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Clinical Reviews in Allergy & Immunology

25-03-2024 | Anaphylaxis | Review

From Skin to Solution: Exploring Epicutaneous Immunotherapy for Peanut Allergy—A Systematic Review and Meta-Analysis

Authors: Umm E Salma Shabbar Banatwala, Muhammad Moiz Nasir, Reema Javed, Areeba Ahmed, Syed Ali Farhan, Ali Ajam

Published in: Clinical Reviews in Allergy & Immunology

Abstract

Peanut allergy is a leading cause of severe food reactions. This meta-analysis evaluates the efficacy and safety of epicutaneous immunotherapy (EPIT) compared to placebo for peanut-allergic individuals. After prospectively registering on PROSPERO, we searched three databases (PubMed, Google Scholar, and Cochrane CENTRAL) and 2 trial registries till September 2023. Analysis was conducted via RevMan where data was computed using risk ratios (RR). The Cochrane Risk of Bias tool and GRADE criteria were used to appraise and evaluate the evidence. From 4927 records, six multicenter randomized placebo-controlled trials comprising 1453 participants were included. The 250 µg EPIT group had a significant increase in successful desensitization compared to placebo (RR: 2.13 (95% C.I: 1.72, 2.64), P < 0.01, I² = 0%), while the 100 µg EPIT group did not (RR: 1.54 (95% C.I: 0.92, 2.58), P = 0.10, I² = 0%) (moderate certainty evidence). Moreover, there was a significant increase in local (RR: 1.69 (95% C.I: 1.06, 2.68), P = 0.03, I² = 89%) and systemic adverse events (RR: 1.75 (95% C.I: 1.14, 2.69), P = 0.01, I² = 0%) with EPIT. Additionally, individuals administered EPIT have an increased probability of requiring rescue medications like epinephrine (RR: 1.91 (95% C.I: 1.12, 3.28), P = 0.02, I² = 0%) and topical corticosteroids (RR: 1.49 (95% C.I: 1.29, 1.73), P < 0.01, I² = 0%) to treat adverse events. The association of adverse events post-treatment including anaphylaxis (RR: 2.31 (95% C.I: 1.00, 5.33), P = 0.05, I² = 36%), skin/subcutaneous disorders like erythema or vesicles (RR: 0.93 (95% C.I: 0.79, 1.08), P = 0.33, I² = 0%), and respiratory disorders like dyspnea or wheezing (RR: 0.94 (95% C.I: 0.77, 1.15), P = 0.55, I² = 0%) with EPIT is inconclusive. EPIT, although effective in desensitization, is linked to an increased risk of adverse events. PROSPERO registration: CRD42023466600.

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Title: From Skin to Solution: Exploring Epicutaneous Immunotherapy for Peanut Allergy—A Systematic Review and Meta-Analysis
Authors: Umm E Salma Shabbar Banatwala
Muhammad Moiz Nasir
Reema Javed
Areeba Ahmed
Syed Ali Farhan
Ali Ajam
Publication date: 25-03-2024
Publisher: Springer US
Keywords: Anaphylaxis
Anaphylaxis
Published in: Clinical Reviews in Allergy & Immunology
Print ISSN: 1080-0549
Electronic ISSN: 1559-0267
DOI: https://doi.org/10.1007/s12016-024-08990-8

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