GRADE-ing the benefit/risk equation in food immunotherapy
File(s)Duca2019_Article_GRADE-ingTheBenefitRiskEquatio.pdf (1.22 MB)
Published version
Author(s)
Duca, Bettina
Patel, Nandinee
Turner, Paul
Type
Journal Article
Abstract
Purpose of Review
We reviewed the existing evidence base to desensitisation for food allergy, applying the Grading of Recommendations, Assessment, Development and Evaluation approach to discuss whether desensitisation is likely to become part of routine treatment for patients with food allergy.
Recent Findings
Desensitisation for food allergy to peanut, egg and cow’s milk is efficacious, but whether such interventions are cost-effective is less clear, due to the issues over a sustained desensitisation effect and the increase in allergic reactions occurring in patients on treatment. Few studies have assessed the change in health-related quality of life associated with treatment, and most have not considered discordance between parent-reported changes in health-related quality of life (HRQL) outcomes compared to those of the patients themselves; none to date have controlled for the improvement in HRQL occurring after initial challenge which will confound outcomes.
Summary
The lack of longer-term safety and cost-effectiveness data, as well as an absence of current consensus in the reporting of patient-relevant outcomes, must be addressed in order to be able to recommend the introduction of desensitisation as a routine treatment in healthcare systems.
We reviewed the existing evidence base to desensitisation for food allergy, applying the Grading of Recommendations, Assessment, Development and Evaluation approach to discuss whether desensitisation is likely to become part of routine treatment for patients with food allergy.
Recent Findings
Desensitisation for food allergy to peanut, egg and cow’s milk is efficacious, but whether such interventions are cost-effective is less clear, due to the issues over a sustained desensitisation effect and the increase in allergic reactions occurring in patients on treatment. Few studies have assessed the change in health-related quality of life associated with treatment, and most have not considered discordance between parent-reported changes in health-related quality of life (HRQL) outcomes compared to those of the patients themselves; none to date have controlled for the improvement in HRQL occurring after initial challenge which will confound outcomes.
Summary
The lack of longer-term safety and cost-effectiveness data, as well as an absence of current consensus in the reporting of patient-relevant outcomes, must be addressed in order to be able to recommend the introduction of desensitisation as a routine treatment in healthcare systems.
Date Issued
2019-06
Date Acceptance
2019-03-15
Citation
Current Allergy and Asthma Reports, 2019, 19 (6)
ISSN
1529-7322
Publisher
Springer (part of Springer Nature)
Journal / Book Title
Current Allergy and Asthma Reports
Volume
19
Issue
6
Copyright Statement
© 2019 The Author(s). This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://
creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
License URL
Sponsor
Medical Research Council (MRC)
J P Moulton Charitable Foundation
Grant Number
MR/K010468/1
n/a
Subjects
Desensitisation
Food allergy
Oral immunotherapy
Outcomes
Safety
Allergy
Publication Status
Published
Article Number
30
Date Publish Online
2019-04-25