Kuna Piotr
Klinika Pneumonologii i Alergologii Instytutu Medycyny Wewnetrznej Uniwersytetu Medycznego w Łodzi.
Pol Merkur Lekarski. 2003 Jun;14(84):695-9.
Allergen-specific immunotherapy is a well-accepted method in the management of respiratory allergic diseases, applied since over 90 years. Traditional immunotherapy is the practice of subcutaneous administering to subjects with allergy, increasing amounts of modified allergen to achieve hyposensitisation. Recently other routes of allergen administration were proposed including bronchial, nasal, oral and sublingual routes. Controlled trials failed to demonstrate the clinical efficacy and the safety of oral and bronchial administration. Nasal immunotherapy is also declining due to limited efficacy and special administration technique. The sublingual route is safe and efficacious. Unfortunately, up to date no well-designed controlled study comparing subcutaneous with sublingual methods of immunotherapy is available. Still several points need to be elucidated, including long lasting efficacy, mechanism of action, optimal dose, adherence to this therapy and cost-effectiveness. However, sublingual immunotherapy is now accepted by WHO as a valid alternative to the subcutaneous route and should be used in all patients who require immunotherapy and do not accept subcutaneous route of allergen administration. One question is presently beyond discussion: it is better to administer sublingual immunotherapy in patients with allergic diseases than not to give immunotherapy at all.
变应原特异性免疫疗法是治疗呼吸道过敏性疾病的一种广泛认可的方法，已应用90多年。传统免疫疗法是对过敏患者进行皮下注射，逐渐增加改良变应原的剂量以实现减敏。最近，有人提出了其他变应原给药途径，包括支气管、鼻腔、口服和舌下途径。对照试验未能证明口服和支气管给药的临床疗效和安全性。鼻腔免疫疗法也因疗效有限和特殊给药技术而逐渐减少。舌下途径既安全又有效。不幸的是，目前尚无比较皮下免疫疗法和舌下免疫疗法的精心设计的对照研究。仍有几个问题需要阐明，包括长期疗效、作用机制、最佳剂量、对该疗法的依从性和成本效益。然而，舌下免疫疗法现已被世界卫生组织接受为皮下途径的有效替代方法，应用于所有需要免疫疗法但不接受皮下变应原给药途径的患者。目前有一个问题毋庸置疑：对过敏性疾病患者进行舌下免疫疗法总比完全不进行免疫疗法要好。
