Mono and multifaceted inhalant and/or food allergen reduction interventions for preventing asthma in children at high risk of developing asthma

Tanja Maas; Janneke Kaper; Aziz Sheikh; J. André Knottnerus; Geertjan Wesseling; Edward Dompeling; Jean WM Muris; Constant Paul van Schayck

doi:10.1002/14651858.CD006480.pub2

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Figure 1

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

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Figure 2

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

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Figure 3

Forest plot of comparison: 1 Current diagnosis asthma ITT, outcome: 1.1 Multifaceted intervention.

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Figure 4

Forest plot of comparison: 1 Current diagnosis asthma ITT, outcome: 1.2 monofaceted intervention.

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Figure 5

Forest plot of comparison: 2 Current wheezing parental reported ITT, outcome: 2.1 Multifaceted.

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Figure 6

Forest plot of comparison: 2 Current wheezing parental reported ITT, outcome: 2.2 monofaceted.

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Figure 7

Forest plot of comparison: 3 Current nocturnal cough parental reported ITT, outcome: 3.1 Multifaceted.

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Figure 8

Forest plot of comparison: 3 Current nocturnal cough parental reported ITT, outcome: 3.2 monofaceted.

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Analysis 1.1

Comparison 1 Current diagnosis asthma ITT, Outcome 1 Multifaceted intervention.

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Analysis 1.2

Comparison 1 Current diagnosis asthma ITT, Outcome 2 Mono‐faceted intervention.

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Analysis 2.1

Comparison 2 Current wheezing parental reported ITT, Outcome 1 Multifaceted.

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Analysis 2.2

Comparison 2 Current wheezing parental reported ITT, Outcome 2 Mono‐faceted.

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Analysis 3.1

Comparison 3 Current nocturnal cough parental reported ITT, Outcome 1 Multifaceted.

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Analysis 3.2

Comparison 3 Current nocturnal cough parental reported ITT, Outcome 2 Mono‐faceted.

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Analysis 4.1

Comparison 4 Current dyspnoea parental reported ITT, Outcome 1 Multifaceted.

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Analysis 5.1

Comparison 5 Sensitivity analyses current asthma on treatment, Outcome 1 Multifaceted interventions.

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Analysis 5.2

Comparison 5 Sensitivity analyses current asthma on treatment, Outcome 2 Mono‐faceted interventions.

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Analysis 6.1

Comparison 6 Sensitivity analyses current dyspnoea on treatment, Outcome 1 Multifaceted interventions.

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Analysis 7.1

Comparison 7 Sensitivity analyses current nocturnal cough on treatment, Outcome 1 Multifaceted interventions.

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Analysis 7.2

Comparison 7 Sensitivity analyses current nocturnal cough on treatment, Outcome 2 Mono‐faceted interventions.

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Analysis 8.1

Comparison 8 Sensitivity analyses current wheezing on treatment, Outcome 1 Multifaceted interventions.

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Analysis 8.2

Comparison 8 Sensitivity analyses current wheezing on treatment, Outcome 2 Mono‐interventions.

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Comparison 1. Current diagnosis asthma ITT

