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Dhami, S; Zaman, H; Varga, E-M; Sturm, G J; Muraro, A; Akdis, C A; Antolín-Amérigo, D; Bilò, M B; Bokanovic, D; Calderon, M A; Cichocka-Jarosz, E; Oude Elberink, J N G; Gawlik, R; Jakob, T; Kosnik, M; Lange, J; Mingomataj, E; Mitsias, D I; Mosbech, H; Ollert, M; Pfaar, O; Pitsios, C; Pravettoni, V; Roberts, G; Ruëff, F; Sin, B A; Asaria, M; Netuveli, G; Sheikh, A
Languages: English
Types: Article
BACKGROUND: The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing the EAACI Guidelines on Allergen Immunotherapy (AIT) for the management of insect venom allergy. To inform this process, we sought to assess the effectiveness, cost-effectiveness and safety of AIT in the management of insect venom allergy. METHODS: We undertook a systematic review, which involved searching 15 international biomedical databases for published and unpublished evidence. Studies were independently screened and critically appraised using established instruments. Data were descriptively summarized and, where possible, meta-analysed. RESULTS: Our searches identified a total of 16 950 potentially eligible studies; of which, 17 satisfied our inclusion criteria. The available evidence was limited both in volume and in quality, but suggested that venom immunotherapy (VIT) could substantially reduce the risk of subsequent severe systemic sting reactions (OR = 0.08, 95% CI 0.03-0.26); meta-analysis showed that it also improved disease-specific quality of life (risk difference = 1.41, 95% CI 1.04-1.79). Adverse effects were experienced in both the build-up and maintenance phases, but most were mild with no fatalities being reported. The very limited evidence found on modelling cost-effectiveness suggested that VIT was likely to be cost-effective in those at high risk of repeated systemic sting reactions and/or impaired quality of life. CONCLUSIONS: The limited available evidence suggested that VIT is effective in reducing severe subsequent systemic sting reactions and in improving disease-specific quality of life. VIT proved to be safe and no fatalities were recorded in the studies included in this review. The cost-effectiveness of VIT needs to be established.
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    • 1. Golden DB. Anaphylaxis to insect stings. Immunol Allergy Clin North Am 2015;35:287-302.
    • 2. Novembre E, Cianferoni A, Bernardini RA, Ingargiola A, Lombardi E, Vierucci Additional Supporting Information may be found in the online version of this article: Appendix S1. Search strategy. Appendix S2. Experts consulted. Appendix S3. PRISMA checklist.
    • 3. Clark S, Camargo CA Jr. Epidemiology of anaphylaxis. Immunol Allergy Clin North Am 2007;27:145-163.
    • 4. Liew WK, Williamson E, Tang ML. Anaphylaxis fatalities and admissions in Australia. J Allergy Clin Immunol 2009;123: 434-442.
    • 5. Pumphrey RS. Lessons for management of anaphylaxis from a study of fatal reactions. Clin Exp Allergy 2000;30:1144-1150.
    • 6. Bilo MB, Cichocka-Jarosz E, Pumphrey R, Oude-Elberink JN, Lange J, Jakob T et al. Self-medication of anaphylactic reactions due to Hymenoptera stings - an EAACI Task Force Consensus Statement. Allergy 2016;71:931-943.
    • 7. Krishna MT, Ewan PM, Diwakar L, Durham SR, Frew AJ, Leech SC et al. Diagnosis and management of hymenoptera venom allergy: British Society for Allergy and Clinical Immunology (BSACI) guidelines. Clin Exp Allergy 2011;41:1201-1220.
    • 8. Stritzke AI, Eng PA. Age-dependent sting recurrence and outcome in immunotherapytreated children with anaphylaxis to Hymenoptera venom. Clin Exp Allergy 2013;43:950-955.
    • 9. Bilo BM, Bonifazi F. Epidemiology of insect-venom anaphylaxis. Curr Opin Allergy Clin Immunol 2008;8:330.
    • 10. Dhami S, Nurmatov U, Varga EM, Sturm G, Muraro A, Akdis CA et al. Allergen immunotherapy for insect venom allergy: protocol for a systematic review. Clin Transl Allergy 2016;6:6.
    • 11. Dhami S, Nurmatov U, Roberts G, Pfaar O, Muraro A, Ansotegui IJ et al. Allergen immunotherapy for allergic rhinoconjunctivitis: protocol for a systematic review. Clin Transl Allergy 2016;6:12.
    • 12. Dhami S, Nurmatov U, Pajno GB, Fernandez-Rivas M, Muraro A, Roberts G et al. Allergen immunotherapy for IgE-mediated food allergy: protocol for a systematic review. Clin Transl Allergy 2016;6:24.
    • 13. Dhami S, Nurmatov U, Agache I, Lau S, Muraro A, Jutel M et al. Allergen immunotherapy for allergic asthma: protocol for a systematic review. Clin Transl Allergy 2016;6:5.
