在草花粉过敏的儿童中用单磷酰脂质A佐剂特异性免疫治疗一个周期后支气管耐受性的诱导
2016/07/28
摘要
目的：皮下注射过敏原特异性免疫治疗（SCIT）是一个临床上行之有效的治疗过敏性疾病的方法，如过敏性鼻炎和哮喘。辅以单磷酸脂质A（MPL）超短期免疫治疗花粉过敏开始后多久后能诱导出支气管耐受性目前尚不清楚。
方法：在69个孩子的前瞻性研究中，双致敏的桦树和草花粉（51个男性，平均年龄11.1岁），评价SCIT治疗1个周期后支气管的耐受性的发展。在所有患者中，在治疗前后都进行支气管过敏原激发试验（BAP）。根据第一轮BAP的结果，将患者分为2组：那些显示负BAP的FEV1减少< 20%（季节性过敏性鼻炎[SAR]组，n = 47）；那些显示正BAP FEV1下降≥20%（SAR伴有过敏性哮喘[ SAR和哮喘]组，n = 22）。所有患者均接受MPL佐剂、桦树花粉超短程免疫治疗，但只有那些对草过敏显示正过敏原激发试验者得到MPL-SCIT治疗。 结果：花粉季后，SAR组的BAP保持不变，但在SAR和哮喘组，BAP得到改善（FEV1下降28.8% VS 12.5%，P＜0.01，）。SCIT治疗后IgG4水平增加（治疗前平均0.34，治疗后平均11.4），而总的和特异性IgE水平保持不变。
结论：对MPL-SCIT 治疗1个周期后，特异性支气管耐性性可以被显著诱导，而在无SCIT治疗的患者中，支气管高反应性可能保持不变。
（杨冬 审校）
Allergy Asthma ImmunolRes. 2016 May;8(3):257-63.doi:10.4168/aair.2016.8.3.257.
Induction of Bronchial Tolerance After 1 Cycle of Monophosphoryl-A-Adjuvanted Specific Immunotherapy in Children With Grass Pollen Allergies.
Rosewich M1, Girod K2, Zielen S2, Schubert R2, Schulze J2.
Author information
Abstract
PURPOSE:Subcutaneous allergen-specific immunotherapy (SCIT) is a well-established and clinically effective method to treat allergic diseases, such as rhinitis and asthma. It remains unclear how soon after initiation of an ultra-short course of grass pollen immunotherapy adjuvanted with monophosphoryl lipid A (MPL)-specific bronchial tolerance can be induced.
METHODS:In a prospective study of 69 children double-sensitized to birch and grass pollens (51 males, average age 11.1 years), development of bronchial tolerance after 1 cycle of SCIT for grass was evaluated. In all the patients, the bronchial allergen provocation test (BAP) was performed before and after treatment. According to the results of the first BAP, the patients were divided into 2 groups: those showing a negative BAP with a decrease in FEV1 of <20% (seasonal allergic rhinitis [SAR] group, n=47); and those showing a positive BAP with a decrease in FEV1 of ≥20% (SAR with allergic asthma [SAR and Asthma] group, n=22). All the patients received MPL-adjuvanted, ultra-short course immunotherapy for birch, but only those with a positive BAP to grass received MPL-SCIT for grass.
RESULTS:After the pollen season, the BAP in the SAR group remained unchanged, while it was improved in the SAR and Asthma group (decrease in FEV1 of 28.8% vs 12.5%, P<0.01). The IgG4 levels increased after SCIT (median before SCIT 0.34 to 11.4 after SCIT), whereas the total and specific IgE levels remained unchanged.
CONCLUSIONS:After 1 cycle of MPL-SCIT, specific bronchial tolerance may be significantly induced, whereas in patients without SCIT, bronchial hyperactivity may remain unchanged.
KEYWORDS:Allergic asthma; bronchial allergen challenge; desensitization, immunologic; pollen allergy; tolerance
Allergy Asthma ImmunolRes. 2016 May;8(3):257-63.doi:10.4168/aair.2016.8.3.257.
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