Edited by: Hans-Uwe Simon
Towards evidence-based medicine in specific grass pollen immunotherapy
Version of Record online: 21 DEC 2009
© 2009 John Wiley & Sons A/S
Volume 65, Issue 4, pages 420–434, April 2010
How to Cite
Calderon, M., Mösges, R., Hellmich, M. and Demoly, P. (2010), Towards evidence-based medicine in specific grass pollen immunotherapy. Allergy, 65: 420–434. doi: 10.1111/j.1398-9995.2009.02292.x
- Issue online: 1 MAR 2010
- Version of Record online: 21 DEC 2009
- Accepted for publication 10 November 2009
- evidence-based medicine;
- grass pollen;
- specific immunotherapy;
To cite this article: Calderon M, Mösges R, Hellmich M, Demoly P. Towards evidence-based medicine in specific grass pollen immunotherapy. Allergy 2010; 65: 420–434.
When initiating grass pollen immunotherapy for seasonal allergic rhinoconjunctivitis, specialist physicians in many European countries must choose between modalities of differing pharmaceutical and regulatory status. We applied an evidence-based medicine (EBM) approach to commercially available subcutaneous and sublingual Gramineae grass pollen immunotherapies (SCIT and SLIT) by evaluating study design, populations, pollen seasons, treatment doses and durations, efficacy, quality of life, safety and compliance. After searching MEDLINE, Embase and the Cochrane Library up until January 2009, we identified 33 randomized, double-blind, placebo-controlled trials (including seven paediatric trials) with a total of 440 specific immunotherapy (SIT)-treated subjects in seven trials (0 paediatric) for SCIT with natural pollen extracts, 168 in three trials (0 paediatric) for SCIT with allergoids, 906 in 16 trials (five paediatric) for natural extract SLIT drops, 41 in two trials (one paediatric) for allergoid SLIT tablets and 1605 in five trials (two paediatric) for natural extract SLIT tablets. Trial design and quality varied significantly within and between SIT modalities. The multinational, rigorous trials of natural extract SLIT tablets correspond to a high level of evidence in adult and paediatric populations. The limited amount of published data on allergoids prevented us from judging the level of evidence for this modality.