Epicutaneous immunotherapy (EPIT) has been shown to effectively desensitise patients with food allergies, especially in children aged 11 years and under, but it may increase the risk of local and systemic adverse events. A systematic review and meta-analysis evaluated the safety and efficacy of EPIT in treating food allergies, specifically peanut and cow’s milk allergies, across ten high-quality randomised controlled trials (RCTs) involving 1970 participants. The aim was to determine its effectiveness in promoting desensitisation, its safety profile, and the potential impact on quality of life.
A comprehensive search of international trial registers, including ClinicalTrials.gov, PubMed, Embase, CENTRAL, and Web of Science, was conducted up until June 2023. Studies were selected based on the criteria of food allergy, epidermal immunotherapy, and RCTs. The risk of bias was assessed using the Cochrane risk-of-bias 2 (ROB 2) tool and considered the primary outcomes of desensitisation, local and systemic adverse events, and quality of life. Secondary outcomes included the use of epinephrine, topical medications, and severe adverse events. The GRADE approach was employed to assess the certainty of evidence.
Results revealed that EPIT significantly promoted desensitisation (RR 2.11, 95% CI 1.72–2.58) with high certainty, particularly in children aged ≤11 years (RR 3.84, 95% CI 2.39–6.26). Additionally, a treatment duration of ≥52 weeks was associated with increased immune tolerance (RR 3.37, 95% CI 2.39–4.75). However, EPIT was also linked to an increase in local adverse reactions (RR 1.63, 95% CI 1.10–2.41) and systemic reactions (RR 1.52, 95% CI 1.01–2.28), with a high degree of certainty for the latter.
EPIT offers promising results for desensitising patients with food allergies, particularly children, and for increasing immune tolerance when administered for longer durations. However, it also presents a notable risk of mild-to-moderate anaphylaxis, which requires careful monitoring. Further research is needed to explore its impact on quality of life and its applicability to a broader range of food allergies. In clinical practice, it will be essential to balance the potential benefits of EPIT with the risks of adverse reactions, especially in young patients and those with a history of severe allergic reactions.
Abigail Craig, EMJ
Reference
Xiang X et al. Epicutaneous immunotherapy for food allergy: a systematic review and meta-analysis. Syst Rev. 2025;14(1):4.
