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polysensitised patients was significantly higher than that in monosensitised patients. Therefore, we performed a sensitivity analysis omitting these three studies (24,25,28). In the sensitivity analysis with six studies (21-23,26,27,29), the clinical effectiveness of HDM AIT regarding nasal symptom score did not significantly differ between monosensitised and polysensitised patients (SMD: -3.68 versus -3.53, respectively, p = 0.876; Figure 3), which is consistent with the result of the pooled analysis including all nine studies. A sensitivity analysis omitting each study is shown in Supplementary Table 1. Potential publication bias was evaluated using a funnel plot (Supplemental Figure 1). In Egger’s test, there was no potential publication bias regarding the changes in nasal symptom score in monosensitised and polysensitised patients (p = 0.144 and p = 0.394). Medication scores Among nine studies, five (21,23,24,26,29) investigated the clinical effectiveness in medication score in monosensitised and polysensitised patients. Four (21,24,26,29) out of five studies were available for a pooled analysis; the mean and SD values of medication score was not obtainable in one study (23). The pooled analysis showed that the change in medication score was not significantly different between monosenstised and polysensitised patients (SMD: -2.63 versus -2.53, p = 0.925; Figure 4). The sensitivity analysis revealed the results when omitting each study were consistent with the results of the pooled analysis (Supplementary Table 2). Quality of life scores Among nine studies, three (24-26) evaluated the clinical improvement in Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score between monosensitised and polysensitised patients. In a pooled analysis, the change in RQLQ score did not differ between monosenstised and polysensitised patients (SMD: -3.18 versus -3.91, p = 0.777; Figure 5). The sensitivity analysis showed the results when omitting each study were consistent with the results of the pooled analysis (Supplementary Table 3). Figure 3. Sensitivity analysis for the comparison of the changes in nasal symptom score after single-allergen immunotherapy between monosensitised and polysensitised patients. Three studies in which the baseline nasal symptom score in polysensitised patients was significantly higher than that in monosensitised patients were omitted. Abbreviations: CI, confidence interval; CSMS, combined symptom and medication score; HDM, house dust mite; TNSS, total nasal symptom score; TSS, total symptom score; SMD, standardised mean difference; VAS, visual analogue scale. Figure 2. Comparison of the changes in nasal symptom score after single-allergen immunotherapy with HDM extract between monosensitised and polysensitised patients. Abbreviations: CI, confidence interval; CSMS, combined symptom and medication score; HDM, house dust mite; TNSS, total nasal symptom score; TSS, total symptom score; SMD, standardised mean difference; VAS, visual analogue scale. 356 Kim et al. Discussion AIT has been demonstrated to induce durable immunological modification in response to the specific allergen, through producing neutralising antibodies, through suppressing numbers and activity of allergen-specific Th2 cells and type 2 innate lymphoid cells, and by inducing regulatory T-cell activity (36,37). The Global Allergy and Asthma European Network/European Academy of Allergy and Clinical Immunology (GA2LEN/EAACI) pocket guide suggests to consider AIT in patients with moderate-severe intermittent or persistent AR and rhinoconjunctivitis, especially those with insufficient response to pharmacotherapy, or those who wish to reduce or avoid long-term pharmacological therapy and its potential adverse effects (38). Since AIT is a specific treatment modality
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