Multiallergen Immunotherapy for Polysensitized Patients with Allergic Rhinitis: A Systematic Review and Meta-Analysis

Polysensitization occurs in 80% of allergic patients. Allergen immunotherapy (AIT) formulations with multiple allergens remain debated for polysensitized patients.

This study aims to evaluate the clinical effectiveness and safety profile of multiallergen AIT in polysensitized allergic rhinitis (AR) patients.

We searched for polysensitized AR patients treated with multiple allergens in immunotherapy in PubMed, Embase, Web of Science and Cochrane Library until June 5, 2025.

Seven randomized clinical trials and 7 nonrandomized studies were included. Multiallergen immunotherapy significantly reduced combined symptom and medication scores versus placebo from baseline (SMD: -3.75, 95% CI (-5.85, -1.65; p < 0.001)). Compared to single-allergen AIT, symptom score changes were no difference (SMD: -0.34, 95% CI -1.21, 0.52; p = 0.44), while medication scores showed slight superiority (SMD: -1.36, 95% CI -2.44, -0.28; p = 0.01). But both scores at the last follow-up were significantly reduced compared with single-allergen treatment (SMD: -1.75, p = 0.01; SMD: -1.30, p = 0.007). Systematic review highlighted superior outcomes with dual-allergen AIT in some studies. The multiallergen group had a safer profile in randomized studies (OR 0.58, 95% CI 0.35, 0.96, p = 0.03). No significant differences were found in adverse events due to AIT treatment among non-randomized studies (OR 0.86, 95% CI 0.64, 1.15, p = 0.3). Multiallergen AIT demonstrated enhanced immune tolerance and modulation of the type 2 immune response similar to single-allergen treatment.

Based on current evidence, multiallergen AIT demonstrates no significant difference in efficacy, a comparable safety profile, and equivalent immunological modulation compared to single-allergen AIT for the treatment of polysensitized allergic rhinitis. Dual-allergen approaches may optimize benefits in clinically relevant cases, though study heterogeneity necessitates standardized trials.