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Specific allergen immunotherapy found not to be effective for atopic eczema

There was a lack of consistent evidence that specific allergen immunotherapy is effective for treating atopic eczema, according to published study results.

Researchers in Europe searched databases, including Cochrane Skin Groups Specialised Register, Central in the Cochrane Library, Medline, Embase, Lilacs, ISI Web of Science and the GREAT database, through July 20, 2015; trial registers through Aug. 3, 2015; and abstracts from the European Academy of Allergy and Clinical Immunology, and the American Academy of Allergy, Asthma and Immunology annual meetings from 2010 to 2015.  Inclusion criteria included randomized controlled trials of specific allergen immunotherapy (SIT) using standardized allergen extracts and compared with placebo or control for treating atopic eczema in patients with allergic sensitization.

From 1,556 records identified, the researchers included 12 studies with 733 patients in the study, with interventions including subcutaneous, sublingual, oral or intradermal SIT in children and/or adults who were allergic to house dust mite, grass pollen or other inhalants.

No significant difference was reported in three studies, with patient-reported global disease severity improvement relative risk of 0.75 (95% CI, 0.45-1.26), and eczema symptoms mean difference of –0.74 on a 20-point scale (95% CI, –1.98 to 0.5).

A significant difference was reported in two studies (SIT improved global disease severity RR = 2.85; 95% CI, 1.02-7.96), with an itch mean difference of –4.2 on a 10-point scale.

Extreme statistical heterogeneity produced limited meta-analysis.

“Meta-analysis of six studies with 262 participants found significant improvement in disease severity was more likely after SIT than in controls,” the researchers wrote. “Quality of evidence was very low due to study limitations (nonblinding) and imprecision.”

Adverse events were not reported, with overall quality of evidence low in the studies.

“We did not find evidence that SIT is an effective treatment for [atopic eczema] as judged by our prespecified primary outcomes,” the researchers wrote. “The evidence regarding SIT efficacy was marked by inconsistency in study findings, and the overall grade of evidence was low. This suggests the need for further rigorous, well-powered studies to clarify whether SIT has benefits for people with [atopic eczema].”

“Therefore, positive effects for SIT in [atopic eczema] cannot currently be excluded,” the researchers concluded.  – by Bruce Thiel

Disclosure: Tam reports no relevant financial disclosures. Please see the full study for other researchers’ relevant financial disclosures.