title: Effectiveness of subcutaneous immunotherapy for allergic rhinoconjunctivitis and asthma: a systematic review.
abstract: OBJECTIVE
  To systematically review the effectiveness and safety of subcutaneous immunotherapy (SCIT) for treatment of allergic rhinoconjunctivitis and asthma, using formulations currently approved in the United States.
  
  
  METHODS
  We searched the following databases up to May 21, 2012: MEDLINE, Embase, LILACS, and the Cochrane Central Register of Controlled Trials.
  
  
  METHODS
  We included randomized controlled trials published in English comparing SCIT to placebo, pharmacotherapy, or other SCIT regimens that reported clinical outcomes of interest. Studies of adults or mixed age populations were included. Studies were excluded if the diagnosis of allergy and/or asthma was not confirmed with objective testing. Paired reviewers selected articles for inclusion and extracted data. We assessed the risk of bias for each study and graded the strength of evidence for each outcome as high, moderate, or low.
  
  
  RESULTS
  Sixty-one studies met our inclusion criteria. Majority of the studies (66%) evaluated single-allergen immunotherapy regimens. The literature provides high-grade evidence that SCIT reduces asthma symptoms, asthma medication usage, rhinitis/rhinoconjunctivitis symptoms, conjunctivitis symptoms, and rhinitis/rhinoconjunctivitis disease-specific quality of life in comparison to placebo or usual care. There is moderate evidence that SCIT decreases rhinitis/rhinoconjunctivitis medication usage. Respiratory reactions were the most common systemic reaction. There were few reports of anaphylaxis; no deaths were reported.
  
  
  CONCLUSIONS
  Generally moderate to strong evidence supports the effectiveness of SCIT for treatment of allergic rhinitis and asthma, particularly with single-allergen immunotherapy regimens. Adverse reactions to SCIT are common, but no deaths were reported in the included studies.
authors.affiliation: Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
authors.forename: Nkiruka
authors.initials: N
authors.lastname: Erekosima
authors.forename: Catalina
authors.initials: C
authors.lastname: Suarez-Cuervo
authors.forename: Murugappan
authors.initials: M
authors.lastname: Ramanathan
authors.forename: Julia M
authors.initials: JM
authors.lastname: Kim
authors.forename: Yohalakshmi
authors.initials: Y
authors.lastname: Chelladurai
authors.forename: Jodi B
authors.initials: JB
authors.lastname: Segal
authors.forename: Sandra Y
authors.initials: SY
authors.lastname: Lin
mesh_terms: D000328:Adult; D001249:Asthma / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D003233:Conjunctivitis, Allergic / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007167:Immunotherapy / Q000009:adverse effects / Q000379:methods; D007279:Injections, Subcutaneous; D008297:Male; D061214:Patient Safety; D016032:Randomized Controlled Trials as Topic; D065631:Rhinitis, Allergic; D012221:Rhinitis, Allergic, Perennial / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents
keywords: Allergy; rhinology