2016 Section 5 Green Book

SUBLINGUAL IMMUNOTHERAPY FOR RHINOCONJUNCTIVITIS AND ASTHMA

of life based on 2 studies 29,32 involving 461 participants. Second, the data for the evidence for the combined symp-

fered in 2 outcomes from our larger re- port. First, there was insufficient evi- dence to grade disease-specific quality

tom plus medication score were graded as low based on 2 studies 31,34 involv- ing 329 participants. A comprehen-

Table 1. Sublingual Immunotherapy Evidence Summary

Strength of the Evidence

No. of Participants

No. of Studies

Summary of Grading Data

Outcome

Allergens

Comparators

Findings

Sublingual immunotherapy vs placebo 22,25-27,35-37, 42,45,47,48 vs inhaled steroids 46 vs placebo-controlled trial of sublingual immunotherapy 41

Two studies with low risk of bias and strong magnitude of effect. 25,35

All placebo-controlled studies demonstrated greater improvement in the sublingual immunotherapy group. The study 46 of sublingual immunotherapy vs inhaled steroids showed improvement in both groups. The majority of studies showed greater improvement in symptoms in the sublingual immunotherapy group vs placebo.

Asthma

625

13 Dust mite 25-27,35-37,42 Alternaria 22,45 Grass mix 46 Tree mix 41 Birch 47 Parietaria 48

High

symptoms

Sublingual immunotherapy vs placebo 10,12,14-17,19, 28-32,35-37,39,42,47-52,54-57,59 vs pharmacotherapy 46,58 vs placebo-controlled trials of sublingual immunotherapy 11,41, 57,60

One study with low risk of bias and strong magnitude. 11 Six studies with

Moderate

Rhinitis or rhino- conjunctivitis symptom scores

2985

36 Grass mix 11,12,16,17,19,31, 32,46,49,50 Dust mite 15,28,29,35-37, 42,51 Parietaria 30,38,48,52 Cedar 53-55 Timothy grass 56 Ragweed 10,57 Birch 47,58 Olive 39 Cat 59 Tree mix 41 Multiple allergens 14,60

medium risk of bias and strong magnitude. 16,39,42, 46,49,50

Sublingual immunotherapy vs placebo 4,45,61 vs 2 placebo- controlled and 1

Two studies with

Five studies

Moderate

Asthma

515

6

Alternaria 45 Birch 61 Tree mix 41

medium risk of bias and strong magnitude. 41,63

demonstrated greater improvement in the sublingual immunotherapy group. 41,43,45,61,63 controlled study 62 found no improvement in symptoms.

symptoms plus rhinitis or rhinocon-

Grass mix 43 Dust mite 62 Multiple allergens 63

One study with

pharmacotherapy- controlled trials of sublingual immunotherapy 41,62,63

junctivitis symptom scores

medium risk of bias and moderate magnitude. 61 medium risk of bias and insufficient data to determine magnitude of effect. 45,62

One placebo-

Two studies with

One study with low risk of bias and moderate magnitude of effect. 43 Five studies with low risk of

Sublingual immunotherapy vs placebo 10-12,14,19,29, 36,39,48,52,55,56 vs a placebo- controlled trial of sublingual immunotherapy 41

All but 2 studies

Moderate

Conjunctivitis symptom scores

1074

13 Grass mix 11,12,19 Dust mite 29,36 Parietaria 48,52 Timothy grass 56 Ragweed 10 Cedar 55 Olive 39 Tree mix 41

showed greater improvement in symptoms in the sublingual immunotherapy group vs placebo. improvement with placebo. 10 change could not be determined in 1 study. 48

bias 11,14,36,48,56 ; 1 of these had strong magnitude. 11 medium risk of bias 10,12,19,39,41,52 ;

Six studies with

One study showed greater

Multiple allergens 14

1 of these had strong magnitude. 41 Seven studies with

The direction of

insufficient data to determine magnitude of effect. 10,12,19,29,48,52,56

(continued)

©2013 American Medical Association. All rights reserved.

JAMA, March 27, 2013—Vol 309, No. 12

Corrected on July 29, 2013

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