Durham S R, Walker S M, Varga E M, Jacobson M R, O'Brien F, Noble W, Till S J, Hamid Q A, Nouri-Aria K T
Department of Upper Respiratory Medicine, Imperial College School of Medicine at the National Heart and Lung Institute, London, United Kingdom.
N Engl J Med. 1999 Aug 12;341(7):468-75. doi: 10.1056/NEJM199908123410702.
Pollen immunotherapy is effective in selected patients with IgE-mediated seasonal allergic rhinitis, although it is questionable whether there is long-term benefit after the discontinuation of treatment.
We conducted a randomized, double-blind, placebo-controlled trial of the discontinuation of immunotherapy for grass-pollen allergy in patients in whom three to four years of this treatment had previously been shown to be effective. During the three years of this trial, primary outcome measures were scores for seasonal symptoms and the use of rescue medication. Objective measures included the immediate conjunctival response and the immediate and late skin responses to allergen challenge. Cutaneous-biopsy specimens obtained 24 hours after intradermal allergen challenge were examined for T-cell infiltration and the presence of cytokine-producing T helper cells (TH2 cells) (as evidenced by the presence of interleukin-4 messenger RNA). A matched group of patients with hay fever who had not received immunotherapy was followed as a control for the natural course of the disease.
Scores for seasonal symptoms and the use of rescue antiallergic medication, which included short courses of prednisolone, remained low after the discontinuation of immunotherapy, and there was no significant difference between patients who continued immunotherapy and those who discontinued it. Symptom scores in both treatment groups (median areas under the curve in 1995, 921 for continuation of immunotherapy and 504 for discontinuation of immunotherapy; P=0.60) were markedly lower than those in the group that had not received immunotherapy (median value in 1995, 2863). Although there was a tendency for immediate sensitivity to allergen to return late after discontinuation, there was a sustained reduction in the late skin response and associated CD3+ T-cell infiltration and interleukin-4 messenger RNA expression.
Immunotherapy for grass-pollen allergy for three to four years induces prolonged clinical remission accompanied by a persistent alteration in immunologic reactivity.
花粉免疫疗法对部分 IgE 介导的季节性过敏性鼻炎患者有效，不过治疗中断后是否有长期益处仍存在疑问。
我们进行了一项随机、双盲、安慰剂对照试验，针对此前已证明接受三到四年草花粉过敏免疫疗法有效的患者，研究停止该疗法后的效果。在该试验的三年期间，主要结局指标为季节性症状评分和急救药物的使用情况。客观指标包括即刻结膜反应以及对过敏原激发的即刻和迟发性皮肤反应。在皮内注射过敏原激发后 24 小时获取的皮肤活检标本，用于检测 T 细胞浸润情况以及产生细胞因子的辅助性 T 细胞（TH2 细胞）的存在情况（通过白细胞介素 -4 信使核糖核酸的存在来证明）。选取一组未接受免疫疗法的花粉症患者作为匹配组，以跟踪疾病的自然病程作为对照。
停止免疫疗法后，季节性症状评分以及包括短期泼尼松龙疗程在内的急救抗过敏药物的使用量仍保持在较低水平，继续免疫疗法的患者与停止免疫疗法的患者之间无显著差异。两个治疗组的症状评分（1995 年曲线下面积的中位数，继续免疫疗法组为 921，停止免疫疗法组为 504；P = 0.60）均显著低于未接受免疫疗法组（1995 年的中位数为 2863）。尽管停止治疗后即刻过敏原敏感性有较晚恢复的趋势，但迟发性皮肤反应以及相关的 CD3 + T 细胞浸润和白细胞介素 -4 信使核糖核酸表达持续降低。
三到四年的草花粉过敏免疫疗法可诱导长期临床缓解，并伴有免疫反应性的持续改变。
