哮喘的特异性免疫治疗：疗效与安全性
2011/03/28
摘要
采用特异性免疫治疗(SIT)来治疗哮喘，目前仍然存在争议。官方文件也没有明确的使用指征。这可能部分因为较少研究针对哮喘进行特异性评价，也未有研究进行正式的样本量计算，客观的肺功能参数也仅进行了散在评价。然而，有较好的高质量试验研究皮下免疫治疗(SCIT)和舌下免疫治疗(SLIT)，这些研究对哮喘症状进行了评价，而且取得了很好的疗效。此外，虽然一些研究的效度受到试验异质性的限制，一些较好的荟萃分析还是得出了阳性结果。对于SIT进行疾病校正后的疗效（预防哮喘发作的能力）也需要进行考虑。有关安全性，死亡是一个额外的事件，在欧洲，过去20年内未有死亡病例报道。哮喘未得到控制，是严重不良反应的一个最重要的危险因素。总之，如果药物治疗能很好控制哮喘，SLIT和SCIT则可用于哮喘相关的鼻炎（最常见的情况）。在该情况下，也有助于改善临床症状。另一方面，当哮喘为呼吸道过敏症的唯一表现时，目前尚不能推荐SIT治疗。
（陈欣 审校）
Clin Exp Allergy. 2011 Jan 24. doi: 10.1111/j.1365-2222.2010.03688.x.
Specific immunotherapy in asthma: efficacy and safety.
Passalacqua G, Canonica GW.
Allergy and Respiratory Diseases, University Of Genoa, Genoa, Italy.
Abstract
The use of specific immunotherapy (SIT) to treat asthma has been, and still is, a matter of debate, and there are no clear or unequivocal indications in the official documents. This is partly due to the fact that there are few studies specifically designed to assess asthma, that none of such studies had a formal sample size calculation, and that objective parameters of pulmonary function have been assessed only sporadically. Nonetheless, there are good quality studies for both subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) where asthma symptoms were evaluated, and showing positive results. Moreover, several favourable meta-analyses are available, although their validity is limited by the great heterogeneity of the trials included. The disease modifying effect of SIT, that is the capacity of preventing asthma onset should be also taken into account. Concerning the safety, fatalities seem to be an exceptional event and in Europe no fatality has been reported over the last two decades. Uncontrolled asthma is universally recognized as the most important risk factor for severe adverse events. In conclusion both SLIT and SCIT can be used in asthma associated with rhinitis (which is the most common condition), provided that asthma is adequately controlled by pharmacotherapy. In such case, a measurable clinical benefit on asthma symptoms can be expected. On the other hand, SIT cannot be presently recommended as single therapy when asthma is the unique manifestation of respiratory allergy.
Clin Exp Allergy. 2011 Jan 24. doi: 10.1111/j.1365-2222.2010.03688.x.
采用特异性免疫治疗(SIT)来治疗哮喘，目前仍然存在争议。官方文件也没有明确的使用指征。这可能部分因为较少研究针对哮喘进行特异性评价，也未有研究进行正式的样本量计算，客观的肺功能参数也仅进行了散在评价。然而，有较好的高质量试验研究皮下免疫治疗(SCIT)和舌下免疫治疗(SLIT)，这些研究对哮喘症状进行了评价，而且取得了很好的疗效。此外，虽然一些研究的效度受到试验异质性的限制，一些较好的荟萃分析还是得出了阳性结果。对于SIT进行疾病校正后的疗效（预防哮喘发作的能力）也需要进行考虑。有关安全性，死亡是一个额外的事件，在欧洲，过去20年内未有死亡病例报道。哮喘未得到控制，是严重不良反应的一个最重要的危险因素。总之，如果药物治疗能很好控制哮喘，SLIT和SCIT则可用于哮喘相关的鼻炎（最常见的情况）。在该情况下，也有助于改善临床症状。另一方面，当哮喘为呼吸道过敏症的唯一表现时，目前尚不能推荐SIT治疗。
（陈欣 审校）
Clin Exp Allergy. 2011 Jan 24. doi: 10.1111/j.1365-2222.2010.03688.x.
Specific immunotherapy in asthma: efficacy and safety.
Passalacqua G, Canonica GW.
Allergy and Respiratory Diseases, University Of Genoa, Genoa, Italy.
Abstract
The use of specific immunotherapy (SIT) to treat asthma has been, and still is, a matter of debate, and there are no clear or unequivocal indications in the official documents. This is partly due to the fact that there are few studies specifically designed to assess asthma, that none of such studies had a formal sample size calculation, and that objective parameters of pulmonary function have been assessed only sporadically. Nonetheless, there are good quality studies for both subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) where asthma symptoms were evaluated, and showing positive results. Moreover, several favourable meta-analyses are available, although their validity is limited by the great heterogeneity of the trials included. The disease modifying effect of SIT, that is the capacity of preventing asthma onset should be also taken into account. Concerning the safety, fatalities seem to be an exceptional event and in Europe no fatality has been reported over the last two decades. Uncontrolled asthma is universally recognized as the most important risk factor for severe adverse events. In conclusion both SLIT and SCIT can be used in asthma associated with rhinitis (which is the most common condition), provided that asthma is adequately controlled by pharmacotherapy. In such case, a measurable clinical benefit on asthma symptoms can be expected. On the other hand, SIT cannot be presently recommended as single therapy when asthma is the unique manifestation of respiratory allergy.
Clin Exp Allergy. 2011 Jan 24. doi: 10.1111/j.1365-2222.2010.03688.x.
上一篇：
有氧训练对哮喘患者社会心理及症状的影响
下一篇：
糠酸莫米松/富马酸福莫特罗临床试验中哮喘持续期的青少年和成人患者的哮喘控制状态变化评估
