The Resource Allergen-specific immunotherapy for the treatment of allergic rhinoconjunctivitis and/or asthma : comparative effectiveness review, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Johns Hopkins University Evidence-based Practice Center ; investigators, Sandra Y. Lin, M.D., Nkiruka Erekosima, M.D., M.P.H., Catalina Suarez-Cuervo, M.D., Murugappan Ramanathan, M.D., Julia M. Kim, M.D., M.P.H., Darcy Ward, M.S., Yohalakshmi Chelladurai, M.B.B.S., M.P.H., and Jodi B. Segal, M.D., M.P.H

Allergen-specific immunotherapy for the treatment of allergic rhinoconjunctivitis and/or asthma : comparative effectiveness review, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Johns Hopkins University Evidence-based Practice Center ; investigators, Sandra Y. Lin, M.D., Nkiruka Erekosima, M.D., M.P.H., Catalina Suarez-Cuervo, M.D., Murugappan Ramanathan, M.D., Julia M. Kim, M.D., M.P.H., Darcy Ward, M.S., Yohalakshmi Chelladurai, M.B.B.S., M.P.H., and Jodi B. Segal, M.D., M.P.H

Label
Allergen-specific immunotherapy for the treatment of allergic rhinoconjunctivitis and/or asthma : comparative effectiveness review
Title
Allergen-specific immunotherapy for the treatment of allergic rhinoconjunctivitis and/or asthma
Title remainder
comparative effectiveness review
Statement of responsibility
prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Johns Hopkins University Evidence-based Practice Center ; investigators, Sandra Y. Lin, M.D., Nkiruka Erekosima, M.D., M.P.H., Catalina Suarez-Cuervo, M.D., Murugappan Ramanathan, M.D., Julia M. Kim, M.D., M.P.H., Darcy Ward, M.S., Yohalakshmi Chelladurai, M.B.B.S., M.P.H., and Jodi B. Segal, M.D., M.P.H
Title variation
Effective health care program
Creator
Contributor
Author
Issuing body
Subject
Genre
Language
eng
Summary
OBJECTIVES: Allergic rhinitis is highly prevalent in North America, affecting 20 to 40 percent of the population. Nearly 9 percent of Americans suffer from asthma, with more than half having evidence of atopy. This comparative effectiveness review describes the effectiveness and safety of subcutaneous immunotherapy and sublingual immunotherapy (off-label use of subcutaneous-aqueous allergens for sublingual desensitization) compared with other therapies for treatment of allergic rhinoconjunctivitis and asthma. DATA SOURCES: We searched the MEDLINE(r), Embase, LILACS, and CENTRAL databases from the beginning of each database through May 21, 2012. REVIEW METHODS: Two reviewers independently selected randomized controlled trials according to established study inclusion criteria. Disagreements were resolved by consensus. Paired reviewers assessed the risk of bias of each study and extracted details about the population, intervention(s), and outcomes of interest. The results were summarized by immunotherapy type (sublingual or subcutaneous), allergen, and outcomes. Studies exclusively enrolling children were reviewed separately. The strength of the body of evidence was graded and summarized. RESULTS: We included 74 references that investigated the efficacy and safety of subcutaneous immunotherapy, 60 studies that investigated the efficacy and safety of sublingual immunotherapy, and 8 studies that compared the two modes of delivery. All 142 studies were randomized controlled studies. The majority of studies were at medium risk of bias due to design choices. The strength of evidence is high that subcutaneous immunotherapy reduces asthma symptoms, rhinitis symptoms, conjunctivitis symptoms, asthma medication use, asthma plus rhinoconjunctivitis medication use, and rhinoconjunctivitis-specific quality of life. The strength of evidence is moderate that subcutaneous immunotherapy reduces rhinoconjunctivitis medication use, relative to usual care, which includes pharmacotherapy. Likewise, the strength of evidence is high that sublingual immunotherapy reduces asthma symptoms. The strength of evidence is moderate that sublingual immunotherapy reduces rhinitis/rhinoconjunctivitis symptoms, combined symptom scores, conjunctivitis symptoms, and medication useusage relative to usual care, and improves allergy-specific quality of life. In studies comparing subcutaneous with sublingual immunotherapy, strength of evidence supporting the superiority of subcutaneous immunotherapy for reducing allergic rhinitis and conjunctivitis symptoms, and the superiority of sublingual immunotherapy for reducing medication use, is low. We identified 13 pediatric studies of subcutaneous immunotherapy, 18 pediatric studies of sublingual immunotherapy, and 