Mauro M, Russello M, Incorvaia C, Gazzola G B, Di Cara G, Frati F
Allergy Unit, Sant'Anna Hospital, Como, Italy.
Eur Ann Allergy Clin Immunol. 2007 Apr;39(4):119-22.
Sublingual immunotherapy (SLIT) is currently considered a valid option to subcutaneous immunotherapy (SCIT), but only a few studies made a direct comparison of their effectiveness. The aim of this study was to compare the clinical and immunological effects of SCIT and SLIT in pollinosis induced by Betulaceae.
Forty-seven adult patients were randomized to receive SCIT or SLIT, performed by Betulaceae (alder, birch, and hazel) extracts from Stallergenes (Antony, France) standardized in index of reactivity (IR) with the treatment schedules proposed by the producer. The clinical effects were established by symptom-medication scores recorded during the month of March. Side effects were reported directly by the physicians for SCIT and were registered in diary cards by the patients for SLIT. Immunologic evaluation was done by measuring specific IgE and IgG4 to Bet v 1.
Thirty-four patients (19 for SCIT and 15 for SLIT) completed the registration of symptoms and drug consumption during pollen period of Betulaceae. Mean cumulative doses of respectively 50.65 IR by SCIT and 4653.1 IR by SLIT were administered, with a SLIT/SCIT ratio of 92. There was no significant difference in mean symptom-medication score between SCIT and SLIT. Systemic reactions occurred in 16% of SCIT treated but in none of SLIT treated. As to immunologic evaluation, Bet v 1 specific IgE did not rise after the pollen season in SCIT treated, while increased non significantly in SLIT treated. Bet v 1 specific IgG4 increased in both treatment, buy only the increase with SCIT was significant (p = 0.001).
SLIT and SCIT with a ratio of about 100 are equally effective in controlling rhinoconjunctivitis caused by tree pollen allergy. SLIT is safer than SCIT, but does not show the same immunologic effects on serum specific IgE and lgG4 antibodies.
舌下免疫疗法（SLIT）目前被认为是皮下免疫疗法（SCIT）的一种有效替代方案，但仅有少数研究对二者的有效性进行了直接比较。本研究旨在比较SCIT和SLIT在桦木科花粉症中的临床和免疫效果。
47例成年患者被随机分为接受SCIT或SLIT治疗组，采用法国安东尼市Stallergenes公司生产的桦木科（桤木、桦树和榛树）提取物进行治疗，提取物的反应性指数（IR）按照生产商建议的治疗方案进行标准化。通过记录3月份的症状-用药评分来确定临床效果。SCIT的副作用由医生直接报告，SLIT的副作用由患者记录在日记卡上。通过检测针对Bet v 1的特异性IgE和IgG4进行免疫评估。
34例患者（19例接受SCIT，15例接受SLIT）完成了桦木科花粉期症状和药物使用情况的记录。SCIT和SLIT的平均累积剂量分别为50.65 IR和4653.1 IR，SLIT/SCIT比值为92。SCIT和SLIT的平均症状-用药评分无显著差异。接受SCIT治疗的患者中有16%发生全身反应，而接受SLIT治疗的患者未发生。在免疫评估方面，接受SCIT治疗的患者花粉季节后Bet v 1特异性IgE未升高，而接受SLIT治疗的患者则无显著升高。两种治疗方法中Bet v 1特异性IgG4均升高，但仅SCIT治疗组的升高具有统计学意义（p = 0.001）。
比值约为100的SLIT和SCIT在控制树花粉过敏引起的鼻结膜炎方面同样有效。SLIT比SCIT更安全，但对血清特异性IgE和IgG4抗体未显示出相同的免疫效果。
