Systematic Review and Meta-Analysis of Oral Immunotherapy Effect on Food Allergy-Related Quality of Life

Uncertainty exists regarding the health-related quality of life (HRQL) benefits of food allergen oral immunotherapy (OIT). Up-to-date meta-analyses incorporating HRQL data from recent randomised trials are lacking.

Systematic searches of MEDLINE, Embase, CENTRAL and Google Scholar were conducted for food OIT randomised trials (versus any comparator) that measured HRQL with a validated instrument (27 July 2023). Hedges' g standardised mean differences in HRQL between OIT and comparator were analysed by allergen, reporting perspective, and treatment/post-treatment periods, and synthesised using random-effects meta-analysis models when results from multiple trials were available.

Ten trials (nine peanut, one baked milk; N = 1330) were included. No between-group differences were observed in parent-reported child HRQL (g = -0.07, 95% CI: -0.19 to 0.04, 9 trials, N = 1259), self-reported child HRQL (g = -0.23, 95% CI: -0.73 to 0.27, 5 trials, N = 435), or self-reported teenager HRQL (g = 0.00, 95% CI: -0.41 to 0.40, 3 trials, N = 209) during peanut OIT treatment. However, 12 months post-treatment, improved parent-reported child HRQL was observed (g = -0.51, 95% CI: -0.84 to -0.19, 3 comparisons from 2 trials, N = 213). No between-group differences were observed in the baked milk OIT trial in children (g = 0.118, 95% CI: -0.63 to 0.87, N = 26).

HRQL benefits were observed after OIT protocol completion, with limited evidence of benefit during active treatment.