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From Skin to Solution: Exploring Epicutaneous Immunotherapy for Peanut Allergy—A Systematic Review and Meta-Analysis

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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.

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Data Availability

No datasets were generated or analysed during the current study.

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Acknowledgements

The authors are thankful the assistance in data representation provided by Shagufta Shabbar, PhD Scholar, Department of Economics at the Institute of Business Administration, Pakistan.

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Authors and Affiliations

  1. Dow University of Health Sciences, Karachi, Pakistan

    Umm E Salma Shabbar Banatwala & Muhammad Moiz Nasir

  2. Department of Dermatology, Al-Mustafa Hospital and Rajput General Hospital, Karachi, Pakistan

    Reema Javed

  3. Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Areeba Ahmed

  4. Department of Plastic and Reconstructive Surgery, Ohio State University, Columbus, OH, USA

    Syed Ali Farhan

  5. Department of Rheumatology and Immunology, Ohio State University, Columbus, OH, USA

    Ali Ajam

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Contributions

1. Umm E Salma Shabbar Banatwala: idea conception, literature search, data extraction, data analysis, and manuscript writing. 2. Muhammad Moiz Nasir: data extraction, data analysis, and manuscript writing. 3. Reema Javed: manuscript writing and editing. 4. Areeba Ahmed: manuscript editing and revision. 5. Syed Ali Farhan: manuscript editing and revision. 6. Ali Ajam: final revision.

Corresponding author

Correspondence to Umm E Salma Shabbar Banatwala.

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Ethics Approval

This study does not require ethical approval since there was no direct interaction with humans or animals. Data from published trials has been used in this analysis.

Consent to Participate

Due to the nature of this study, informed consent from participants was not required as this study is a meta-analysis that includes trials that had these participants.

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The authors declare no competing interests.

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Key Messages

• Peanut allergy can cause fatal food reactions and is usually not outgrown, unlike other food allergies.

• Epicutaneous immunotherapy improves desensitization to peanut protein but is associated with a variety of adverse events.

• Epicutaneous immunotherapy exhibits no significantly increased risk of anaphylaxis. However, the calculated P-value of 0.05 warrants caution.

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Supplementary file1 (DOCX 77 KB)

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Banatwala, U.E.S., Nasir, M.M., Javed, R. et al. From Skin to Solution: Exploring Epicutaneous Immunotherapy for Peanut Allergy—A Systematic Review and Meta-Analysis. Clinic Rev Allerg Immunol (2024). https://doi.org/10.1007/s12016-024-08990-8

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