Allergen injection immunotherapy for seasonal allergic rhinitis

Evidence Summaries

Level of Evidence = A

Allergen immunotherapy is effective in reducing symptoms and medication use in seasonal allergic rhinitis and conjunctivitis. Adverse effects appear to be rare.

A Cochrane review 1 included 51 studies with a total of 2871 subjects, each receiving on average 18 injections. Duration of immunotherapy varied from three days to three years. Symptom score data from 15 trials were suitable for meta-analysis and showed an overall reduction in the immunotherapy group (SMD -0.73; 95% CI -0.97 to -0.50, P < 0.00001; n=1063). Reduction was seen in nasal symptoms (SMD -1.59, 95% CI -2.28 to -0.89; 8 trials, n=633), ocular symptoms (SMD -1.80, 95% CI -3.28 to -0.31; 3 trials, n=345), and brochial symptoms (SMD -0.59, 95% CI -1.06 to -0.11; 5 trials, n=429). Medication score data from 13 trials showed an overall reduction in the immunotherapy group (SMD of -0.57 (95% CI -0.82 to -0.33, p<0.00001)). Clinical interpretation of the effect size is difficult. Adrenaline was given in 0.13% (19 of 14085 injections) of those on active treatment and in 0.01% (1 of 8278 injections) of the placebo group for treatment of adverse events. There were no fatalities.

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References

1. Calderon MA, Alves B, Jacobson M, Hurwitz B, Sheikh A, Durham S. Allergen injection immunotherapy for seasonal allergic rhinitis. Cochrane Database Syst Rev 2007 Jan 24;(1):CD001936.  [PMID:17253469]


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