    • 14. Dhami S, Nurmatov U, Halken S, Calderon MA, Muraro A, Roberts G et al. Allergen immunotherapy for the prevention of allergic disease: protocol for a systematic review. Pediatr Allergy Immunol 2016;27:236-241.
    • 15. Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions. Version 5.1.0 (updated March 2011). The Cochrane Collaboration; 2011. Available at: http://training.cochrane.org/handbook Last accessed on 26 November 2016
    • 16. EPOC Group. Available at: http://epoc.- cochrane.org/literature-searching-systematicreviews
    • 17. Cochrane Effective Practice & Organisation of Care (EPOC) Group. Personal communication Michelle Fiander, Information Specialist & Trial Search Co-ordinator. Ottawa, ON, Canada: EPOC; 2012.
    • 18. Bilo BM, Bonifazi F. Hymenoptera venom immunotherapy. Immunotherapy 2011;3: 229-246.
    • 19. Effective Practice and Organization of Care Group. What study designs should be included in an EPOC review and what should they be called. Available at: http:// epoc.cochrane.org/sites/epoc.- cochrane.org/files/uploads/EPOC%20Study %20Designs%20About.pdf (Accessed on 11 November 2015).
    • 20. Passalacqua G, Baena-Cagnani CE, Bousquet J, Canonica GW, Casale TB, Cox L et al. Grading local side effects of sublingual immunotherapy for respiratory allergy: speaking the same language. J Allergy Clin Immunol 2013;132:93-98. Available at: http://www.jacionline.org/article/S0091-6749 (13)00528-9/pdf
    • 21. World Allergy Organization Subcutaneous Immunotherapy Systemic Reaction Grading System. Available at: https://www.aaaai.org/ Aaaai/media/MediaLibrary/PDF%20Documents/Immunotherapy%20Forms/7b-WorldAllergy-Organization-Systemic-ReactionGrading-systemx.pdf
    • 22. CASP Checklist for Systematic Reviews. Available at: http://media.wix.com/ugd/ dded87_a02ff2e3445f4952992d5a96- ca562576.pdf
    • 23. Effective Practice and Organisation of Care Group. EPOC Website. Available at: http:// epoc.cochrane.org/epoc-specific-resourcesreview-authors
    • 24. The Cochrane Collaboration's Tool for Assessing Risk of Bias. Available at: http:// handbook.cochrane.org/chapter_8/ table_8_5_a_the_cochrane_collaborations_ tool_for_assessing.htm
    • 25. Cochrane Effective Practice and Organisation of Care Group. Methods papers. Available at: http://epoc.cochrane.org/sites/ epoc.cochrane.org/files/uploads/baseline.pdf
    • 26. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions. Version 5.0.2 (Chapter 11, Section 11). The Cochrane Collaboration; 2011
    • 27. Bonadonna P, Bonifacio M, Lombardo C, Zanotti R. Hymenoptera allergy and mast cell activation syndromes. R Curr Allergy Asthma Rep 2016;16:5.
    • 28. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994;50:1088-1101.
    • 29. Boyle RJ, Elremeli M, Hockenhull J, Cherry MG, Bulsara MK, Daniels M et al. Venom immunotherapy for preventing allergic reactions to insect stings (Review). Cochrane Database Syst Rev 2012;10:CD008838.
    • 30. Dhami S, Panesar SS, Roberts G, Muraro A, Worm M, Bilo MB et al. Management of anaphylaxis: a systematic review. Allergy 2014;69:168-175.
    • 31. Hockenhull JE, lremeli M, Cherry MG, Mahon J, Lai M, Darroch J et al. A systematic review of the clinical effectiveness and cost-effectiveness of Pharmalgen for the treatment of bee and wasp venom allergy. Health Technol Assess 2012;16:III-IV, 1-110.
    • 32. Park JH, Yim BK, Lee J-H, Lee S, Kim T-H. Risk associated with bee venom therapy: a systematic review and meta-analysis. PLoS ONE 2015;10:e0126971.
    • 33. Watanabe ASA, Fonseca L, Galva~o C, Kalil J, Castro F. Specific immunotherapy using Hymenoptera venom: systematic review (Imunoterapia especıfica com venenos de Hymenoptera: revisa~o sistematica). Sao Paulo Med J 2010;128:30-37.
    • 34. Hunt KJ, Valentine MD, Sobotka AK, Benton AW, Amodio FJ, Lichtenstein LM. A controlled trial of immunotherapy in insect hypersensitivity. N Engl J Med 1978;299:157-161.
    • 35. Oude Elberink JO, De Monchy JGR, Van Der Heide S, Guyatt GH, Dubois AEJ. Venom immunotherapy improves healthrelated quality of life in patients allergic to yellow jacket venom. J Allergy Clin Immunol 2002;110:174-182.
