TY - JOUR T1 - Allergen immunotherapy for the treatment of allergic rhinitis and/or asthma: an umbrella review JF - CMAJ Open SP - E373 LP - E385 DO - 10.9778/cmajo.20160066 VL - 5 IS - 2 AU - Jesse Elliott AU - Shannon E. Kelly AU - Amy Johnston AU - Becky Skidmore AU - Tara Gomes AU - George A. Wells Y1 - 2017/04/01 UR - http://www.cmajopen.ca/content/5/2/E373.abstract N2 - Background: Allergic rhinitis and asthma are important public health concerns, yet there is no consensus about the benefits and harms of allergen-specific immunotherapy to treat these conditions. We performed an umbrella review of systematic reviews summarizing the current evidence for the benefits and harms of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT).Methods: We searched MEDLINE, Embase, the Cochrane Library and the grey literature from Jan. 1, 2010 to Nov. 20, 2016 for systematic reviews of randomized controlled trials or prospectively controlled studies involving children or adults with allergic rhinitis or asthma. Outcomes were summarized narratively (benefits: total combined symptom-medication score, symptom score, medication score, disease-specific quality of life, adherence; harms: anaphylaxis, death, local and systemic reactions).Results: Twenty-three systematic reviews were included. SCIT and SLIT were more effective than placebo for most outcomes. SCIT was better than SLIT at improving medication and symptom scores, with no differences in quality of life; however, data were limited for this comparison. Anaphylaxis and death were infrequently reported. Few reviews assessed benefits or harms among children.Interpretation: Allergen immunotherapy appears to be effective among patients with allergic rhinitis and asthma. The safety of allergen immunotherapy is not conclusively established, although death and anaphylaxis appear to be rare. PROSPERO no.: CRD42015024590 ER -