Rak S, Heinrich C, Jacobsen L, Scheynius A, Venge P
Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Göteborg, Sweden.
J Allergy Clin Immunol. 2001 Dec;108(6):921-8. doi: 10.1067/mai.2001.119743.
Both specific immunotherapy (SIT) and nasal steroid (NS) have been shown to effectively reduce symptoms of allergic rhinitis. Although a number of investigators have convincingly shown anti-inflammatory effects of both treatments in separate studies, few comparative studies have been performed.
The purpose of this study was to compare the effects of preseason SIT with a standardized allergen extract and NS in seasonal allergic disease (rhinoconjunctivitis and asthma).
We examined 41 patients allergic to birch pollen, 21 with rhinoconjunctivitis and 20 with both rhinoconjunctivitis and asthma; they were treated in a randomized, double-blinded comparative study with birch SIT and NS (budesonide 400 microg daily). Bronchial hyperresponsiveness was measured before and during the season. Changes in eosinophil number, eosinophil cationic protein, and eosinophil chemotactic activity (ECA) in peripheral blood were investigated.
Symptoms of rhinoconjunctivitis increased significantly less in the NS-treated patients than in the SIT-treated patients during the final 2 weeks of the season (P = .03 and P = .04, respectively). Seasonal peak expiratory flow values decreased significantly only in the NS-treated patients (P = .01). In the NS-treated patients, bronchial hyperresponsiveness increased significantly during the season (P = .0001); however, SIT treatment prevented seasonal PC(20) increase in the asthmatic patients. Measurement of blood eosinophils, eosinophil cationic protein, and eosinophil chemotactic activity demonstrated significant seasonal increase only in the NS-treated asthmatic patients.
Treatment with NS was more effective than short-course preseason SIT in reducing symptoms of rhinoconjunctivitis; however, the 2 therapies were equivalent in terms of the need for rescue medication. SIT prevented seasonal increase in bronchial hyperresponsiveness, eosinophil number, eosinophil cationic protein, and eosinophil chemotactic activity only in asthmatic patients. The mechanisms underlying bronchial hyperresponsiveness developing during allergen exposure in rhinitis might be different from those operating in asthma.
特异性免疫疗法（SIT）和鼻用类固醇（NS）均已被证明可有效减轻过敏性鼻炎的症状。尽管许多研究人员在各自的研究中令人信服地证明了这两种治疗方法的抗炎作用，但很少有比较研究。
本研究的目的是比较季前SIT联合标准化变应原提取物与NS在季节性过敏性疾病（ rhinoconjunctivitis和哮喘）中的效果。
我们检查了41例对桦树花粉过敏的患者，其中21例患有rhinoconjunctivitis，20例同时患有rhinoconjunctivitis和哮喘；他们在一项随机、双盲比较研究中接受桦树SIT和NS（布地奈德每日400微克）治疗。在季节前和季节期间测量支气管高反应性。研究外周血中嗜酸性粒细胞数量、嗜酸性粒细胞阳离子蛋白和嗜酸性粒细胞趋化活性（ECA）的变化。
在季节的最后2周，接受NS治疗的患者rhinoconjunctivitis症状的增加明显少于接受SIT治疗的患者（分别为P = 0.03和P = 0.04）。季节性呼气峰值流量值仅在接受NS治疗的患者中显著下降（P = 0.01）。在接受NS治疗的患者中，支气管高反应性在季节期间显著增加（P = 0.0001）；然而，SIT治疗可防止哮喘患者季节性PC（20）增加。血液嗜酸性粒细胞、嗜酸性粒细胞阳离子蛋白和嗜酸性粒细胞趋化活性的测量表明，仅在接受NS治疗的哮喘患者中季节性显著增加。
在减轻rhinoconjunctivitis症状方面，NS治疗比短疗程季前SIT更有效；然而，在急救药物需求方面，这两种疗法相当。SIT仅在哮喘患者中防止支气管高反应性、嗜酸性粒细胞数量、嗜酸性粒细胞阳离子蛋白和嗜酸性粒细胞趋化活性的季节性增加。在鼻炎中变应原暴露期间发生支气管高反应性的潜在机制可能与哮喘中起作用的机制不同。
