Epicutaneous Immunotherapy for food allergy: a systematic review and meta-analysis

Abstract

Abstract Background There is ongoing debate about the safety and efficacy of Epicutaneous immunotherapy (EPIT) in treating food allergies. With this in mind, the purpose of this study is to evalute the safety and efficacy of EPIT. Methods We conducted a comprehensive search across four databases (to June 2023) to identify relevant randomized controlled trials (RCTs) comparing EPIT with non-EPIT for the treatment of food allergies, with no language restrictions. Result Ten studies involving 1970 participants were included. Ten high-quality RCTs focusing on peanut allergy and cow's milk allergy were included in the analysis. The meta-analysis revealed that EPIT promoted desensitization in patients with food allergy (RR2.11,95%CI 1.72–2.58; I2 = 0%, high certainty), particularly in aged ≤ 11 years (RR3.84,95%CI 2.39–6.26; I2 = 34%). Additionally, treatment duration ≥ 52 weeks was found to increase immune tolerance (RR 3.37, 95% CI 2.39–4.75; I2 = 13%). Patients who undergo EPIT treatment not only raised the local adverse reactions (RR 1.63, 95% CI 1.10–2.41; I2 = 82%, low certainty), but also raised systemic adverse reactions (RR 1.52, 95% CI 1.01–2.28; I2 = 0%, high certainty). Conclusion After EPIT treatment, patients with food allergy can effectively increase their immune tolerance to food. However, it also significantly increases mild to moderate anaphylaxis. There is limited data on the impact of EPIT on quality of life and other food allergic diseases, indicating a need for further research. PROSPERO ID: CRD42023438950