Oral immunotherapy for peanut allergy (PACE): a systematic review and meta-analysis of efficacy and safety.

Administration, Oral Child Child, Preschool Desensitization, Immunologic / adverse effects Female Humans Male Peanut Hypersensitivity / therapy Quality of Life Randomized Controlled Trials as Topic

Journal

Lancet (London, England)
ISSN: 1474-547X
Titre abrégé: Lancet
Pays: England
ID NLM: 2985213R

Informations de publication

Date de publication:
01 06 2019
Historique:
received: 03 01 2019
revised: 15 02 2019
accepted: 19 02 2019
pubmed: 30 4 2019
medline: 21 6 2019
entrez: 30 4 2019
Statut: ppublish

Résumé

Oral immunotherapy is an emerging experimental treatment for peanut allergy, but its benefits and harms are unclear. We systematically reviewed the efficacy and safety of oral immunotherapy versus allergen avoidance or placebo (no oral immunotherapy) for peanut allergy. In the Peanut Allergen immunotherapy, Clarifying the Evidence (PACE) systematic review and meta-analysis, we searched MEDLINE, EMBASE, Cochrane Controlled Register of Trials, Latin American & Caribbean Health Sciences Literature, China National Knowledge Infrastructure, WHO's Clinical Trials Registry Platform, US Food and Drug Administration, and European Medicines Agency databases from inception to Dec 6, 2018, for randomised controlled trials comparing oral immunotherapy versus no oral immunotherapy for peanut allergy, without language restrictions. We screened studies, extracted data, and assessed risk of bias independently in duplicate. Main outcomes included anaphylaxis, allergic or adverse reactions, epinephrine use, and quality of life, meta-analysed by random effects. We assessed certainty (quality) of evidence by the GRADE approach. This study is registered with PROSPERO, number CRD42019117930. 12 trials (n=1041; median age across trials 8·7 years [IQR 5·9-11·2]) showed that oral immunotherapy versus no oral immunotherapy increased anaphylaxis risk (risk ratio [RR] 3·12 [95% CI 1·76-5·55], I In patients with peanut allergy, high-certainty evidence shows that available peanut oral immunotherapy regimens considerably increase allergic and anaphylactic reactions over avoidance or placebo, despite effectively inducing desensitisation. Safer peanut allergy treatment approaches and rigorous randomised controlled trials that evaluate patient-important outcomes are needed. None.

Sections du résumé

BACKGROUND
Oral immunotherapy is an emerging experimental treatment for peanut allergy, but its benefits and harms are unclear. We systematically reviewed the efficacy and safety of oral immunotherapy versus allergen avoidance or placebo (no oral immunotherapy) for peanut allergy.
METHODS
In the Peanut Allergen immunotherapy, Clarifying the Evidence (PACE) systematic review and meta-analysis, we searched MEDLINE, EMBASE, Cochrane Controlled Register of Trials, Latin American & Caribbean Health Sciences Literature, China National Knowledge Infrastructure, WHO's Clinical Trials Registry Platform, US Food and Drug Administration, and European Medicines Agency databases from inception to Dec 6, 2018, for randomised controlled trials comparing oral immunotherapy versus no oral immunotherapy for peanut allergy, without language restrictions. We screened studies, extracted data, and assessed risk of bias independently in duplicate. Main outcomes included anaphylaxis, allergic or adverse reactions, epinephrine use, and quality of life, meta-analysed by random effects. We assessed certainty (quality) of evidence by the GRADE approach. This study is registered with PROSPERO, number CRD42019117930.
RESULTS
12 trials (n=1041; median age across trials 8·7 years [IQR 5·9-11·2]) showed that oral immunotherapy versus no oral immunotherapy increased anaphylaxis risk (risk ratio [RR] 3·12 [95% CI 1·76-5·55], I
INTERPRETATION
In patients with peanut allergy, high-certainty evidence shows that available peanut oral immunotherapy regimens considerably increase allergic and anaphylactic reactions over avoidance or placebo, despite effectively inducing desensitisation. Safer peanut allergy treatment approaches and rigorous randomised controlled trials that evaluate patient-important outcomes are needed.
FUNDING
None.

Identifiants

DOI: 10.1016/S0140-6736(19)30420-9 PMID: 31030987
pubmed: 31030987
pii: S0140-6736(19)30420-9
doi: 10.1016/S0140-6736(19)30420-9
pii:
doi:

Types de publication

Journal Article Meta-Analysis Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

2222-2232

Commentaires et corrections

Type : CommentIn
Type : ErratumIn
Type : CommentIn
Type : CommentIn
Type : CommentIn

Informations de copyright

Copyright © 2019 Elsevier Ltd. All rights reserved.

Auteurs

Derek K Chu (DK)

Department of Medicine, McMaster University, Hamilton, Ontario, ON, Canada; St Joseph's Healthcare Hamilton, Hamilton, Ontario, ON, Canada. Electronic address: chudk@mcmaster.ca.

Robert A Wood (RA)

Division of Allergy & Immunology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Shannon French (S)

Department of Medicine, McMaster University, Hamilton, Ontario, ON, Canada; Department of Pediatrics, McMaster University, Hamilton, Ontario, ON, Canada; St Joseph's Healthcare Hamilton, Hamilton, Ontario, ON, Canada.

Alessandro Fiocchi (A)

Allergy Division, Bambino Gesù Children's Hospital, Istituti di Ricovero e Cura a Carattere Scientifico, Rome, Italy.

Manel Jordana (M)

Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, ON, Canada.

Susan Waserman (S)

Department of Medicine, McMaster University, Hamilton, Ontario, ON, Canada; St Joseph's Healthcare Hamilton, Hamilton, Ontario, ON, Canada.

Jan L Brożek (JL)

Department of Medicine, McMaster University, Hamilton, Ontario, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, ON, Canada; Michael G DeGroote Cochrane Canada Centre, Hamilton, ON, Canada.

Holger J Schünemann (HJ)

Department of Medicine, McMaster University, Hamilton, Ontario, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, ON, Canada; St Joseph's Healthcare Hamilton, Hamilton, Ontario, ON, Canada; Michael G DeGroote Cochrane Canada Centre, Hamilton, ON, Canada.

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Classifications MeSH

questionsmedicales.fr › Thérapeutique › Traitement médicamenteux › Voies d'administration de substances chimiques et des médicaments › Administration par voie orale › Oral immunotherapy for peanut allergy (PACE):...
questionsmedicales.fr › Personnes › Tranches d'âge › Enfant › Oral immunotherapy for peanut allergy (PACE):...
questionsmedicales.fr › Personnes › Tranches d'âge › Enfant › Enfant d'âge préscolaire › Oral immunotherapy for peanut allergy (PACE):...
questionsmedicales.fr › Techniques d'investigation › Techniques immunologiques › Immunosuppression thérapeutique › Désensibilisation immunologique › Oral immunotherapy for peanut allergy (PACE):...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Oral immunotherapy for peanut allergy (PACE):...
questionsmedicales.fr › Maladies du système immunitaire › Hypersensibilité › Hypersensibilité immédiate › Hypersensibilité alimentaire › Hypersensibilité aux noix et aux arachides › Hypersensibilité aux arachides › Oral immunotherapy for peanut allergy (PACE):...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Mesures épidémiologiques › Démographie › État de santé › Qualité de vie › Oral immunotherapy for peanut allergy (PACE):...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études cliniques comme sujet › Essais cliniques comme sujet › Essais cliniques contrôlés comme sujet › Essais contrôlés randomisés comme sujet › Oral immunotherapy for peanut allergy (PACE):...