Background

Allergen immunotherapy (AIT)–associated adverse events are a major concern for safety and efficacy of AIT. Presently, there is no consensus to whether antihistamine premedication could improve such conditions.

Objective

To identify the superiority of antihistamine pretreatment in AIT.

Methods

A comprehensive literature search for randomized controlled trials reporting the effects of antihistamine premedication on safety and efficacy of AIT was performed in MEDLINE, Embase, and Cochrane Library databases. Safety was evaluated according to the number of patients reporting systemic adverse reactions (SARs, the primary outcome) and efficacy according to the number of patients achieving target maintenance dose (TMD) and sustained unresponsiveness to allergen.

Results

A total of 11 randomized controlled trials (including 609 patients) satisfied the inclusion criteria for the meta-analysis. All premedication protocols were temporary. Pooled analysis revealed that compared with control patients, significantly fewer antihistamine-pretreated patients reported total and moderate-to-severe SARs (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.23-0.56; P < .05 and OR, 0.20; 95% CI, 0.06-0.74; P < .05, respectively) and total and moderate-to-severe SAR episodes (OR, 0.42; 95% CI, 0.34-0.53; P < .05 and OR, 0.09; 95% CI, 0.01-0.50; P < .05, respectively). Similarly, antihistamine pretreatment significantly increased the number of patients achieving TMD (OR, 2.94; 95% CI, 1.72-5.03; P < .05), but not sustained unresponsiveness (OR, 1.65; 95% CI, 0.77-3.54; P = 0.2), compared with the control group. Subgroup analysis according to different allergens and dose-escalating approaches also displayed superiority of antihistamine pretreatment than control.

Conclusion

Antihistamine premedication can markedly improve safety and efficacy of AIT by reducing frequency and severity of SAR and increasing TMD.

中文翻译：

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抗组胺药术前用药可提高过敏原免疫治疗的安全性和有效性

背景

过敏原免疫疗法 (AIT) 相关的不良事件是 AIT 安全性和有效性的主要问题。目前，抗组胺药术前用药是否能改善此类情况尚无共识。

客观的

确定抗组胺药预处理在 AIT 中的优越性。

方法

在 MEDLINE、Embase 和 Cochrane 图书馆数据库中对报告抗组胺药术前用药对 AIT 安全性和有效性影响的随机对照试验进行了全面的文献检索。根据报告全身不良反应（SAR，主要结果）的患者数量评估安全性，根据达到目标维持剂量（TMD）和持续对过敏原无反应的患者数量评估疗效。

结果

共有11项随机对照试验（包括609例患者）满足荟萃分析的纳入标准。所有术前用药方案都是临时的。汇总分析显示，与对照患者相比，接受抗组胺药治疗的患者报告总和中度至重度 SAR 的人数明显减少（优势比 [OR]，0.36；95% 置信区间 [CI]，0.23-0.56；P < .05 和OR，0.20；95% CI，0.06-0.74；P < .05，分别）和总和中度至重度 SAR 发作（OR，0.42；95% CI，0.34-0.53；P < .05 和 OR，0.09 ；95% CI，0.01-0.50；分别为P < .05）。同样，抗组胺药预处理显着增加了达到 TMD 的患者数量（OR，2.94；95% CI，1.72-5.03；P< .05），但 与对照组相比没有持续无反应（OR，1.65；95% CI，0.77-3.54；P = 0.2）。根据不同过敏原和剂量递增方法进行的亚组分析也显示抗组胺药预处理优于对照组。

结论

抗组胺药术前用药可以通过降低 SAR 的频率和严重程度以及增加 TMD 来显着提高 AIT 的安全性和有效性。