孟鲁司特治疗能改变儿童哮喘患者免疫治疗的早期疗效
2010/08/11
背景：过敏原特异性免疫治疗（SIT）是唯一一个可能治愈过敏性疾病的方法。SIT治疗过程中，增加调节性T细胞诱导的治疗可能进一步增加SIT的有效性。
目的：本研究旨在评价孟鲁斯特治疗对哮喘患者过敏原特异性免疫治疗早期临床和免疫学疗效的影响。
方法：本研究为随机、双盲、安慰剂对照试验。36名哮喘儿童和对尘螨过敏的患儿入选本项研究，这些患儿处于为期7个月的采用每天400～800 mg布地奈德吸入治疗的洗脱期。在之后为期3个月的SIT治疗建立阶段，将患儿随机分为2组，除采用糖皮质激素吸入治疗（ICS）外，一组另外给予5 mg孟鲁斯特（n=18）治疗，而另一组则另外给予安慰剂（n=18），但不允许改变ICS的剂量。在为期7个月的SIT治疗维持阶段，调整ICS剂量以达到哮喘控制。
结果：经过12个月的SIT治疗，平均每日为控制哮喘症状使用的ICS剂量，安慰剂组下降值较孟鲁斯特组多16.7％。孟鲁斯特干预治疗显著妨碍了调节性T淋巴细胞的诱导。在SIT建立阶段，安慰剂组哮喘患者频繁出现哮喘症状，因而未纳入数据统计。
结论：我们研究并未显示孟鲁斯特对SIT的有益作用。事实上，得出了相反的结论：与安慰剂相比，孟鲁斯特使SIT治疗有效性下降。
（林江涛 审校）
J Allergy Clin Immunol. 2010 Jun;125(6):1220-1227.
Montelukast treatment may alter the early efficacy of immunotherapy in children with asthma.
Majak P, Rychlik B, Pułaski L, Błauz A, Agnieszka B, Bobrowska-Korzeniowska M, Kuna P, Stelmach I.
Department of Pediatrics and Allergy, Medical University of Lodz, Lodz, Poland.
Abstract
BACKGROUND: Allergen-specific immunotherapy (SIT) is the only available potentially curative approach in the management of allergic diseases. Therapies that boost regulatory T cell induction during SIT might further enhance its effectiveness.
OBJECTIVE: The purpose of this study was to assess the effect of montelukast treatment on early clinical and immunologic effects of allergen-specific immunotherapy in children with asthma.
METHODS: It was a randomized, double-blind, placebo-controlled trial conducted in 36 children with asthma and allergy to house dust mites who required from 400 to 800 microg of inhaled budesonide per day during the 7-month . Patients were randomly allocated to receive 5 mg montelukast daily (n = 18) or placebo (n = 18) as an addition to inhaled corticosteroid (ICS) treatment during the 3-month build-up phase of SIT, when modification of ICS doses was not allowed. During the 7 months of the maintenance phase of SIT, ICS doses were adjusted to control the asthma symptoms.
RESULTS: After 12 months of SIT, a reduction of the median daily ICS dose, necessary to control asthma symptoms, was 16.7% grater in patients from the placebo group than in patients from the montelukast group. Intervention with montelukast significantly impaired the induction of regulatory T lymphocytes. During the build-up phase of SIT, patients in the placebo group frequently experienced an increase in asthma symptoms leading to exclusions from the per protocol population.
CONCLUSION: Our study failed to show a beneficial effect of montelukast on SIT. In fact, quite the opposite occurred: compared with placebo, montelukast intervention led to less effectiveness of SIT.
J Allergy Clin Immunol. 2010 Jun;125(6):1220-7.
目的：本研究旨在评价孟鲁斯特治疗对哮喘患者过敏原特异性免疫治疗早期临床和免疫学疗效的影响。
方法：本研究为随机、双盲、安慰剂对照试验。36名哮喘儿童和对尘螨过敏的患儿入选本项研究，这些患儿处于为期7个月的采用每天400～800 mg布地奈德吸入治疗的洗脱期。在之后为期3个月的SIT治疗建立阶段，将患儿随机分为2组，除采用糖皮质激素吸入治疗（ICS）外，一组另外给予5 mg孟鲁斯特（n=18）治疗，而另一组则另外给予安慰剂（n=18），但不允许改变ICS的剂量。在为期7个月的SIT治疗维持阶段，调整ICS剂量以达到哮喘控制。
结果：经过12个月的SIT治疗，平均每日为控制哮喘症状使用的ICS剂量，安慰剂组下降值较孟鲁斯特组多16.7％。孟鲁斯特干预治疗显著妨碍了调节性T淋巴细胞的诱导。在SIT建立阶段，安慰剂组哮喘患者频繁出现哮喘症状，因而未纳入数据统计。
结论：我们研究并未显示孟鲁斯特对SIT的有益作用。事实上，得出了相反的结论：与安慰剂相比，孟鲁斯特使SIT治疗有效性下降。
（林江涛 审校）
J Allergy Clin Immunol. 2010 Jun;125(6):1220-1227.
Montelukast treatment may alter the early efficacy of immunotherapy in children with asthma.
Majak P, Rychlik B, Pułaski L, Błauz A, Agnieszka B, Bobrowska-Korzeniowska M, Kuna P, Stelmach I.
Department of Pediatrics and Allergy, Medical University of Lodz, Lodz, Poland.
Abstract
BACKGROUND: Allergen-specific immunotherapy (SIT) is the only available potentially curative approach in the management of allergic diseases. Therapies that boost regulatory T cell induction during SIT might further enhance its effectiveness.
OBJECTIVE: The purpose of this study was to assess the effect of montelukast treatment on early clinical and immunologic effects of allergen-specific immunotherapy in children with asthma.
METHODS: It was a randomized, double-blind, placebo-controlled trial conducted in 36 children with asthma and allergy to house dust mites who required from 400 to 800 microg of inhaled budesonide per day during the 7-month . Patients were randomly allocated to receive 5 mg montelukast daily (n = 18) or placebo (n = 18) as an addition to inhaled corticosteroid (ICS) treatment during the 3-month build-up phase of SIT, when modification of ICS doses was not allowed. During the 7 months of the maintenance phase of SIT, ICS doses were adjusted to control the asthma symptoms.
RESULTS: After 12 months of SIT, a reduction of the median daily ICS dose, necessary to control asthma symptoms, was 16.7% grater in patients from the placebo group than in patients from the montelukast group. Intervention with montelukast significantly impaired the induction of regulatory T lymphocytes. During the build-up phase of SIT, patients in the placebo group frequently experienced an increase in asthma symptoms leading to exclusions from the per protocol population.
CONCLUSION: Our study failed to show a beneficial effect of montelukast on SIT. In fact, quite the opposite occurred: compared with placebo, montelukast intervention led to less effectiveness of SIT.
J Allergy Clin Immunol. 2010 Jun;125(6):1220-7.
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难治性哮喘儿童的激素反应和临床特征
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沙丁胺醇和异丙托溴铵对吸烟和非吸烟哮喘患者的相对及额外的支气管舒张反应
