Meta-analysis finds 2.31% EoE incidence with food allergen immunotherapy, none with aeroallergen SLIT
This systematic review and meta-analysis examined the incidence of confirmed eosinophilic esophagitis (EoE) as a side effect of allergen immunotherapy (AIT). The analysis included 17 studies, with 15 on food desensitization (oral immunotherapy with food allergens, n=3302 patients) and 2 on sublingual immunotherapy with aeroallergens (n=1436 patients). The study design, setting, and follow-up duration were not reported.
The primary outcome was the incidence of confirmed EoE. In food desensitization studies, the pooled incidence was 2.31% (95% CI 1.45, 3.36). In the two studies on sublingual immunotherapy with aeroallergens, 0 cases were reported among 1436 patients. No comparator group was reported for this analysis.
EoE was reported as an adverse event. Data on serious adverse events, discontinuations, and general tolerability were not reported. A key limitation is that only two studies on sublingual immunotherapy with aeroallergens met the inclusion criteria, limiting the certainty of the finding of no cases. The evidence describes an association from observational data; causation is not explicitly established.
For practice, this meta-analysis suggests clinicians should be aware of a potential association between food allergen immunotherapy and EoE, with an observed incidence around 2-3%. The apparent absence of cases with aeroallergen SLIT is based on very limited evidence. These findings should be interpreted cautiously due to the observational nature of the included studies.
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