Abstract：
Peanut allergy is a leading cause of severe food reactions. This meta-analysis evaluates the efficacy and safety of epicutaneous immunotherapy (EPIT) compared to placebo for peanut-allergic individuals. After prospectively registering on PROSPERO, we searched three databases (PubMed, Google Scholar, and Cochrane CENTRAL) and 2 trial registries till September 2023. Analysis was conducted via RevMan where data was computed using risk ratios (RR). The Cochrane Risk of Bias tool and GRADE criteria were used to appraise and evaluate the evidence. From 4927 records, six multicenter randomized placebo-controlled trials comprising 1453 participants were included. The 250 µg EPIT group had a significant increase in successful desensitization compared to placebo (RR: 2.13 (95% C.I: 1.72, 2.64), P < 0.01, I2 = 0%), while the 100 µg EPIT group did not (RR: 1.54 (95% C.I: 0.92, 2.58), P = 0.10, I2 = 0%) (moderate certainty evidence). Moreover, there was a significant increase in local (RR: 1.69 (95% C.I: 1.06, 2.68), P = 0.03, I2 = 89%) and systemic adverse events (RR: 1.75 (95% C.I: 1.14, 2.69), P = 0.01, I2 = 0%) with EPIT. Additionally, individuals administered EPIT have an increased probability of requiring rescue medications like epinephrine (RR: 1.91 (95% C.I: 1.12, 3.28), P = 0.02, I2 = 0%) and topical corticosteroids (RR: 1.49 (95% C.I: 1.29, 1.73), P < 0.01, I2 = 0%) to treat adverse events. The association of adverse events post-treatment including anaphylaxis (RR: 2.31 (95% C.I: 1.00, 5.33), P = 0.05, I2 = 36%), skin/subcutaneous disorders like erythema or vesicles (RR: 0.93 (95% C.I: 0.79, 1.08), P = 0.33, I2 = 0%), and respiratory disorders like dyspnea or wheezing (RR: 0.94 (95% C.I: 0.77, 1.15), P = 0.55, I2 = 0%) with EPIT is inconclusive. EPIT, although effective in desensitization, is linked to an increased risk of adverse events. PROSPERO registration: CRD42023466600.
摘要：
花生过敏是严重食物反应的主要原因。这项荟萃分析评估了表皮免疫疗法（EPIT）与安慰剂相比对花生过敏个体的疗效和安全性。在PROSPERO上进行前瞻性注册后，我们搜索了三个数据库(PubMed，谷歌学者，和CochraneCENTRAL)和2个试验登记处，直至2023年9月。通过RevMan进行分析，其中使用风险比（RR）计算数据。使用Cochrane偏差风险工具和GRADE标准来评估和评估证据。从4927条记录中，纳入了6项多中心随机安慰剂对照试验,包括1453名参与者.与安慰剂相比，250µgEPIT组在成功脱敏方面显着增加（RR：2.13（95％C.I：1.72，2.64），P<0.01，I2=0%），而100µgEPIT组则没有（RR：1.54（95％C.I：0.92，2.58），P=0.10，I2=0%）（中度确定性证据）。此外，本地显着增加（RR：1.69（95％C.I：1.06，2.68），P=0.03，I2=89％）和全身不良事件（RR：1.75（95％C.I：1.14，2.69），P=0.01，I2=0%）与EPIT。此外,服用EPIT的个体需要肾上腺素等救护药物的可能性增加（RR：1.91（95％C.I：1.12，3.28），P=0.02，I2=0％）和局部皮质类固醇（RR：1.49（95％C.I：1.29，1.73），P<0.01，I2=0%）治疗不良事件。包括过敏反应在内的治疗后不良事件的关联（RR：2.31（95％C.I：1.00，5.33），P=0.05，I2=36%），皮肤/皮下疾病，如红斑或囊泡（RR：0.93（95％C.I：0.79，1.08），P=0.33，I2=0%），和呼吸系统疾病，如呼吸困难或喘息（RR：0.94（95％C.I：0.77，1.15），P=0.55，I2=0%）与EPIT是不确定的。EPIT,虽然脱敏有效，与不良事件风险增加有关。PROSPERO注册：CRD42023466600。
