Marogna M, Spadolini I, Massolo A
Pneumology Unit, Cuasso al Monte, Macchi Hospital Foundation, Varese.
Eur Ann Allergy Clin Immunol. 2005 Apr;37(4):135-42.
Some aspects of allergic progression still need to be addressed. To prevent the onset of the progression is not, at present, a very realistic aim, although therapeutic instruments are available to delay and, if possible, to stop it. We attempted to clarify these points in an observational open controlled three-parallel group study in a real-life setting.
3838 patients with respiratory allergy due to house dust mite have been enrolled in this observational study. 2200 patients with rhinitis and/or intermittent or mild persistent asthma, poorly responsive to standard pharmacological therapy (SPT) were treated for three years with SPT associated or not with specific immunotherapy (SIT). Symptom medication scores, pulmonary function test (PFT) and methacholine (MCh) challenge were performed at the beginning and at the end of the study. 1638 pure rhinitics, responsive to SPT, enrolled as a control group, used self-medication (SM) on demand to assess the incidence of asthma in non-treated patients with standard therapeutic protocols.
694 patients have been treated with SPT+SIT, 1506 with SPT and 1638 with SM. Co-morbidity rhinitis-asthma incidence was higher in the SM group (an overall 69.27% including asthma and bronchial hyperreactivity). Persistent rhinitis proved more often to be associated with asthma than intermittent rhinitis. Likewise, the moderate-severe forms compared to the mild ones. The addition of SIT to SPT reduced the allergic progression in all patients.
In everyday clinical practice too, SIT proves its efficacy in the treatment of allergic march. Patients with moderate-severe persistent rhinitis appear as the ideal candidates for this therapy.
过敏进展的某些方面仍有待解决。目前，预防进展的发生并非一个非常现实的目标，尽管有治疗手段可延缓并在可能的情况下阻止其发展。我们试图在现实环境中进行的一项观察性开放对照三平行组研究中阐明这些问题。
3838例因屋尘螨引起呼吸道过敏的患者参与了这项观察性研究。2200例对标准药物治疗（SPT）反应不佳的鼻炎和/或间歇性或轻度持续性哮喘患者接受了三年的SPT治疗，治疗中联合或不联合特异性免疫疗法（SIT）。在研究开始和结束时进行症状药物评分、肺功能测试（PFT）和乙酰甲胆碱（MCh）激发试验。1638例对SPT有反应的单纯鼻炎患者作为对照组，按需使用自我药疗（SM）来评估采用标准治疗方案的未治疗患者的哮喘发病率。
694例患者接受了SPT+SIT治疗，1506例接受了SPT治疗，1638例接受了SM治疗。SM组鼻炎-哮喘合并症的发病率更高（包括哮喘和支气管高反应性在内总体为69.27%）。持续性鼻炎比间歇性鼻炎更常与哮喘相关。同样，中重度形式比轻度形式更常与哮喘相关。在SPT基础上加用SIT可降低所有患者的过敏进展。
在日常临床实践中，SIT也证明了其在治疗过敏进程中的疗效。中重度持续性鼻炎患者似乎是这种治疗的理想候选者。
