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First published online on October 20, 2007
Chest, doi:10.1378/chest.06-1425
A more recent version of this article appeared on March 1, 2008
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Meta-analysis of the efficacy of sublingual immunotherapy in the treatment of allergic asthma in pediatric patients, 3 to 18 years of age.

Martin Penagos, MD, MSc1,2; Giovanni Passalacqua, MD1; Enrico Compalati, MD1; Carlos E. Baena-Cagnani, MD3; Socorro Orozco, MD4; Alvaro Pedroza, MD4 and Giorgio Walter Canonica, MD1

1 Allergy & Respiratory Diseases, Department of Internal Medicine, University of Genoa, Genoa, Italy 2 Infants Service, Pediatrics Hospital, CMN "Siglo XXI", IMSS, Mexico City, Mexico 3 University of Cordoba, Argentina 4 Allergy Service, National Pediatrics Institute. Mexico City, Mexico

canonica{at}unige.it

Abstract

Background: Recent studies have documented the efficacy and safety of sublingual immunotherapy (SLIT) in patients with rhinitis, but the value of this treatment in asthma is still debated. We evaluated the efficacy of SLIT in the treatment of allergic asthma in children, by a meta-analysis of randomized, double-blind and placebo-controlled (DBPC) clinical trials.

Methods: Electronic databases were searched up to May 31st, 2006, for randomized, DBPC trials assessing SLIT in pediatric asthma. Effects on primary outcomes (symptom scores and concomitant use of rescue medication) were calculated with standardized mean differences (SMD) using the random-effects model. We performed the meta-analysis by using RevMan 4.2.8 and we followed the recommendations of the Cochrane Collaboration and the QUORUM guidelines.

Results: Seventy three articles were identified and reviewed. Nine studies, all published after 1990, fulfilled the selection criteria. 441 patients had a final assessment and were included in the analysis. Two hundred thirty two patients received SLIT and 209 placebo. The results of the present analysis demonstrated a relevant heterogeneity due to widely differing scoring systems. Overall, there was a significant reduction in both symptoms (SMD –1.14, 95%CI –2.10 to -0.18; p = 0.02) and medication use (SMD –1.63, 95%CI –2.83 to –0.44; p = 0.007) following SLIT.

Conclusion: SLIT with standardized extracts reduces both symptom scores and rescue medication use in children with allergic asthma compared with placebo.

Key Words: sublingual immunotherapy • asthma • children • efficacy • randomized controlled trials • meta-analysis


Related Editorial

Is Sublingual Immunotherapy "Ready for Prime Time"?
Robert G. Townley
Chest 2008 133: 589-590. [Full Text] [PDF]



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R. G. Townley
Is Sublingual Immunotherapy "Ready for Prime Time"?
Chest, March 1, 2008; 133(3): 589 - 590.
[Full Text] [PDF]


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