Abstract：
BACKGROUND: Cow\'s milk and egg allergy affect approximately 1.9% and 0.9% of children, respectively. Dietary advancement therapies (DAT), including milk (ML) and egg (EL) ladders, baked milk (BM-OIT) and baked egg (BE-OIT) oral immunotherapy are potential therapeutic options for these patients.
OBJECTIVE: To perform systematic review and meta-analysis of the safety and efficacy of DAT in children with IgE-mediated milk or egg allergy.
METHODS: A systematic literature review was conducted, exploring 22 potential outcomes, with meta-analysis performed where >3 studies reported data. The GRADE approach was used to determine the certainty of evidence for each outcome, and the Johanna Briggs Institute tools for determining risk of bias.
RESULTS: Twenty-nine studies met inclusion criteria among 9946 titles screened. Tolerance occurred in 69% of EL, 58% of ML, 49% of BE-OIT and 29% of BM-OIT patients. All-severity allergic reactions occurred in 21% of EL, 25% of ML, 20% of BE-OIT and 61% of BM-OIT patients, with epinephrine use in 3% of EL, 2% of ML, and 9% of BM-OIT patients. At-home reactions occurred in 19% of BE-OIT and 10% of BM-OIT patients. Discontinuation occurred in 14% of EL, 17% of ML, 17% of BE-OIT and 20% of BM-OIT patients. Mean time to BE egg and BE-OIT tolerance was 13.25 months (4 studies) and 19.1 months (3 studies). Certainty of evidence was very low, and risk of bias high. Study heterogeneity was high, attributable to multiple factors.
CONCLUSIONS: There is very low certainty of evidence supporting DAT safety and efficacy. We cannot conclude DAT accelerates tolerance development.
OBJECTIVE: To perform systematic review and meta-analysis of the safety and efficacy of DAT in children with IgE-mediated milk or egg allergy.
METHODS: A systematic literature review was conducted, exploring 22 potential outcomes, with meta-analysis performed where >3 studies reported data. The GRADE approach was used to determine the certainty of evidence for each outcome, and the Johanna Briggs Institute tools for determining risk of bias.
RESULTS: Twenty-nine studies met inclusion criteria among 9946 titles screened. Tolerance occurred in 69% of EL, 58% of ML, 49% of BE-OIT and 29% of BM-OIT patients. All-severity allergic reactions occurred in 21% of EL, 25% of ML, 20% of BE-OIT and 61% of BM-OIT patients, with epinephrine use in 3% of EL, 2% of ML, and 9% of BM-OIT patients. At-home reactions occurred in 19% of BE-OIT and 10% of BM-OIT patients. Discontinuation occurred in 14% of EL, 17% of ML, 17% of BE-OIT and 20% of BM-OIT patients. Mean time to BE egg and BE-OIT tolerance was 13.25 months (4 studies) and 19.1 months (3 studies). Certainty of evidence was very low, and risk of bias high. Study heterogeneity was high, attributable to multiple factors.
CONCLUSIONS: There is very low certainty of evidence supporting DAT safety and efficacy. We cannot conclude DAT accelerates tolerance development.
摘要：
背景：牛奶和鸡蛋过敏影响约1.9％和0.9％的儿童，分别。饮食进步疗法（DAT），包括牛奶（ML）和鸡蛋（EL）梯子，烤牛奶（BM-OIT）和烤鸡蛋（BE-OIT）口服免疫疗法是这些患者的潜在治疗选择。
目的：对IgE介导的牛奶或鸡蛋过敏儿童DAT的安全性和有效性进行系统评价和荟萃分析。
方法：进行了系统的文献综述，探索22种潜在结果，进行荟萃分析，其中>3项研究报告数据。等级方法用于确定每个结果的证据的确定性，以及JohannaBriggs研究所用于确定偏差风险的工具。
结果：在筛选的9946项研究中，有29项研究符合纳入标准。公差发生在69%的EL，58%的ML，49%的BE-OIT和29%的BM-OIT患者。所有严重的过敏反应发生在21%的EL，25%的ML，20%的BE-OIT和61%的BM-OIT患者，在3%的EL中使用肾上腺素，2%的ML，和9％的BM-OIT患者。19％的BE-OIT患者和10％的BM-OIT患者发生家庭反应。停药发生在14%的EL，17%的ML，17%的BE-OIT和20%的BM-OIT患者。产卵和BE-OIT耐受性的平均时间为13.25个月（4项研究）和19.1个月（3项研究）。证据的确定性很低,偏见的风险很高。研究异质性高，可归因于多种因素。
结论：支持DAT安全性和有效性的证据的确定性非常低。我们不能得出DAT加速耐受性发展的结论。
目的：对IgE介导的牛奶或鸡蛋过敏儿童DAT的安全性和有效性进行系统评价和荟萃分析。
方法：进行了系统的文献综述，探索22种潜在结果，进行荟萃分析，其中>3项研究报告数据。等级方法用于确定每个结果的证据的确定性，以及JohannaBriggs研究所用于确定偏差风险的工具。
结果：在筛选的9946项研究中，有29项研究符合纳入标准。公差发生在69%的EL，58%的ML，49%的BE-OIT和29%的BM-OIT患者。所有严重的过敏反应发生在21%的EL，25%的ML，20%的BE-OIT和61%的BM-OIT患者，在3%的EL中使用肾上腺素，2%的ML，和9％的BM-OIT患者。19％的BE-OIT患者和10％的BM-OIT患者发生家庭反应。停药发生在14%的EL，17%的ML，17%的BE-OIT和20%的BM-OIT患者。产卵和BE-OIT耐受性的平均时间为13.25个月（4项研究）和19.1个月（3项研究）。证据的确定性很低,偏见的风险很高。研究异质性高，可归因于多种因素。
结论：支持DAT安全性和有效性的证据的确定性非常低。我们不能得出DAT加速耐受性发展的结论。
