Allergy Asthma Immunol Res.  2017 May;9(3):220-228. 10.4168/aair.2017.9.3.220.

Efficacy of Sublingual Immunotherapy for House Dust Mite-Induced Allergic Rhinitis: A Meta-Analysis of Randomized Controlled Trials

• Feng B
• Xiang H
• Jin H
• Gao J
• Huang S
• Shi Y
• Chen R
• Chen B

• KMID: 2371722
• DOI: http://doi.org/10.4168/aair.2017.9.3.220

Abstract

PURPOSE
Allergic rhinitis (AR) has become a global issue for a large part of the general population. Sublingual immunotherapy (SLIT) has been used extensively to treat persistent allergic rhinitis (PAR). Although systematic reviews have confirmed the effectiveness of SLIT for the treatment of AR, a considerable number of studies using extracts of house dust mites (HDMs) for immunotherapy found no consensus on basic treatment parameters and questioned the efficacy of SLIT.
METHODS
In this study, we evaluated SLIT for PAR by a meta-analysis of randomized controlled trials (RCTs). Medline, Embase, and Cochrane Library database searches were performed for RCTs on the treatment of PAR by SLIT that assessed clinical outcomes related to efficacy through May 2016. Descriptive and quantitative information was abstracted. An analysis was performed with standardized mean differences (SMDs) under a fixed or random effects model. Subgroup analyses were performed. Heterogeneity was assessed using the I2 metric.
RESULTS
In total, 25 studies were eligible for inclusion in the meta-analysis for symptom scores and 15 studies for medication scores. SLIT was significantly different from the controls for symptom scores (SMD=1.23; 95% confidence interval [CI]=1.74 to 0.73; P<0.001). For medication scores, significant differences for SLIT were also observed versus the controls (SMD=-1.39; 95% CI=-1.90 to -0.88; P<0.001).
CONCLUSIONS
Our meta-analysis indicates that SLIT provided significant symptom relief and reduced the need for medications in PAR. In this study, significant evidence was obtained despite heterogeneity with regard to the use of mite extract. Specifically, the mite extract used was provided by the patients with PAR. Furthermore, to confirm both the objective outcomes and the effective doses of HDM allergen extracts, experimental data should be obtained from large high-quality population-based studies.

Keyword

Allergic rhinitis; immunotherapy; sublingual; house dust mite; meta-analysis

MeSH Terms

Consensus
Dust*
Humans
Immunotherapy
Mites
Population Characteristics
Pyroglyphidae
Rhinitis, Allergic*
Sublingual Immunotherapy*
Dust

Figure

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  Fig. 1 Classification of material reviewed for this meta-analysis.

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  Fig. 2 Risk of bias summary.

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  Fig. 3 Risk of bias graph.

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  Fig. 4 Nasal symptom scores.

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  Fig. 5 Funnel plot for nasal symptom scores.

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  Fig. 6 Nasal medication scores.

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  Fig. 7 Funnel plot for nasal medication scores.

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