哮喘联盟

   摘要
   前言：与房尘螨(HDM)相关的特应性疾病，例如过敏性鼻炎和哮喘的患病率逐渐增加。房尘螨是一种常见的变应原，与过敏性鼻炎和哮喘的发生高度相关。虽然避免接触变应原和使用药物是治疗HDM相关性过敏性疾病的一部分，但却很难改变疾病的进程。上个世纪一直使用的变应原免疫疗法 (AIT) 已被证实能有效治疗过敏性呼吸道疾病。
   涉及领域：本综述特别聚焦于HDM-AIT疗法，并讨论了HDM-皮下免疫学疗法(SCIT) 与 HDM-舌下免疫学疗法(SLIT) 在治疗过敏性鼻炎和哮喘儿童及成人患者中的临床疗效和安全性、停止治疗后的长期疗效、以及免疫学改变的差异。
   专家观点：大部分研究只涉及了小样本量的患者，不同研究中的主要变应原剂量有所不同，且研究质量参差不齐。HDM-SCIT治疗成人和儿童患者的有效性及其停止治疗后的长期有效性具有良好的证据支持；反之，目前HDM-SLIT疗法的证据尚不足以令人信服，尤其是对于儿童患者。在仔细筛选的患者中，HDM-SCIT是有效和安全的。而在HDM-SLIT被推荐用于临床实践常规治疗鼻炎和/或哮喘之前，尚需更多确证的临床试验支持。
 

（林江涛 审校）
Expert Opin Biol Ther. 2013 Oct 8. [Epub ahead of print]

 

Allergen immunotherapy for house dust mite: clinical efficacy and immunological mechanisms in allergic rhinitis and asthma.
 

Eifan AO, Calderon MA, Durham SR.
 

ABSTRACT
INTRODUCTION: There is an increasing prevalence of atopic diseases such as allergic rhinitis and asthma with house dust mite (HDM) being the common allergen that is highly associated with allergic rhinitis and asthma. Allergen avoidance and pharmacotherapy are part of treatment but it has proved difficult to change the course of HDM-related allergic diseases. Allergen immunotherapy (AIT) has been in use for the past century and has been shown to be effective in the treatment of allergic respiratory disease.
AREAS COVERED:This review exclusively focuses on HDM-AIT and discusses the differences in clinical efficacy and safety, long-term effect after discontinuation and immunological changes observed in both HDM-subcutaneous immunotherapy (SCIT) and HDM-sublingual immunotherapy (SLIT) in the treatment of allergic rhinitis and asthma in both pediatric and adult populations.
EXPERT OPINION: The majority of studies involved small numbers of patients, variable doses of major allergens and are of variable quality. There is good evidence for HDM-SCIT efficacy and its long-term effect in adults and children, whereas at the present time, evidence for HDM-SLIT is unconvincing, particularly in children. In carefully selected patients, HDM-SCIT is effective and safe. More definitive trials are needed before HDM-SLIT can be recommended in routine practice for rhinitis and/or asthma.
 

Expert Opin Biol Ther. 2013 Oct 8. [Epub ahead of print]