Sublingual immunotherapy vs placebo in the management of grass pollen-induced allergic rhinitis in adults: A systematic review and meta-analysis

TY - JOUR

T1 - Sublingual immunotherapy vs placebo in the management of grass pollen-induced allergic rhinitis in adults

T2 - A systematic review and meta-analysis

AU - Boldovjáková, Dominika

AU - Cordoni, Sara

AU - Fraser, Craig John

AU - Love, Aimee Beth

AU - Patrick, Lorna

AU - Ramsay, Gary James

AU - Ferguson, Aaron Stephen James

AU - Gomati, Anas

AU - Ram, Bhaskar

N1 - Funding Information: With thanks to Dr Neil Scott, MA, MSc, PhD (Medical Statistics Team, Division of Applied Health Sciences, University of Aberdeen) for statistical consultation and support. Publisher Copyright: © 2020 John Wiley & Sons Ltd

PY - 2021/1

Y1 - 2021/1

N2 - Introduction: Allergic rhinitis (AR) is a common inflammatory condition of the nasal mucosa affecting approximately 20% of the population worldwide. Current therapies include intranasal antihistamines, corticosteroids, subcutaneous and sublingual immunotherapy (SLIT). This review and meta-analysis assess the efficacy of SLIT in the management of grass pollen-induced AR in adults.Methods: Ovid EMBASE, Ovid EBM Reviews, Cochrane Central Register of Controlled Trials, Ovid MedLine and PubMed were searched using the following terms: ‘sublingual immunotherapy’, ‘SLIT’, ‘rhinitis’, ‘allergic rhinitis’, ‘rhinosinusitis’ and ‘rhino-conjunctivitis’. All included studies were double-blind, placebo-controlled and randomised trials. Primary outcome was symptom score and secondary outcome included quality of life and safety profile. Meta-analysis of symptom improvement was carried out.Results: Six studies were identified with 979 subjects randomly allocated to SLIT and 992 to a placebo control. All studies reported an improvement in symptoms with SLIT, with five reaching statistical significance (P <.05). Four studies reported statistically significant improvement in quality of life (P <.05). Oral pruritus was the most common adverse event reported. The overall risk of bias was high in 50% of the studies.Conclusions: Sublingual immunotherapy was a safe and effective treatment for grass pollen-induced AR in adults, and therefore, consideration should be given to its use for moderate-to-severe disease in the UK-wide population.

AB - Introduction: Allergic rhinitis (AR) is a common inflammatory condition of the nasal mucosa affecting approximately 20% of the population worldwide. Current therapies include intranasal antihistamines, corticosteroids, subcutaneous and sublingual immunotherapy (SLIT). This review and meta-analysis assess the efficacy of SLIT in the management of grass pollen-induced AR in adults.Methods: Ovid EMBASE, Ovid EBM Reviews, Cochrane Central Register of Controlled Trials, Ovid MedLine and PubMed were searched using the following terms: ‘sublingual immunotherapy’, ‘SLIT’, ‘rhinitis’, ‘allergic rhinitis’, ‘rhinosinusitis’ and ‘rhino-conjunctivitis’. All included studies were double-blind, placebo-controlled and randomised trials. Primary outcome was symptom score and secondary outcome included quality of life and safety profile. Meta-analysis of symptom improvement was carried out.Results: Six studies were identified with 979 subjects randomly allocated to SLIT and 992 to a placebo control. All studies reported an improvement in symptoms with SLIT, with five reaching statistical significance (P <.05). Four studies reported statistically significant improvement in quality of life (P <.05). Oral pruritus was the most common adverse event reported. The overall risk of bias was high in 50% of the studies.Conclusions: Sublingual immunotherapy was a safe and effective treatment for grass pollen-induced AR in adults, and therefore, consideration should be given to its use for moderate-to-severe disease in the UK-wide population.

KW - allergic

KW - poaceae

KW - pollen

KW - rhinitis

KW - sublingual immunotherapy

UR - https://www.scopus.com/pages/publications/85092379193

U2 - 10.1111/coa.13651

DO - 10.1111/coa.13651

M3 - Review article

C2 - 32979035

AN - SCOPUS:85092379193

SN - 1749-4478

VL - 46

SP - 52

EP - 59

JO - Clinical Otolaryngology

JF - Clinical Otolaryngology

IS - 1

ER -