Background There is substantial interest in allergen-specific
immunotherapy in food allergy. We systematically reviewed its efficacy
and safety. Methods We searched six bibliographic databases from 1946 to
30 April 2021 for randomised controlled trials about immunotherapy alone
or with biologicals in IgE-mediated food allergy confirmed by oral food
challenge. We pooled the data using random-effects meta-analysis.
Results We included 36 trials with 2,126 participants, mainly children.
Oral immunotherapy increased tolerance whilst on therapy for peanut (RR
9.9, 95% CI 4.5. to 21.4, high certainty); cow’s milk (RR 5.7, 1.9 to
16.7, moderate certainty) and hen’s egg allergy (RR 8.9, 4.4 to 18,
moderate certainty). The number needed to treat to increase tolerance to
a single dose of 300mg or 1000mg peanut protein was 2. In peanut
allergy, oral immunotherapy did not increase adverse reactions (RR 1.1,
1.0 to 1.2, low certainty) or severe reactions (RR 1,6, 0.7 to 3.5, low
certainty). It may increase adverse reactions in cow’s milk (RR 3.9, 2.1
to 7.5, low certainty) and hen’s egg allergy (RR 7.0, 2.4 to 19.8,
moderate certainty), but reactions tended to be mild and
gastrointestinal. Epicutaneous immunotherapy increased tolerance whilst
on therapy for peanut (RR 2.6, 1.8 to 3.8, moderate certainty). Results
were unclear for other allergies and administration routes. Conclusions
Oral immunotherapy improves tolerance whilst on therapy and is probably
safe in peanut, cow’s milk and hen’s egg allergy. However, our review
found little about whether this improves quality of life, is sustained
or cost-effective.
Outcomes of Baked Milk and Egg Challenge in Cow’s Milk and Hen’s Egg Allergy: Can Tolerance Be Predicted with Allergen-Specific IgE and Prick-to-Prick Test?
