Comparison of adverse events between cluster and conventional immunotherapy for allergic rhinitis patients with or without asthma: A systematic review and meta-analysis
Author links open overlay panelZihanJiangHaoXiaoHongtingZhangShixiLiuJuanMeng
Sichuan University (四川大学), West China Hospital, Department of Otorhinolaryngology, Chengdu, China
Received 24 May 2019, Available online 7 August 2019.

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https://doi.org/10.1016/j.amjoto.2019.07.013Get rights and content
Abstract
Background
Cluster schedule of allergen-specific immunotherapy (AIT) is a cost-effective choice for allergic rhinitis (AR) patients, but its safety has been questioned due to the greater dosages required at each treatment compared with conventional immunotherapy. It remains a question that whether cluster schedule leads to a higher risk of side effects.

Objective
This study was designed to update the evidence and investigate whether cluster schedule leads to a higher risk of local adverse reactions (LARs) and systemic adverse reactions (SARs) than cluster schedule does.

Methods
We searched the Cochrane Central Register of Controlled Trials, EMBASE and Medline thoroughly and included studies comparing cluster and conventional schedules. A meta-analysis of 5 outcomes related to adverse events was performed after bias and heterogeneity assessments. And as a result of language limitations, we considered only articles in Chinese and English.

Results
5 observational studies and 6 interventional studies were included in the meta-analysis. There were no differences between cluster and conventional schedules when analyzing SARs by the number of patients, delayed SARs, grade 2 SARs and LARs. Analyses of SARs by injection, grade 1 SARs and LARs by injection in observational studies showed that cluster schedule had a lower risk of adverse events than did conventional schedule.

Conclusion
Our data suggest that cluster schedule is as safe as or even safer than conventional schedule for AR patients with or without asthma (AS).

Abbreviations
AITallergen-specific immunotherapyARallergic rhinitisASasthmaLARslocal adverse reactionsSARssystemic adverse reactionsSCITsubcutaneous immunotherapyRCTsrandomized controlled trialsPARperennial(or persistent) allergic rhinitisSARseasonal allergic rhinitisIARintermittent allergic rhinitis
Keywords
Rhinitis, allergicDesensitization, immunologic/methodDesensitization, immunotherapy/adverse effectsAllergens/administration and dosageAllergens/adverse effectsAllergen/therapeutic useHumans