屋尘螨免疫治疗开始前的严重程度和疾病控制：ANTARES一个法国的观察调查
2016/06/20
摘要
背景：变应原免疫治疗（AIT）可用于屋尘螨诱导（HDM）的过敏性鼻炎患者（AR）的治疗，无论患者是否患上哮喘。目前的指南没有对这些患者的治疗管理策略提供足够的支持。然而用变应原免疫治疗（AIT）来治疗过敏已经有了长期的经验。本研究旨在描述屋尘螨过敏患者临床特征和过程用于确定是否应该开始使用变应原免疫治疗（AIT）。
方法：这是一个在法国从2013到2014年进行的、典型的过敏患者的观察性、多中心、前瞻性的横断面研究。任何5岁以上、确诊屋尘螨过敏并且在最近12个月之内没有进行过变应原免疫治疗（AIT）的病患才是合格的。使用医生和病人的问卷调查对数据进行收集。
结果：从随机选取的195名过敏治疗师中入组1589例过敏患者（60%成年人，40%孩子）参与研究。一个有1212例患者（年龄中位数：22岁；52%为女性）的亚组被选出来进行AIT治疗，患过敏性鼻炎（AR）的中位时间为3年。其中，根据AR和及其对哮喘影响的指南，59%有中度至重度持续性AR，57.5%是多重过敏，56.5%同时患有结膜炎（鼻炎中位症状总评分：11）。42%的过敏患者患有哮喘，62%的患者按照全球哮喘患者指南得到了控制。20%患者哮喘控制问卷得分为1-1.5, 37%的得分≥1.5。共有57%患者接受了≥2药的处方（主要是抗组胺药）。日常活动和睡眠质量受轻度至中度的影响，鼻结膜炎生活质量的问卷得分为2.7 ± 1.5。变应原免疫治疗（AIT）的主要驱动力是过敏性鼻炎患者通过前期的指南处方治疗后没有达到满意的效果。
结论：屋尘螨-过敏性鼻炎相关的结膜炎在这些病患中有60%的患者有，哮喘有40%的患者有。 >40 % 的患者，变应原免疫治疗（ AIT）开始时哮喘控制不佳。
（杨冬 审校）
Allergy Asthma ClinImmunol. 2016 Apr 11;12:13.doi:10.1186/s13223-016-0119-z. eCollection 2016.
Severity and disease control before house dust mite immunotherapy initiation: ANTARES a French observational survey.
Demoly P1, Broué-Chabbert A2, Wessel F3, Chartier A4.
Author information
Abstract
BACKGROUND:Allergen immunotherapy (AIT) may be prescribed for patients with allergic rhinitis (AR) induced by house dust mites (HDM) whetherasthma is present or not. Current guidelines provide insufficient support for therapeutic management strategy of these patients. Allergists however have long-term experience with AIT. This study aims to describe the characteristics of the patients seen in clinical practice with HDM allergy and the process used to determine whether AIT should be initiated.
METHODS:This was an observational, multicenter, prospective and cross-sectional study, conducted in France from 2013 to 2014 with a representative sample of allergy specialists. Any patient over 5 years of age with confirmed HDM allergy untreated with AIT within the last 12 months was eligible. Data were prospectively collected using physician and patient questionnaires.
RESULTS:A total of 1589 patients (60 % adults, 40 % children) were included by 195 randomly selected allergists. A subgroup of 1212 patients (median age: 22 years; 52 % women) were selected for AIT treatment with a median time of AR diagnosis of 3 years. Amongst these, 59 % had a moderate to severe persistent AR according to AR and its Impact on Asthma guidelines, 57.5 % were polysensitized, and 56.5 % also suffered from conjunctivitis (median rhinitis total symptom score: 11). Asthma was present in 42 % of patients, and was controlled according to Global Initiative forAsthma guidelines in 62 % of patients. The asthma control questionnaire score was 1-1.5 in 20 % and ≥1.5 in 37 % of patients. A total of 57 % patients received a prescription of ≥2 medications (mainly antihistamines). Usual daily activities and sleep quality were slightly-to-moderately impaired as the mean rhinoconjunctivitis quality of life questionnaire score was 2.7 ± 1.5. The major driver of AIT prescription is AR uncontrolled by previous medications leading to patient dissatisfaction.
CONCLUSIONS:HDM-AR associated conjunctivitis was present in 60 % and asthma in 40 % of cases. In >40 % of these cases, asthma was inadequately controlled at the start of AIT.
KEYWORDS:Allergen immunotherapy; Allergic rhinitis; Asthma; House dust mites; Pharmaco-epidemiology
Allergy Asthma ClinImmunol. 2016 Apr 11;12:13.doi:10.1186/s13223-016-0119-z. eCollection 2016.
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