Sublingual immunotherapy in patients with latex allergy: systematic review and meta-analysis of randomized controlled trials

Abstract

Latex allergy (LA) is a commonly observed entity for which sublingual immunotherapy (SLIT) has been shown to be effective in many small randomized clinical trials. The present study was conducted with an aim of systematically reviewing the existing literature on the efficacy and safety of SLIT in patients with LA and to apply the principles of meta-analysis. A search for randomized controlled trials with appropriate search strategy in PubMed and CENTRAL was conducted. Studies with documented clinical history of LA and SLIT administered in any dose, duration and regimen compared with placebo were included. Outcome measures were symptom scores, glove provocation test score, serum IgE levels, induration following latex skin prick test, medication scores and adverse effects. Random effects model was used when moderate to severe heterogeneity was observed and fixed effects model when there was mild heterogeneity. Forest plots for standardized mean difference (95% confidence interval) for all the continuous outcome measures were created. A total of 152 records were identified from the electronic databases and four studies were finally included in the meta-analysis. A statistically significant reduction for induration following glove provocation test (pooled results from two studies) was observed in the SLIT group with SMD of −0.9 [−1.71, −0.08]. No significant differences were observed in any other outcome measures between the interventions. We did not identify significant reduction in most of the outcome measures with SLIT in patients with LA except for glove provocation test score wherein only two studies were included. Large and more randomized controlled trials are required to ascertain and confirm the utility of SLIT in such patients.