한빛사 논문
Jung Min Bae, MDa,b,†, Yoon Young Choi, MDc,†, Chang Ook Park, MDa,b, Kee Yang Chung, MD, PhDa,b, Kwang Hoon Lee, MD, PhDa,b,c,*
aDepartment of Dermatology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
bCutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea
cDepartment of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
dBrain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, South Korea
†These authors contributed equally to this work.
*Corresponding author: Kwang Hoon Lee, MD, PhD, Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea.
Abstract
Background
Allergen-specific immunotherapy (allergen-SIT) is the only treatment directed at the cause of IgE-mediated allergic diseases. However, there is controversy over the use of SIT for patients with atopic dermatitis.
Objective
We performed a systematic review and meta-analysis to assess the efficacy of SIT for patients with atopic dermatitis.
Methods
We performed manual searches of reference lists and computerized searches of the MEDLINE, EMBASE, CINAHL, Web of Science, and Cochrane databases (through December 10, 2012) for randomized controlled trials that compared SIT with placebo for patients with atopic dermatitis. The outcome of interest was a dichotomous variable, in terms of treatment success; a meta-analysis was performed by using a random-effects analysis. Subgroup analyses were carried out to evaluate the effects of long-term treatment (more than 1 year), SIT for severe atopic dermatitis, SIT for children, and subcutaneous and sublingual administration of immunotherapy.
Results
We analyzed 8 randomized controlled trials that comprised a total of 385 subjects. We found that SIT has a significant positive effect on atopic dermatitis (odds ratio [OR], 5.35; 95% CI, 1.61-17.77; number needed to treat, 3; 95% CI, 2-9). SIT also showed significant efficacy in long-term treatment (OR, 6.42; 95% CI, 1.50-27.52) for patients with severe atopic dermatitis (OR, 3.13; 95% CI, 1.31-7.48), and when administered subcutaneously (OR, 4.27; 95% CI, 1.36-13.39).
Conclusions
A meta-analysis provides moderate-level evidence for the efficacy of SIT against atopic dermatitis. However, these findings are based on an analysis of a small number of randomized controlled trials, with considerable heterogeneity among trials.
Key words: Allergen-specific immunotherapy, atopic dermatitis, meta-analysis, subcutaneous immunotherapy, sublingual immunotherapy, systematic review
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