舌下免疫治疗
2008/10/10
在发达国家，约四分之一的成年人患有过敏性鼻炎。然而，少数过敏性鼻炎患者在规则抗组织胺药物和皮质类固醇治疗下，其临床症状（鼻子发痒，流泪，打喷嚏，流鼻涕）等仍然得不到明显的缓解。
特异性免疫治疗（specific immunotherapy, SIT），是一种用逐渐增加剂量的变应原提取物对过敏患者进行反复接触，提高患者对此类变应原的耐受性，从而控制或减轻过敏症状的一种治疗方法。治疗的有效性取决于使用变应原的剂量和途径。目前特异性免疫治疗主要包括注射免疫治疗和舌下免疫治疗方法。注射免疫治疗是美国FDA（食品和药物管理局）唯一批准使用的特异性免疫治疗方法，但存在一些局限性，如需要在医院注射、偶可出现致命性的过敏反应等。
在许多欧洲国家，舌下免疫治疗已得到较为普遍的应用。 草-花粉是目前唯一获欧洲监管机构批准使用的舌下免疫治疗用的抗原。2006年，文献报道了三个关于草-花粉片舌下含服免疫治疗的双盲，安慰剂对照的临床研究。 结果显示，1600例患者中，有35%至40％的患者治疗一年后，其临床症状得到明显缓解。舌下免疫疗法的最常见副作用是药物对口腔及舌下的局部刺激，临床研究表明约有47％和52％的患者可出现此副作用。
尽管在一些指南中提到，舌下免疫治疗是治疗过敏性鼻炎的有效方法，但目前并没有统一的治疗草案。 2008年1月，在由英国变态反应及临床免疫协会制定的指南中指出： 舌下免疫治疗是治疗过敏性鼻炎和支气管哮喘的安全、有效的方法，但具体治疗的方法及流程有待于进一步的临床观察。
（张清玲 广州呼吸疾病研究所 510120 摘译）
（N Engl J Med ,2008 may;358:2259-2264.）
Anthony J. Frew, M.D. Sublingual Immunotherapy.
N Engl J Med ,2008 may;358:2259-64.
Allergic rhinitis is a common condition affecting about one quarter of adults in the developed world. Mnority of patients with allergic rhinitis continue to have troublesome symptoms despite the regular and appropriate use of antihistamines and topical corticosteroids.
Specific immunotherapy is a method of reducing sensitivity to a given allergen by repeated administration of a dose of that allergen. It can alter the sensitivity of patients to inhaled allergens and improve allergic symptoms that do not respond to standard pharmacotherapy. The benefit of specific immunotherapy is dependent on both the dose and the route of administration. Injection immunotherapy and sublingual immunotherapy are two forms of specific immunotherapy. Injection immunotherapy is the only form of specific immunotherapy approved by the Food and Drug Administration (FDA). However, this form of immunotherapy has a number of limitations, including death from anaphylaxis and injections have to be given in a doctor’s office.
Sublingual immunotherapy has been adopted in many European countries for patients who might otherwise be considered for conventional injection immunotherapy. The only agent that is currently commercially available for sublingual immunotherapy (Grazax, ALK-Abelló) is the extract of the grass pollen (Phleum pratense). In 2006, the results of three large, double-blind, placebo-controlled trials of a grass-pollen tablet for sublingual immunotherapy (which included more than 1600 patients)showed a 35 to 40% reduction in clinical symptoms in the first year of treatment and a similar reduction in the use of rescue medication. The most common side effect of sublingual immunotherapy is local irritation in the mouth and under the tongue; clinical trials have shown that the rate of local irritation was 47% and 52%.
Although sublingual immunotherapy is mentioned in several guidelines for the treatment of allergic rhinitis, no specific protocols for its use have been endorsed. The British Society for Allergy and Clinical Immunology notes in guidelines published in January 2008 that “sublingual immunotherapy has been shown to be effective in both rhinitis and asthmatic patients and to have a good safety profile.”
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