Allergy & Respiratory Disease Clinic, Department of Internal Medicine, University of Genoa, Genoa, Italy.
Allergy. 2009 Nov;64(11):1570-9. doi: 10.1111/j.1398-9995.2009.02129.x. Epub 2009 Sep 30.
Recent meta-analyses documented the efficacy and safety of sublingual immunotherapy (SLIT) in patients with allergic rhinitis (AR) and asthma (AA). Although SLIT appeared globally effective, the sub-analyses for single allergens provided uncertain results. This study is aimed to investigate the efficacy of SLIT with house dust mite (HDM) extracts in AR and AA through an updated reassessment of randomized controlled trials. Electronic databases were searched up to March 31, 2008, for randomized DBPC trials, assessing the efficacy of SLIT in AR and AA due to HDM sensitization. Outcomes were symptom scores and rescue medications use. For AR, eight studies fulfilled the selection criteria. A significant reduction in symptoms of AR (SMD -0.95; CI 95%-1.77 to -0.14 P = 0.02) was found in 194 patients (adults and children) receiving SLIT compared to 188 receiving placebo. For AA, with nine studies, similar results were found for symptoms (SMD -0.95; CI 95%-1.74 to -0.15 P = 0.02) in 243 patients (adults and children) receiving SLIT compared to 209 receiving placebo. A reduction in rescue medication use was found for AR (SMD -1.88; CI 95%-3.65 to -0.12 P = 0.04) in 89 patients, and AA (SMD -1.48; CI 95%-2.70 to -0.26 P = 0.02) in 202 patients. A relevant inter-study heterogeneity was detected. Promising evidence of efficacy for SLIT, using mite extract in allergic patients suffering from AR and AA, are herein shown. These findings suggest that more data are needed, derived from large-population-based high quality studies, and corroborated by objective outcomes, mainly for AA.
最近的荟萃分析证明了舌下免疫疗法（SLIT）在过敏性鼻炎（AR）和哮喘（AA）患者中的疗效和安全性。尽管 SLIT 在全球范围内似乎有效，但对单一过敏原的亚分析结果并不确定。本研究旨在通过对随机对照试验的更新再评估，研究尘螨（HDM）提取物的 SLIT 在 AR 和 AA 中的疗效。截至 2008 年 3 月 31 日，电子数据库搜索了评估因 HDM 致敏而接受 SLIT 的 AR 和 AA 的随机双盲安慰剂对照试验（DBPC）。结局为症状评分和急救药物使用。对于 AR，八项研究符合选择标准。与接受安慰剂的 188 名患者相比，194 名（成人和儿童）接受 SLIT 的患者的 AR 症状显著减少（SMD -0.95；95%CI-1.77 至-0.14，P=0.02）。对于 AA，九项研究发现，243 名（成人和儿童）接受 SLIT 的患者的症状（SMD -0.95；95%CI-1.74 至-0.15，P=0.02）与接受安慰剂的 209 名患者相似。在 89 名患者中发现了 AR 急救药物使用减少（SMD -1.88；95%CI-3.65 至-0.12，P=0.04），在 202 名患者中发现了 AA（SMD -1.48；95%CI-2.70 至-0.26，P=0.02）。检测到相关的研究间异质性。本文显示了使用螨提取物治疗 AR 和 AA 过敏患者的 SLIT 疗效的有希望的证据。这些发现表明，需要更多的数据，这些数据来自基于大人群的高质量研究，并辅以客观结局，特别是对 AA。