    • 36. Oude Elberink JO, van der Heide S, Guyatt GH, Dubois AEJ. Immunotherapy improves health-related quality of life of adult patients with dermal reactions following yellow jacket stings. Clin Exp Allergy 2009;39:883-889.
    • 37. Schuberth KC, Lichtenstein LM, KageySobotka A, Szklo M, Kwiterovich K, Valentine MD. Epidemiologic study of insect allergy in II. Effect of accidental stings in allergic children. J Pediatr 1983;102:361-365.
    • 38. Valentine MD, Schuberth K, Kagey-Sobotka A, Graft D, Kwiterovich K, Szklo M et al. The value of immunotherapy with venom in children with allergy to insect stings. N Engl J Med 1990;323:1601-1603.
    • 39. Golden DB, Kagey-Sobotka A, Norman PS, Hamilton RG, Lichtenstein LM. Outcomes of allergy to insect stings in children, with and without venom immunotherapy. N Engl J Med 2004;351:668-674.
    • 40. Pasaoglu G, Sin BA, Misirligil Z. Rush hymenoptera venom immunotherapy is efficacious and safe. J Investig Allergol Clin Immunol 2006;16:232-238.
    • 41. Reisman RE, Dvorin DD, Randolph CC, Georgitis JW. Stinging insect allergy: natural history and modification with venom immunotherapy. J Allergy Clin Immunol 1985;75:735-740.
    • 42. Brehler R, Wolf H, Ku€tting B, Schnitker J, Luger T. Safety of a two-day ultrarush insect venom immunotherapy protocol in comparison with protocols of longer duration and involving a larger number of injections. J Allergy Clin Immunol 2000;105:1231-1235.
    • 43. Ru€eff F, Przybilla B, Bilo MB, Mu€ller U, Scheipl F, Aberer W et al. Predictors of side effects during the buildup phase of venom immunotherapy for Hymenoptera venom allergy: the importance of baseline serum tryptase. J Allergy Clin Immunol 2010;126:105-111.
    • 44. Stoevesandt J, Hosp C, Kerstan A, Trautmann A. Risk stratification of systemic allergic reactions during Hymenoptera venom immunotherapy build-up phase. J Dtsch Dermatol Ges 2014;12:2 44-256.
    • 45. Mosbech H, Mueller U. Side-effects of insect venom immunotherapy: results from an EAACI multicenter study. Allergy 2000;55:1005-1010.
    • 46. Brown SG, Wiese MD, Blackman KE, Heddle RJ. Ant venom immunotherapy: a double-blind, placebo-controlled, crossover trial. Lancet 2003;361:1001-1006.
    • 47. Oude Elberink JN, van der Heide S, Guyatt GH, Dubois AE. Analysis of the burden of treatment in patients receiving an EpiPen for yellow jacket anaphylaxis. J Allergy Clin Immunol 2006;118:699-704.
    • 48. Golden DB, Kelly D, Hamilton RG, Craig TJ. Venom immunotherapy reduces large local reactions to insect stings. J Allergy Clin Immunol 2009;123:1371-1375.
    • 49. Severino MG, Cortellini G, Bonadonna P, Francescato E, Panzini I, Macchia D et al. Sublingual immunotherapy for large local reactions caused by honeybee sting: a double-blind, placebo-controlled trial. J Allergy Clin Immunol 2008;122:44-48.
    • 50. Ross R, Nelson H, Finegold I. Effectiveness of specific immunotherapy in the treatment of hymenoptera venom hypersensitivity: a meta-analysis. Clin Ther 2000;22:351-358.
    • 51. Mueller grading scale. Available at: http:// www.gpnotebook.co.uk/simplepage.cfm? ID=x20120321132301331321 Last accessed on 7 December 2016
    • 52. Ring J, Meßmer K. Incidence and severity of anaphylactoid reactions to colloid volume substitutes. Lancet 1977;1: 466-469.
    • 53. Bonifazi F, Jutel M, Bilo MB, Birnbaum J, Muller U, Bucher C et al. EAACI position paper prevention and treatment of hymenoptera venom allergy. Available at: http:// www.eaaci.org/attachments/887_Hymenoptera%20PP%20-%20Prevention%20&% 20Treatment%20%28Part%20II%29.pdf
    • 54. Golden D, Moffitt J, Nicklas R. Stinging insect hypersensitivity: a practice parameter update. J Allergy Clin Immunol 2011;127:852-854.
    • 55. Rue¨ ff F, Bilo` MB, Jutel M, Mosbech H, Mu¨ ller U. Przybilla B; Interest group on Hymenoptera venom allergy of the European Academy of Allergology and Clinical Immunology. Sublingual immunotherapy with venom is not recommended for patients with Hymenoptera venom allergy. J Allergy Clin Immunol. 2009;123: 272-273.
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