3 pediatric studies comparing subcutaneous and sublingual immunotherapy. The strength of evidence is moderate that subcutaneous immunotherapy reduces asthma symptoms and rhinitis symptoms in comparison to usual care. The strength of evidence is low that subcutaneous immunotherapy reduces conjunctivitis symptoms, medication scores, combined symptom-medication scores, or improves quality of life relative to usual care. The strength of evidence is high that sublingual immunotherapy reduces asthma symptoms, and moderate that it reduces rhinitis/rhinoconjunctivitis symptoms, combined asthma plus rhinitis/rhinoconjunctivitis symptoms, conjunctivitis symptoms, and decreases medication use. While local reactions were frequent with both treatment regimens, there were rare reports of anaphylaxis in the subcutaneous immunotherapy studies, and no anaphylaxis reported in the sublingual immunotherapy studies. CONCLUSIONS: With some variation across outcomes, the overall body of evidence consistently provides moderate to high support for the effectiveness and safety of both subcutaneous and sublingual immunotherapy for the treatment of allergic rhinitis and asthma. The evidence to support the use of immunotherapy in children is somewhat weaker than the evidence supporting its use in adults. The superiority of one route of administration over the other is not known
Member of
Cataloging source
NLM
http://library.link/vocab/creatorName
Lin, Sandra Y
Funding information
Conducted by the Johns Hopkins University Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ)
Government publication
federal national government publication
Illustrations
illustrations
Index
no index present
Literary form
non fiction
Nature of contents
  • dictionaries
  • bibliography
NLM call number
WV 335
http://library.link/vocab/relatedWorkOrContributorName
  • Erekosima, Nkiruka
  • Suarez-Cuervo, Catalina
  • Ramanathan, Murugappan
  • Kim, Julia M.
  • Ward, Darcy
  • Chelladurai, Yohalakshmi
  • Segal, Jodi B.
  • United States
  • Johns Hopkins University
  • Effective Health Care Program (U.S.)
Series statement
  • Comparative effectiveness review
  • AHRQ publication
Series volume
  • number 111
  • no. 13-EHC061-EF
http://library.link/vocab/subjectName
  • Rhinitis, Allergic, Perennial
  • Asthma
  • Comparative Effectiveness Research
  • Conjunctivitis, Allergic
  • Evidence-Based Medicine
  • Immunotherapy
http://bibfra.me/vocab/relation/supportingbody
  • SGEpYsXqBGk
  • RzTDSdffmEM
Label
Allergen-specific immunotherapy for the treatment of allergic rhinoconjunctivitis and/or asthma : comparative effectiveness review, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Johns Hopkins University Evidence-based Practice Center ; investigators, Sandra Y. Lin, M.D., Nkiruka Erekosima, M.D., M.P.H., Catalina Suarez-Cuervo, M.D., Murugappan Ramanathan, M.D., Julia M. Kim, M.D., M.P.H., Darcy Ward, M.S., Yohalakshmi Chelladurai, M.B.B.S., M.P.H., and Jodi B. Segal, M.D., M.P.H
Instantiates
Publication
Note
"March 2013. Errata added May and August 2013."
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
cr
Carrier MARC source
rdacarrier.
Content category
text
Content type code
txt
Content type MARC source
rdacontent.
Control code
847523490
Extent
1 online resource (489 pages)
Form of item
online
Media category
computer
Media MARC source
rdamedia.
Media type code
c
Other physical details
illustrations.
Specific material designation
remote
System control number
(OCoLC)847523490
Label
Allergen-specific immunotherapy for the treatment of allergic rhinoconjunctivitis and/or asthma : comparative effectiveness review, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Johns Hopkins University Evidence-based Practice Center ; investigators, Sandra Y. Lin, M.D., Nkiruka Erekosima, M.D., M.P.H., Catalina Suarez-Cuervo, M.D., Murugappan Ramanathan, M.D., Julia M. Kim, M.D., M.P.H., Darcy Ward, M.S., Yohalakshmi Chelladurai, M.B.B.S., M.P.H., and Jodi B. Segal, M.D., M.P.H
Publication
Note
"March 2013. Errata added May and August 2013."
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
cr
Carrier MARC source
rdacarrier.
Content category
text
Content type code
txt
Content type MARC source
rdacontent.
Control code
847523490
Extent
1 online resource (489 pages)
Form of item
online
Media category
computer
Media MARC source
rdamedia.
Media type code
c
Other physical details
illustrations.
Specific material designation
remote
System control number
(OCoLC)847523490

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