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Sublingual immunotherapy for pediatric allergic conjunctivitis: a meta-analysis of randomized controlled trials
Jie Yang1, Li Zhang2, Zhixiang Zhao3
1Department of Ophthalmology, Zhejiang Hospital, Hangzhou, Zhejiang, China.
Insights
Sublingual immunotherapy (SLIT) effectively reduces ocular symptoms in children with allergic conjunctivitis (AC) and allergic rhinoconjunctivitis (ARC). This safe treatment is particularly beneficial for pollen-induced AC.
Area of Science:
- Allergy and Immunology
- Pediatric Ophthalmology
- Clinical Trials and Meta-Analysis
Background:
- Allergic conjunctivitis (AC) and allergic rhinoconjunctivitis (ARC) are common chronic conditions in children, with ocular symptoms often undertreated.
- Sublingual immunotherapy (SLIT) is a guideline-recommended, safe treatment for pediatric ARC, but its specific efficacy for eye symptoms requires evaluation.
Purpose of the Study:
- To evaluate the therapeutic efficacy of sublingual immunotherapy (SLIT) in ameliorating ocular symptoms in pediatric patients with allergic conjunctivitis (AC) or allergic rhinoconjunctivitis (ARC).
- To synthesize evidence from randomized controlled trials (RCTs) through a meta-analysis to determine the impact of SLIT on eye-related symptoms in children.
Main Methods:
- A meta-analysis was conducted on 13 randomized controlled trials (RCTs) involving pediatric patients (ages 3-18) with AC or ARC.
- Searches were performed in Cochrane Library, EMBASE, and Medline (1990-2017).
- Standardized mean differences (SMDs) and random effects models were used to assess therapeutic effects, with subgroup and sensitivity analyses conducted.
Main Results:
- Sublingual immunotherapy (SLIT) significantly reduced ocular symptoms in children with AC or ARC compared to controls (SMD = -0.21, p = 0.04).
- SLIT demonstrated a clear reduction in pollen-induced pediatric AC (SMD = -0.36, p < 0.0001).
- However, SLIT did not show a significant effect on mite-induced AC (SMD = 0.20, p = 0.34).
Conclusions:
- Sublingual immunotherapy (SLIT) is an effective treatment for relieving ocular symptoms in children diagnosed with allergic conjunctivitis (AC) or allergic rhinoconjunctivitis (ARC).
- Further high-quality, large-scale, population-based trials are recommended to confirm these findings and further elucidate SLIT's efficacy.
Background:
Allergic conjunctivitis (AC) is a common chronic condition, especially in children. Ocular symptoms are often overlooked during treatment of allergic rhinoconjunctivitis (ARC). Pediatric ARC can be effectively treated using sublingual immunotherapy (SLIT), which is a guideline-recommended safe treatment approach. However, the therapeutic efficacy of SLIT in terms of ameliorating eye symptoms has not been effectively evaluated.
Methods:
We performed a meta-analysis of randomized controlled trials (RCTs) evaluating the use of SLIT for infants, children, and adolescents (aged from 3 to 18 years) with AC or ARC. We searched the Cochrane Library database, EMBASE, and Medline from November 1990 to 2017 to find papers dealing with the effects of SLIT on pediatric AC or ARC. We used standardized mean differences (SMDs) to assess therapeutic effects, employing a random effects model. Subgroup and sensitivity analyses were also conducted. The I2 metric was used to evaluate heterogeneity.
Results:
In total, 13 clinical RCTs were included in our meta-analysis. SLIT reduced ocular symptoms to a level below that of controls (SMD = -0.21; 95% confidence interval [CI], -0.41 to -0.01; p = 0.04; I2 = 55%). Notably, on subgroup analysis, SLIT clearly reduced pollen-induced pediatric AC (SMD = -0.36; 95% CI, -0.53 to -0.19; p < 0.0001; I2 = 25%) but not mite-induced AC (SMD = 0.20; 95% CI, -0.20 to 0.60; p = 0.34; I2 = 46%).
Conclusion:
SLIT relieved ocular symptoms in children with ARC or AC. To confirm these results, future meta-analyses should evaluate high-quality, large-scale population-based trials.
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