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Efficacy evaluation of allergen-specific immunotherapy in children with asthma: a systematic review and meta-analysis
Kangping Wu1, Suling Wu2, Lina Wang3
1Department of Pediatric Respiratory Medicine, Hangzhou Children's Hospital, No.201 Wenhui Road, Gongshu, Zhejiang, 310014, Hangzhou, China. wkp828702@163.com.
Insights
Allergen-specific immunotherapy effectively improves childhood asthma symptoms and reduces medication needs. However, significant heterogeneity among studies necessitates further research for optimal application.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Evidence-Based Medicine
Background:
- Childhood asthma, a prevalent chronic respiratory condition, presents challenges with conventional treatments, including frequent attacks and side effects.
- Allergen-specific immunotherapy (AIT) offers a potential etiological approach by inducing immune tolerance to allergens, aiming for long-term symptom relief.
- Existing evidence on AIT's efficacy in pediatric asthma requires systematic synthesis to guide clinical practice.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy of allergen-specific immunotherapy for improving symptoms and reducing medication requirements in children with asthma.
- To synthesize findings from high-quality randomized controlled trials (RCTs) to assess the impact of AIT on key asthma outcome measures.
Main Methods:
- A comprehensive literature search was conducted across major databases (PubMed, Embase, Web of Science, Cochrane Central, CNKI) following Cochrane guidelines.
- Ten randomized controlled trials (RCTs) meeting predefined inclusion criteria were selected for meta-analysis.
- Data extraction and risk of bias assessment were performed independently by two reviewers; main outcomes included Total Asthma Symptom Score (TASS), Total Medication Score (TMS), VAS score, and FEV1%.
Main Results:
- Meta-analysis of 10 RCTs indicated that allergen-specific immunotherapy significantly improved childhood asthma symptoms, evidenced by reductions in TASS (SMD=-1.05) and TMS (SMD=-1.32).
- No significant differences were observed in Visual Analog Scale (VAS) scores or Forced Expiratory Volume in 1 second (FEV1%) between AIT and control groups.
- High heterogeneity was noted across all outcome indicators, suggesting variability in study designs or populations.
Conclusions:
- Allergen-specific immunotherapy demonstrates a positive effect on improving asthma symptoms and decreasing medication use in children.
- Significant heterogeneity among the included studies highlights the need for cautious interpretation of results.
- Further high-quality RCTs are warranted to confirm the safety and long-term efficacy of AIT for optimizing its role in childhood asthma management.
Background:
Asthma is the most common chronic respiratory disease in children. Although conventional treatments such as inhaled corticosteroids and long-acting β2-receptor agonists can effectively control symptoms, some children still face the problem of frequent attacks and drug side effects. As a potential etiological treatment, allergen-specific immunotherapy aims to induce immune tolerance by gradually increasing exposure to specific allergens, thereby relieving asthma symptoms in the long term. This meta-analysis aims to synthesize the existing high-quality evidence and systematically review the efficacy of allergen-specific immunotherapy for childhood asthma.
Methods:
We performed literature search, screening, and data extraction according to the Cochrane Collaboration guidelines. A computerized search of PubMed, Embase, Web of Science, Cochrane Central, and CNKI databases was performed, and 10 randomized controlled clinical trials (RCTs) were included. Two independent reviewers screened the literature, extracted data, and assessed the risk of bias according to predefined criteria. The main outcome measures included TASS, TMS, VAS scores, and FEV1%.
Results:
A total of 10 RCT studies were included, and all met the inclusion criteria. Meta-analysis results showed that allergen-specific immunotherapy showed a positive effect in improving the symptoms of childhood asthma and reducing the need for medication. Specifically, immunotherapy significantly reduced the total asthma symptom score (TASS, SMD=-1.05, 95% CI [-2.09; -0.01]) and total medication score (TMS, SMD=-1.32, 95%CI [-2.21; -0.43]). However, no significant difference was found in VAS score and FEV1% (SMD=-1.77, 95% CI [-3.76;0.22]; SMD = 0.51, 95% CI [-0.38;1.40]). All indicators had high heterogeneity.
Conclusion:
Allergen-specific immunotherapy showed a positive effect in improving the symptoms of childhood asthma and reducing the need for medication, but there was significant heterogeneity among different studies. More high-quality RCTs are needed in the future to further explore the safety and long-term efficacy of immunotherapy to optimize its application in the management of childhood asthma.
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