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Multifaceted intervention Show forest plot	6		Odds Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Current diagnosis asthma defined as doctor diagnosis at age 2 years	3	1157	Odds Ratio (M‐H, Random, 95% CI)	0.71 [0.53, 0.95]
1.2 Current diagnosis asthma defined as doctor diagnosis at age 4 years	1	136	Odds Ratio (M‐H, Random, 95% CI)	0.56 [0.26, 1.23]
1.3 Current diagnosis asthma defined as respiratory symptoms plus BHR and/or reversibility at age 7 years	1	545	Odds Ratio (M‐H, Random, 95% CI)	0.52 [0.31, 0.89]
1.4 Current diagnosis asthma defined as respiratory symptoms plus BHR and/or reversibility at age 8 years	1	136	Odds Ratio (M‐H, Random, 95% CI)	0.54 [0.17, 1.70]
1.5 Current diagnosis asthma defined as doctor diagnosis at age < 5 years last reported	3	1157	Odds Ratio (M‐H, Random, 95% CI)	0.72 [0.54, 0.96]
1.6 Current diagnosis asthma defined as respiratory symptoms plus BHR and/or reversibility at age >= 5 yrs last reported	2	681	Odds Ratio (M‐H, Random, 95% CI)	0.52 [0.32, 0.85]
2 Mono‐faceted intervention Show forest plot	8		Odds Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Current diagnosis asthma defined as doctor diagnosis at age 2 years	3	1224	Odds Ratio (M‐H, Random, 95% CI)	0.88 [0.48, 1.64]
2.2 Current diagnosis asthma defined as doctor diagnosis at age 3 years	2	872	Odds Ratio (M‐H, Random, 95% CI)	0.84 [0.41, 1.71]
2.3 Current diagnosis asthma defined as doctor diagnosis at age 4 years	2	528	Odds Ratio (M‐H, Random, 95% CI)	1.09 [0.60, 1.98]
2.4 Current diagnosis asthma defined as doctor diagnosis at age 5 years	1	616	Odds Ratio (M‐H, Random, 95% CI)	0.86 [0.57, 1.29]
2.5 Current diagnosis asthma defined as respiratory symptoms plus BHR and/or reversibility at age 7 years	1	357	Odds Ratio (M‐H, Random, 95% CI)	0.73 [0.40, 1.35]
2.6 Current diagnosis asthma defined as doctor diagnosis at age < 5 years last reported	5	2131	Odds Ratio (M‐H, Random, 95% CI)	1.12 [0.76, 1.64]
2.7 Current diagnosis asthma defined as respiratory symptoms plus BHR and/or reversibility at age >= 5 yrs last reported	2	967	Odds Ratio (M‐H, Random, 95% CI)	0.83 [0.59, 1.16]

Comparison 1. Current diagnosis asthma ITT

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Comparison 2. Current wheezing parental reported ITT

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Multifaceted Show forest plot	4		Odds Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Current wheezing parental reported at age 2 years	2	1021	Odds Ratio (M‐H, Random, 95% CI)	0.81 [0.34, 1.90]
1.2 Current wheezing parental reported at age 7 & 8 years	2	681	Odds Ratio (M‐H, Random, 95% CI)	0.52 [0.30, 0.88]
1.3 Current wheezing parental reported data last reported	3	1157	Odds Ratio (M‐H, Random, 95% CI)	0.53 [0.35, 0.81]
2 Mono‐faceted Show forest plot	4		Odds Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Current wheezing parental reported at age 3 years	2	907	Odds Ratio (M‐H, Random, 95% CI)	0.93 [0.65, 1.35]
2.2 Current wheezing parental reported at age 4 years	1	810	Odds Ratio (M‐H, Random, 95% CI)	1.01 [0.50, 2.02]
2.3 Current wheezing parental reported at age 5 years	1	616	Odds Ratio (M‐H, Random, 95% CI)	0.88 [0.60, 1.28]
2.4 Current wheezing parental reported data last reported	3	1717	Odds Ratio (M‐H, Random, 95% CI)	0.90 [0.67, 1.22]

Comparison 2. Current wheezing parental reported ITT

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Comparison 3. Current nocturnal cough parental reported ITT

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Multifaceted Show forest plot	3		Odds Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Current nocturnal cough parental reported at age 2 years	1	443	Odds Ratio (M‐H, Random, 95% CI)	0.71 [0.47, 1.08]
1.2 Current nocturnal cough parental reported at age 7 & 8 years	2	681	Odds Ratio (M‐H, Random, 95% CI)	0.63 [0.21, 1.92]
1.3 Current nocturnal cough parental reported data last reported	3	1157	Odds Ratio (M‐H, Random, 95% CI)	0.70 [0.42, 1.16]
2 Mono‐faceted Show forest plot	3		Odds Ratio (M‐H, Random, 95% CI)	Subtotals only

2.1 Current nocturnal cough parental reported data last reported	3	1800	Odds Ratio (M‐H, Random, 95% CI)	1.03 [0.77, 1.38]

Comparison 3. Current nocturnal cough parental reported ITT

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Comparison 4. Current dyspnoea parental reported ITT

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Multifaceted Show forest plot	1		Odds Ratio (M‐H, Random, 95% CI)	Subtotals only

