Comments |
|---|---|
| «de Silva D, Rodríguez Del Río P, de Jong NW, ym. A...»1 | Desentization = "ability to consume foods containing the allergen with no / almost
no reaction whilst being treated with immunotherapy". Risk of bias were low for the 7 trials on peanut allergy. Most trials were placebo controlled and dropout rates were low. Trials on cow's milk and egg allergy were in higher risk of bias mainly due to inadequate outcome assessment. Measured also several other outcomes including tolerance to 1000mg dose, adverse events a |
| «Chu DK, Wood RA, French S, ym. Oral immunotherapy ...»2 | The study reported also other adverse reactions including vomiting, anaphylaxis, angioedema, respiratory reactions, and serious adverse events. |
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Relative risk (95% CI) |
|---|---|---|---|---|---|
| I= intervention; C=comparison; CI=confidence interval | |||||
| «de Silva D, Rodríguez Del Río P, de Jong NW, ym. A...»1 | 6 Studies (719/304) |
13-156 weeks | 488 (68%) | 18 (6%) | 9.88 (4.55-21.43) absolute difference 62% |
| Level of evidence: high | |||||
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Relative risk (95% CI) |
|---|---|---|---|---|---|
| I= intervention; C=comparison; CI=confidence interval | |||||
| «de Silva D, Rodríguez Del Río P, de Jong NW, ym. A...»1 | 7 (126/123) | 13-80 weeks | 86 (68%) | 19 (15%) | 5.7 (1.9–16.7) absolute difference 57% |
| Level of evidence: High The quality of evidence it was limited by study limitations, but level of evidence was not downgraded due to very large effect size. |
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| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Relative risk (95% CI) |
|---|---|---|---|---|---|
| I= intervention; C=comparison; CI=confidence interval | |||||
| «de Silva D, Rodríguez Del Río P, de Jong NW, ym. A...»1 | 6 (159/100) | 13-80 weeks | 134 (84%) | 5 (5%) | 8.9 (4.4–18.0) absolute difference 79% |
| Level of evidence: high The quality of evidence it was limited by study limitations, but level of evidence was not downgraded due to very large effect size. |
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| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Relative risk (95% CI) |
|---|---|---|---|---|---|
| I= intervention; C=comparison; CI=confidence interval | |||||
| «de Silva D, Rodríguez Del Río P, de Jong NW, ym. A...»1 | 5 (453/191) | 13-156 weeks | 58 (13%) | 9 (5%) | 2.5 (1.37–4.72) absolute difference 8% |
| «Chu DK, Wood RA, French S, ym. Oral immunotherapy ...»2 | 9 (660/324) | 0.5-6 years | 78 (12%) | 12 (4%) | 2.21 (1.27–3.83) absolute difference 8% |
| Level of evidence: high | |||||
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Relative risk (95% CI) |
|---|---|---|---|---|---|
| I= intervention; C=comparison; CI=confidence interval | |||||
| «de Silva D, Rodríguez Del Río P, de Jong NW, ym. A...»1 | 8 (133/115) | 13-80 weeks | 8 (6%) | 0 (0%) | 5.05 (1.00–25.57) absolute difference 6% |
| Level of evidence: low The quality of evidence is was limited by study limitations and imprecision |
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| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Relative risk (95% CI) |
|---|---|---|---|---|---|
| I= intervention; C=comparison; CI=confidence interval | |||||
| «de Silva D, Rodríguez Del Río P, de Jong NW, ym. A...»1 | 4 (121/65) | 13-80 weeks | 8 (7%) | 0 (0%) | 3.7 (0.45–30.02) absolute difference 7% |
| Level of evidence: very low The quality of evidence is was limited by study limitations and imprecision (two levels) |
|||||
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Relative risk (95% CI) |
|---|---|---|---|---|---|
| I= intervention; C=comparison; CI=confidence interval | |||||
| «Chu DK, Wood RA, French S, ym. Oral immunotherapy ...»2 | 9 (574/284) | 0.5-6 years | 320 (56%) | 9 (3%) | 12.4 (6.82–22.61) absolute difference 53% |
| Level of evidence: high | |||||