title: Allergen immunotherapy for insect venom allergy: a systematic review and meta-analysis.
abstract: BACKGROUND
  The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing the EAACI Guidelines on Allergen Immunotherapy (AIT) for the management of insect venom allergy. To inform this process, we sought to assess the effectiveness, cost-effectiveness and safety of AIT in the management of insect venom allergy.
  
  
  METHODS
  We undertook a systematic review, which involved searching 15 international biomedical databases for published and unpublished evidence. Studies were independently screened and critically appraised using established instruments. Data were descriptively summarized and, where possible, meta-analysed.
  
  
  RESULTS
  Our searches identified a total of 16 950 potentially eligible studies; of which, 17 satisfied our inclusion criteria. The available evidence was limited both in volume and in quality, but suggested that venom immunotherapy (VIT) could substantially reduce the risk of subsequent severe systemic sting reactions (OR = 0.08, 95% CI 0.03-0.26); meta-analysis showed that it also improved disease-specific quality of life (risk difference = 1.41, 95% CI 1.04-1.79). Adverse effects were experienced in both the build-up and maintenance phases, but most were mild with no fatalities being reported. The very limited evidence found on modelling cost-effectiveness suggested that VIT was likely to be cost-effective in those at high risk of repeated systemic sting reactions and/or impaired quality of life.
  
  
  CONCLUSIONS
  The limited available evidence suggested that VIT is effective in reducing severe subsequent systemic sting reactions and in improving disease-specific quality of life. VIT proved to be safe and no fatalities were recorded in the studies included in this review. The cost-effectiveness of VIT needs to be established.
authors.affiliation: Evidence-Based Health Care Ltd, Edinburgh, UK.
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authors.affiliation: Department of Pediatric and Adolescent Medicine, Respiratory and Allergic Disease Division, Medical University of Graz, Graz, Austria.
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authors.affiliation: Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria.|Outpatient Allergy Clinic Reumannplatz, Vienna, Austria.
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authors.affiliation: Swiss Institute of Allergy and Asthma Research (SIAF), Switzerland Servicio de Enfermedades del Sistema Inmune-Alergia, University of Zurich, Zurich, Switzerland.|Departamento de Medicina y Especialidades Médicas, Hospital Universitario Príncipe de Asturias, Madrid, Spain.
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authors.affiliation: Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria.
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authors.affiliation: Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland.
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authors.affiliation: Department of Allergology and Internal Medicine, University of Groningen, University Medical Hospital Groningen, Groningen, The Netherlands.|Groningen Research Center for Asthma and COPD (GRIAC), Groningen, The Netherlands.
authors.forename: J N G
authors.initials: JN
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authors.affiliation: Department of Internal Medicine, Allergy and Clinical Immunology, Medical University of Silesia, Katowice, Poland.
authors.forename: R
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authors.affiliation: Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland.
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authors.affiliation: Department of Allergology and Clinical Immunology, Mother Theresa School of Medicine, Tirana, Albania.|Department of Paraclinical Disciplines, Faculty of Technical Medical Sciences, Medicine University of Tirana, Tirana, Albania.
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authors.affiliation: Department of Allergy and Clinical Immunology, 2nd Pediatric Clinic, University of Athens, Athens, Greece.
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authors.affiliation: Allergy Clinic, Copenhagen University Hospital Gentofte, Gentofte, Denmark.
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authors.affiliation: Department of Infection and Immunity, Luxembourg Institute of Health (LIH), Strassen, Luxembourg.
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authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Mannheim, Germany.|Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.|Center for Rhinology Allergology, Wiesbaden, Germany.
authors.forename: O
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authors.forename: C
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authors.affiliation: UOC Clinical Allergy and Immunology, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: V
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authors.affiliation: The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK.|NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.|Faculty of Medicine, University of Southampton, Southampton, UK.
authors.forename: G
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authors.lastname: Roberts
authors.affiliation: Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, Munich, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Ruëff
authors.affiliation: Department of Pulmonary Diseases, Division of Immunology and Allergy, Faculty of Medicine, Ankara University, Ankara, Turkey.
authors.forename: B A
authors.initials: BA
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authors.affiliation: Institute for Health and Human Development, University of East London, London, UK.
authors.forename: G
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mesh_terms: D000485:Allergens / Q000276:immunology; D000818:Animals; D001180:Arthropod Venoms / Q000276:immunology*; D003362:Cost-Benefit Analysis; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000191:economics / Q000379:methods; D019468:Disease Management; D006801:Humans; D006967:Hypersensitivity / Q000276:immunology* / Q000628:therapy*; D007299:Insect Bites and Stings / Q000276:immunology / Q000628:therapy; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000485:Allergens; D001180:Arthropod Venoms
keywords: Allergy; anaphylaxis; hymenoptera venom allergy; insect venom allergy; systemic sting reaction