The following is a summary of “Allergen immunotherapy for atopic dermatitis: Systematic review and meta-analysis of benefits and harms,” published in the January 2023 issue of Allergy & Immunology byYepes- Nuñez, et al.

Atopic dermatitis (AD, often known as eczema) is caused by extrinsic stimuli such as allergens, irritants, and microorganisms, in addition to abnormalities in the skin barrier and immunological dysregulation. Aeroallergens in the environment (aeroallergens) are thought to have a part in the development of AD. However, it was not known. The advantages and disadvantages of allergen immunotherapy (AIT) for AD have been thoroughly analyzed by researchers for a study.

To update the 2022 American Academy of Allergy, Asthma & Immunology/American College of Allergy, Asthma, and Immunology Joint Task Force on Practice Parameters AD Guideline, they searched the MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, Global Resource for Eczema Trials, and Web of Science databases from inception to December 2021 for randomized controlled trials comparing subcutaneous immunotherapy (SCIT), sublingual immunotherapy (SLIT) and/or no AIT (placebo or standard care) for guideline panel–defined patient-important outcomes: AD intensity, itching, quality of life (QoL) associated with AD, flares, and adverse events. Raters separately screened the data, extracted it, and double-checked their assessments of bias. Using frequentist and Bayesian random-effects models, they combined the impacts of the interventions. The GRADE method was used to assess the quality of the evidence.

The results of 23 randomized controlled trials, which included 1,957 adult and pediatric patients who were primarily sensitive to house dust mites, demonstrated that add-on SCIT and SLIT had similar relative and absolute effects and were likely to produce significant improvements in AD severity, as measured by a 50% decrease in the SCORing Atopic Dermatitis (risk ratio [95% CI] 1.53 [1.31-1.78]; 26% vs 40%, absolute difference 14%); and QoL, defined as Dermatology Life Quality Index by 4 points or more (risk ratio [95% CI] 1.44 [1.03-2.01]; 39% vs 56%, absolute difference 17%; both outcomes moderate certainty). Both AIT delivery methods raised the probability of adverse events (risk ratio [95% CI] 1.61 [1.44-1.79]; 66% with SCIT vs 41% with placebo; 13% with SLIT vs 8% with placebo; high certainty). The impact of AIT on eczema flares and sleep disturbances remained mostly unknown. Sensitivity and subgroup analysis supported the main conclusions.

The severity of AD and quality of life can be significantly and comparably improved by SCIT and SLIT to aeroallergens, notably home dust mites. Compared to SLIT, SCIT increased side effects more. The results suggested a multidisciplinary and collaborative decision-making strategy for the best management of AD.

Reference: jacionline.org/article/S0091-6749(22)01322-7/fulltext