We read with interest the systematic review and meta-analysis on the efficacy of allergen-specific immunotherapy for atopic dermatitis by Bae et al and would Like to comment on the methodology used.The authors state the review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance, but it is unclear whether there was an a priori protocol, as recommended by PRISMA. In addition, if there was such a protocol, the predefined primary outcome is also unclear. The described primary outcome is treatment success "as assessed by the investigators or patients, regardless of different evaluation methods" and "measured by any scoring system." Given that randomized controlled trials often report more than 1 outcome, what was the protocol's plan for selection of a single outcome for an overall meta-analysis? This review appears to have restricted analysis to the single most available outcome from each included trial, an approach that violates the recommendations of PRISMA and the Cochrane Collaboration.
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