Allergen immunotherapy and/or biologicals for IgE‐mediated food allergy: A systematic review and meta‐analysis

Abstract

Background There is substantial interest in immunotherapy and biologicals in IgE‐mediated food allergy. Methods We searched six databases for randomized controlled trials about immunotherapy alone or with biologicals (to April 2021) or biological monotherapy (to September 2021) in food allergy confirmed by oral food challenge. We pooled the data using random‐effects meta‐analysis. Results We included 36 trials about immunotherapy with 2126 mainly child participants. Oral immunotherapy increased tolerance whilst on therapy for peanut (RR 9.9, 95% CI 4.5.–21.4, high certainty); cow's milk (RR 5.7, 1.9–16.7, moderate certainty) and hen's egg allergy (RR 8.9, 4.4–18, moderate certainty). The number needed to treat to increase tolerance to a single dose of 300 mg or 1000 mg peanut protein was 2. Oral immunotherapy did not increase adverse reactions (RR 1.1, 1.0–1.2, low certainty) or severe reactions in peanut allergy (RR 1,6, 0.7–3.5, low certainty), but may increase (mild) adverse reactions in cow's milk (RR 3.9, 2.1–7.5, low certainty) and hen's egg allergy (RR 7.0, 2.4–19.8, moderate certainty). Epicutaneous immunotherapy increased tolerance whilst on therapy for peanut (RR 2.6, 1.8–3.8, moderate certainty). Results were unclear for other allergies and administration routes. There were too few trials of biologicals alone (3) or with immunotherapy (1) to draw conclusions. Conclusions Oral immunotherapy improves tolerance whilst on therapy and is probably safe in peanut, cow's milk and hen's egg allergy. More research is needed about quality of life, cost and biologicals.

Oral immunotherapy for Immunoglobulin E‐mediated cow's milk allergy in children: A systematic review and meta analysis

“…OIT with CM may be an effective and safe alternative therapy for children with IMCMA. The conclusions on the efficacy of OIT are similar to other studies 7,11,24–26 . The main benefit of OIT is the ability to accidentally consume even a small amount of CM (e.g., 5 ml) or milk products without a reaction.…”

Cow's milk allergy

“…Furthermore, CM-OIT is time- and resource- consuming and predictors of good respondents are missing. Notwithstanding, overall the benefits of CM-OIT seem to outweighs the disadvantages in children with CMA [74 ▪▪ ].…”

“…Several protocols have been evaluated, with the most notable examples being the weekly [65], or slow up-dosing regimens [66], the rapid oral desensitization combined with omalizumab (different maintenance feeding regimens [67,68] and baked CM-OIT [69–71]. Notwithstanding the heterogeneity among studies, children with IgE-CMA seem to tolerate significantly more CM while on therapy [72,73,74 ▪▪ ]. Currently, randomized controlled evidence on sustained unresponsiveness or health-related quality of life (HR-QoL) is lacking [72,73,74 ▪▪ ].…”

Measuring the Impact of Food Immunotherapy on Health-Related Quality of Life in Clinical Trials

“…To date, studies of food immunotherapy have largely focused on efficacy and safety outcomes such as desensitization (increase in reaction threshold), remission, and treatment-related adverse events ( 9 – 11 ). While crucial to assessment of intervention efficacy, these fail to capture the effects of treatment on patient-important factors impacted by food allergy such as psychological and emotional wellbeing, social interaction and participation, which are central to life-long management of chronic illness.…”

“…At the same time, there are significant gaps in the measurement and reporting of data in relation to reactions and allergen ingestion following treatment for food allergy. Evidence that novel immunotherapies improve HRQL is limited ( 11 , 21 ) and in particular, there are few long-term studies assessing for sustained improvements ( 22 , 23 ).…”