1.1 Current dyspnoea parental reported at age 2 years	1	476	Odds Ratio (M‐H, Random, 95% CI)	1.18 [0.67, 2.08]

Comparison 4. Current dyspnoea parental reported ITT

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Comparison 5. Sensitivity analyses current asthma on treatment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Multifaceted interventions Show forest plot	5	1624	Odds Ratio (M‐H, Random, 95% CI)	0.67 [0.52, 0.86]

1.1 < 5 years last reported	3	1039	Odds Ratio (M‐H, Random, 95% CI)	0.73 [0.55, 0.98]
1.2 >= 5 years last reported	2	585	Odds Ratio (M‐H, Random, 95% CI)	0.52 [0.32, 0.85]
2 Mono‐faceted interventions Show forest plot	8	5232	Odds Ratio (M‐H, Random, 95% CI)	1.02 [0.85, 1.22]

2.1 2 years	3	967	Odds Ratio (M‐H, Random, 95% CI)	1.13 [0.42, 3.10]
2.2 3 years	2	798	Odds Ratio (M‐H, Random, 95% CI)	0.83 [0.42, 1.65]
2.3 4 years	2	349	Odds Ratio (M‐H, Random, 95% CI)	1.25 [0.68, 2.32]
2.4 5 years	1	539	Odds Ratio (M‐H, Random, 95% CI)	0.86 [0.57, 1.30]
2.5 7 years	1	165	Odds Ratio (M‐H, Random, 95% CI)	1.15 [0.58, 2.29]
2.6 < 5 years last reported	5	1710	Odds Ratio (M‐H, Random, 95% CI)	1.13 [0.77, 1.67]
2.7 >= 5 years last reported	2	704	Odds Ratio (M‐H, Random, 95% CI)	0.93 [0.65, 1.32]

Comparison 5. Sensitivity analyses current asthma on treatment

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Comparison 6. Sensitivity analyses current dyspnoea on treatment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Multifaceted interventions Show forest plot	1	443	Odds Ratio (M‐H, Random, 95% CI)	0.65 [0.39, 1.08]

1.1 last reported	1	443	Odds Ratio (M‐H, Random, 95% CI)	0.65 [0.39, 1.08]

Comparison 6. Sensitivity analyses current dyspnoea on treatment

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Comparison 7. Sensitivity analyses current nocturnal cough on treatment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Multifaceted interventions Show forest plot	3	1028	Odds Ratio (M‐H, Random, 95% CI)	0.73 [0.46, 1.16]

1.1 Last reported	3	1028	Odds Ratio (M‐H, Random, 95% CI)	0.73 [0.46, 1.16]
2 Mono‐faceted interventions Show forest plot	3	1405	Odds Ratio (M‐H, Random, 95% CI)	0.91 [0.67, 1.22]

2.1 Last reported	3	1405	Odds Ratio (M‐H, Random, 95% CI)	0.91 [0.67, 1.22]

Comparison 7. Sensitivity analyses current nocturnal cough on treatment

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Comparison 8. Sensitivity analyses current wheezing on treatment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Multifaceted interventions Show forest plot	4	2560	Odds Ratio (M‐H, Random, 95% CI)	0.60 [0.45, 0.80]

1.1 2 years	2	947	Odds Ratio (M‐H, Random, 95% CI)	0.89 [0.33, 2.40]
1.2 7 & 8 years	2	585	Odds Ratio (M‐H, Random, 95% CI)	0.53 [0.31, 0.91]
1.3 Last reported	3	1028	Odds Ratio (M‐H, Random, 95% CI)	0.54 [0.36, 0.83]
2 Mono‐interventions Show forest plot	4	3316	Odds Ratio (M‐H, Random, 95% CI)	0.87 [0.72, 1.06]

2.1 3 & 4 years	3	1396	Odds Ratio (M‐H, Random, 95% CI)	0.89 [0.64, 1.23]
2.2 5 years	1	539	Odds Ratio (M‐H, Random, 95% CI)	0.88 [0.59, 1.29]
2.3 Last reported	3	1381	Odds Ratio (M‐H, Random, 95% CI)	0.85 [0.63, 1.15]

Comparison 8. Sensitivity analyses current wheezing on treatment

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