Abstract
BackgroundAlthough allergen specific immunotherapy (SIT) represents the only immune- modifying and curative option available for patients with allergic rhinitis (AR), the optimal schedule for specific subcutaneous immunotherapy (SCIT) is still unknown. The objective of this study is to systematically assess the efficacy and safety of cluster SCIT for patients with AR.MethodsBy searching PubMed, EMBASE and the Cochrane clinical trials database from 1980 through May 10th, 2013, we collected and analyzed the randomized controlled trials (RCTs) of cluster SCIT to assess its efficacy and safety.ResultsEight trials involving 567 participants were included in this systematic review. Our meta-analysis showed that cluster SCIT have similar effect in reduction of both rhinitis symptoms and the requirement for anti-allergic medication compared with conventional SCIT, but when comparing cluster SCIT with placebo, no statistic significance were found in reduction of symptom scores or medication scores. Some caution is required in this interpretation as there was significant heterogeneity between studies. Data relating to Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) in 3 included studies were analyzed, which consistently point to the efficacy of cluster SCIT in improving quality of life compared to placebo. To assess the safety of cluster SCIT, meta-analysis showed that no differences existed in the incidence of either local adverse reaction or systemic adverse reaction between the cluster group and control group.ConclusionBased on the current limited evidence, we still could not conclude affirmatively that cluster SCIT was a safe and efficacious option for the treatment of AR patients. Further large-scale, well-designed RCTs on this topic are still needed.
Highlights
Allergic rhinitis (AR) is a common airway disease with a reported prevalence of 10–30%
Study Identification and Selection An initial database search identified a total of 53 randomized controlled trials (RCTs)
RCTs were excluded because of duplicate studies, and 23 RCTs were excluded based on the titles and abstracts
Summary
Allergic rhinitis (AR) is a common airway disease with a reported prevalence of 10–30%. Current treatment modalities include allergen avoidance, antihistamine, nasal steroid and allergen specific immunotherapy (SIT) [1]. Antihistamine and nasal steroid), SIT (subcutaneous or sublingual route) represents the only immune-modifying and curative available option for the treatment of AR patients [2]. In contrast to the sublingual SIT, subcutaneous immunotherapy (SCIT) entails repeated injections with allergen extracts. Despite the wellestablished benefits of SCIT, only a small percentage of candidate AR patients were willing to accept this therapeutic option with good compliance [3]. Allergen specific immunotherapy (SIT) represents the only immune- modifying and curative option available for patients with allergic rhinitis (AR), the optimal schedule for specific subcutaneous immunotherapy (SCIT) is still unknown.
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